肺结核病人血清同型半胱氨酸检测报告与分布特点研究

发布时间：2018-06-22 00:06

本文选题：同型半胱氨酸 + 药物性肾损伤　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:分别采集各年龄段初治和复诊结核病人空腹血清标本,检测血清中的同型半胱氨酸含量水平,探讨同型半胱氨酸水平因年龄性别等原因导致的人群分布是否也适应于结核病人这一人群,评估结核病患者是否因感染结核病而导致体内的同型半胱氨酸水平出现异常,结核病有可能导致的脂类代谢异常以及结核药物性肾损伤是否对其水平也会产生影响,本研究从性别、年龄、初复治三个因素分析结核病人体内的同型半胱氨酸水平,评估结核病人这一人群初步整体的血清同型半胱氨酸水平。方法:使用德国的罗氏诊断公司cobas 6000全自动型生化仪仪器,采用开放式通道进行试剂安装并测定,试剂选用北京万泰德瑞公司所出品的同型半胱氨酸血清测定试剂。同型半胱氨酸血清学检测方法选用改良循环酶法,方法学机制为氧化型HCY被转变成未结合的HCY,未结合的HCY在CBS的催化反应下和丝氨酸进行结合并且生成L-胱硫酰醚。L-胱硫醚在CBL氧化下又生成HCY、丙酮酸和NH3。该过程所生成的丙酮酸能够用乳酸脱氢酶NADH和LDH测定到,NAD转化成NADH的速度与样本中HCY的浓度成正向比值。结果:使用统计学方法对144例检测的结果数值进行分别解析。按照性别分组,男性组96例,女性48例,比较HCY值是否有差异,首先检验方差齐性,F=1.647,P0.05,方差不齐;于是采用welch t检验,t’=0.9165,P0.05,无统计学意义。即男性与女性之间的HCY值无明显统计学差异(图1)。以年龄为横坐标,HCY值为纵坐标,绘制出散点图。由图可以看出,年龄与HCY值无线性关系。进一步进行皮尔逊相联性检验,关联的系数r=0.097,P=0.247,P0.05,年龄与HCY值无关联关系。按初复诊分成两组,对比HCY值是否有差异,首先检验方差齐性,F=1.616,P0.05,方差齐;于是采用t检验,t=2.062,P=0.0410.05,具有统计学意义。即初诊与复诊两者的HCY值具有统计学差异。讨论:本研究检测的结果显示,结核病人的性别及年龄对血清内同型半胱氨平高低不具有统计学上的差异,复诊结核病人与初治结核病人的血清同型半胱氨酸水平有统计学上的显著差异性,说明随着疾病的进展与服用抗结核药所导致的肝肾损伤,都有机会成为造成HCY血清含量增高的因素。同型半胱氨酸血清含量的升高与心脑血管病患、孕期的合并症、认知缺陷和骨质疏松症等很多疾病的发生存在非常紧密的联系,且被认为为冠心病的独立危险因子,因此结核病人监测血清同型半胱氨酸水平并采取相应的治疗措施也应该成为我们结核科临床医生需要去考虑的问题。
[Abstract]:Objective: to collect fasting serum samples from patients with tuberculosis at different ages and to detect the level of homocysteine in serum. To investigate whether the distribution of homocysteine due to age and sex is suitable for TB patients, and to assess whether TB patients have abnormal homocysteine levels due to tuberculosis infection. The abnormal lipid metabolism caused by tuberculosis and whether the renal injury induced by tuberculosis drugs will also affect its level. This study analyzed homocysteine levels in TB patients from three factors: sex, age, and initial relapse. Evaluate the initial overall serum homocysteine levels in TB patients. Methods: the cobas 6000 automatic biochemical instrument of Roche Diagnostic Company of Germany was used to install and determine the reagent with open channel. The reagent was determined with homocysteine serum produced by Beijing Wantaideri Company. The method of homocysteine serological detection was modified circular enzyme method. The mechanism is that the oxidized HCY is transformed into unbound HCY, which binds to serine in the catalytic reaction of CBS and produces L- cysteyl ether. L- cystathyl sulfide is oxidized by CBL to form HCY, pyruvate and NH _ 3. The pyruvate produced in this process can be determined by lactate dehydrogenase nadh and LDH to determine the rate of conversion of nadh to nadh and the positive ratio of HCY concentration to the concentration of HCY in the sample. Results: 144 cases were analyzed by statistical method. According to the sex group, 96 males and 48 females were divided into male group and female group. Whether there were differences in HCY values, the variance was not uniform at first by testing the homogeneity of variance (F = 1.647) P0.05, then the welch t test was used to test 0.9165 (P 0.05), which had no statistical significance. There was no significant difference in HCY between men and women (Fig. 1). Taking the age as the ordinate and the HCY value as the ordinate, the scattered plot is drawn. As can be seen from the figure, age and HCY value wireless sex relationship. Furthermore, Pearson correlation test showed that the coefficient of correlation was 0. 097 and 0. 247, and there was no correlation between age and HCY value. The patients were divided into two groups according to the initial visit, and the difference of HCY value was compared. First, the homogeneity of variance was tested, and the variance was the same, and then the t test was used to test 2.062 and 0.0410.05, which was statistically significant. That is to say, the HCY value of first diagnosis and follow-up are statistically different. Discussion: the results of this study showed that there was no statistical difference between sex and age in patients with tuberculosis on the level of homotypic cysteamine in serum. There were significant differences in serum homocysteine levels between rediagnosed and newly treated TB patients, indicating that with the progression of the disease and the liver and kidney injury caused by anti-tuberculosis drugs, Both have the opportunity to be a factor in the increase in HCY serum levels. The increase of homocysteine serum level is closely associated with cardiovascular and cerebrovascular disease, complications during pregnancy, cognitive impairment and osteoporosis, and is considered as an independent risk factor for coronary heart disease. Therefore, it should be considered by our TB clinicians to monitor the serum homocysteine level and take appropriate treatment measures.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521;R446.1

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