血清UCH-L1在急性脑卒中的诊断价值

发布时间：2018-04-12 12:03

本文选题：急性脑梗死 + 脑出血　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景与目的急性脑卒中是神经系统最常见疾病,其发病率相当高,很容易遗留残疾后遗症,严重者死亡率也很高,对人类的健康危害极大,早期合理的治疗能明显改善预后。一种准确的、迅速的急性脑梗死的诊断方法尤为重要,直接影响这些患者的疗效和后期恢复。目前脑卒中的诊断方法仍以病史、临床症状及影像结果为主,且与初次接诊医生的临床经验和医疗水平有很大关系。这些因素多方面的影响急性期的诊断及其后续的治疗。因此,探索一种新式的、迅速、容易操作可行的、灵敏性及特异性均很高的方法势在必行,能及早辨别和准确分类急性脑卒中。血清泛素C末端水解酶-1(UCH-L1)是一种半胱氨酸水解酶,广泛介入细胞周期的调控、细胞的凋亡、炎症反应、基因表达和信息传导等许多生理病理反应进程。其在大脑中的含量非常之多,具有很高的表达特异性,经常成为神经系统损伤的标志物。本研究目标是探索血清UCH-L1在急性脑卒中患者中的诊断价值。方法前瞻性连续纳入自2015年03月至2016年03月就诊于河南省人民医院、辉县市人民医院、周口市中心医院等11家医院的发病12h以内的急性脑卒中患者,根据疾病不同分为急性脑梗死(AIS)组,脑出血(ICH)组和短暂性脑缺血发作(TIA)组。记录患者性别、年龄、病史、入院情况及影像学特点等临床资料。另外选取2016年3月至2016年7月于河南省人民医院体检中心进行体检的健康人作为对照组。对所有研究对象进行静脉血采集,集中采用直接酶联免疫吸附法行血清UCH-L1水平定量检测。采纳SPSS17.0统计软件进行数据分析,计量资料用(x±SD)或中位数(四分位数)[M(Q1,Q3)]表示,计数资料用百分比(%)表示。两组间分类变采纳χ2检验或Fisher精确检验,连续变量采纳Student’s t检验或Mann Whitney U检验;三组间对比采纳Kruskal-Wallis检验。非参数Spearman相关性检验用于UCH-L1与临床数据之间相关性分析。P0.05有统计学意义。结果共纳入732例卒中患者,男449例,女283例,平均年龄(62.2±11.2)岁。其中AIS患者440例、ICH患者243例和TIA患者49例。AIS组与ICH组患者血清UCH-L1水平比较差异无统计学意义[431.71±230.83ng/L vs 414.70±204.15ng/L,P=0.31],但是两组UCH-L1水平显著高于TIA组和健康对照组[269.31±216.46ng/L和275.67±162.70 ng/L,P0.01],而血清UCH-L1水平在TIA组和健康对照组间相似。血清UCH-L1水平与卒中患者初始NIHSS评分和发病时间均无相关性(z=-0.837,P=0.402和z=-0.48,P=0.631;χ2=0.662,P=0.718和χ2=0.662,P=0.718)。血清UCH-L1水平与卒中危险因素无关(P0.05)。血清UCH-L1识别卒中患者和TIA患者的AUC为0.77(95%CI0.687-0.856),当血清UCH-L1取307.25ng/L时,预测卒中的敏感性和特异性分别为67.9%和76%。而鉴别ICH患者和AIS患者的AUC为0.48(95%CI0.438-0.528)。结论血清UCH-L1可以作为鉴别卒中和TIA的生物标记物,但是与卒中危险因素、疾病严重程度和发病时间均无明确相关性,且不能鉴别急性脑梗死和脑出血。
[Abstract]:Background and objective Acute stroke is the most common disease of nervous system, its incidence is very high, it is easy to leave disability sequelae, the death rate of severe stroke is also very high, it is very harmful to human health, early and reasonable treatment can obviously improve the prognosis.An accurate and rapid diagnostic method for acute cerebral infarction is particularly important, directly affecting the outcome and late recovery of these patients.At present, the diagnostic methods of stroke are still mainly history, clinical symptoms and imaging results, and have a great relationship with the clinical experience and medical level of the first-time doctor.These factors affect the diagnosis and subsequent treatment of acute stage.Therefore, it is imperative to explore a new, rapid, easy to operate, sensitive and specific method to identify and classify acute stroke as early as possible.Serum ubiquitin C-terminal hydrolase (UCH-L1) is a cysteine hydrolase, which is involved in many physiological and pathological processes, such as cell cycle regulation, cell apoptosis, inflammatory reaction, gene expression and information transmission.It has high expression specificity and is often used as a marker of nervous system injury.The aim of this study was to explore the diagnostic value of serum UCH-L1 in patients with acute stroke.Methods from March 2015 to March 2016, patients with acute stroke were included in 11 hospitals, including Henan Provincial people's Hospital, Huixian people's Hospital, Zhoukou Central Hospital and so on.The patients were divided into acute cerebral infarction (AIS) group, cerebral hemorrhage (ICH) group and transient ischemic attack (TIA) group.Gender, age, history, admission and imaging features were recorded.In addition, healthy persons from March 2016 to July 2016 in Henan Provincial people's Hospital physical examination were selected as the control group.Venous blood samples were collected from all subjects and serum UCH-L1 levels were detected quantitatively by direct enzyme-linked immunosorbent assay (Elisa).SPSS17.0 statistical software was used to analyze the data. The measurement data were expressed in terms of x 卤SD) or median (quartile) [MNQ1Q3], and the counting data were expressed in percentage).蠂 2 test or Fisher accurate test was adopted for classification between the two groups, Student's t test or Mann Whitney U test was adopted for continuous variables, and Kruskal-Wallis test was adopted for comparison among the three groups.Nonparametric Spearman correlation test was used to analyze the correlation between UCH-L1 and clinical data.Results there were 732 stroke patients (449 males and 283 females) with an average age of 62.2 卤11.2 years.The levels were similar between TIA group and healthy control group.There was no correlation between the level of serum UCH-L1 and the initial NIHSS score and onset time of stroke patients. There was no correlation between serum UCH-L1 level and the initial NIHSS score and onset time of stroke patients, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time.Serum UCH-L1 level was not correlated with stroke risk factors (P 0.05).The AUC of serum UCH-L1 in patients with stroke and TIA was 0.77 ~ 95CI 0.687-0.856. The sensitivity and specificity of predicting stroke were 67.9% and 76.9%, respectively, when serum UCH-L1 was taken for 307.25ng/L.The AUC for differentiating ICH patients from AIS patients was 0.48C 95 CI 0.438-0.528%.Conclusion Serum UCH-L1 can be used as a biomarker for differentiating stroke from TIA, but it is not correlated with risk factors, severity and duration of stroke, and can not distinguish acute cerebral infarction from cerebral hemorrhage.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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