远隔肢体缺血适应对急性脑梗死患者血清胱抑素水平的影响
发布时间：2018-07-17 03:17
【摘要】：目的：观察急性脑梗死患者血清胱抑素C(Cystatin C,CysC)水平的变化，远隔肢体缺血适应（Limb remote ischemic conditioning,LRIC）对急性脑梗死患者血清CysC水平及神经功能缺损程度的影响，探讨血清CysC水平与急性脑梗死的关系以及LRIC对急性脑梗死的作用及可能的病理生理机制。 方法： 1.选择健康体检者51例为正常对照组，急性脑梗死患者81例为病例组，符合制定的入组标准及排除标准，两组在年龄、性别构成方面具有可比性。通过对照研究方法，依据治疗方案的不同将病例组随机分为病例对照组（48例）及LRIC组（33例），两组在年龄、性别构成、发病时间、病情严重程度方面具有可比性。 2.应用日立全自动生化分析仪及相关试剂检测血清CysC（免疫比浊法测定mg/L）、尿素氮（Blood urea nitrogen，BUN）（脲酶速率法测定，mmol/L）及肌酐（Creatinine，Cre）（HMMPS法测定，μmol/L）水平。 3.观察病例组入院第2日（治疗前）及入院第7日（治疗后）血清CysC、BUN、Cre水平的变化并于治疗前后应用美国国立卫生研究院卒中量表（National Instituteof Health stroke scale，NIHSS）对病例组患者的神经功能缺损程度进行评定。第一次（治疗前）结果记为“1”，第二次（治疗后）结果记为“2”，第一次结果与第二次结果的差记为“差值”。观察并记录RLIC操作的不良反应。所有资料采用SPSS20.0统计软件进行分析处理，检验的显著性水准为双侧检验P0.05。 结果： 1.病例组治疗前后血清CysC水平（0.993±0.249，，0.971±0.256）较正常对照组（0.836±0.161）显著升高（均为P0.01）；病例组治疗前后血清BUN水平（5.503±1.372，4.556±1.394）均低于正常对照组（5.701±2.438），治疗前较正常对照组差异无统计学意义，治疗后差异具有统计学意义（P0.01）；病例组治疗前血清Cre水平（63.722±21.067）较正常对照组（59.000±13.954）高，治疗后（56.120±16.866）较正常对照组低，差异均无统计学意义。 2.病例组血清CysC1水平与NIHSS2评分均呈显著正相关(r=0.239，P0.05)与NIHSS1评分无显著相关； CysC2水平与NIHSS1评分呈显著正相关（r=0.288,P0.05），与NIHSS2评分无显著相关；病例组血清CysC1水平与BUN1水平呈显著正相关（r=0.459，P0.01），与BUN2水平无显著相关；CysC2水平与BUN1、BUN2水平均呈显著正相关（r=0.369、0.296，均为P0.05）；CysC1水平与Cre1、Cre2水平均呈显著正相关（r=0.497、0.483，均为P0.01）；CysC2水平与Cre1、Cre2水平均呈显著正相关（r=0.632、0.643，均为P0.01）。 3.病例对照组与LRIC组治疗前NIHSS评分（2.000±2.467，1.180±1.310）无显著性差异；病例对照组与LRIC组治疗后NIHSS评分（1.630±2.340，0.610±1.088）均较治疗前显著降低（P0.05，P0.01），且LRIC组NIHSS评分差值（0.580±0.663）较病例对照组（0.290±0.944）显著增大（P0.05）。 4.病例对照组及LRIC组治疗后血清CysC水平（0.972±0.249），0.969±0.272）均较治疗前CysC水平（0.973±0.228，1.019±0.274）降低，但LRIC组降低更明显且具有统计学意义（P0.01）；病例对照组与LRIC组治疗后血清BUN水平（4.581±1.254，4.515±1.632）、Cre水平（57.452±17.226，53.947±16.487）均较治疗前BUN水平（5.343±1.334，5.736±1.415）、Cre水平（64.031±22.166，63.273±19.687）显著降低，差异均具有统计学意义（均为P0.01）；LRIC组CysC差值（0.046±0.065）、BUN差值（1.129±1.020）与Cre差值水平（10.368±10.243）较病例对照组CysC差值（0.030±0.742）、BUN差值（0.829±1.437）与Cre差值水平（7.597±9.694）降低幅度大，但差异无统计学意义。病例对照组与LRIC组治疗前血清CysC水平、BUN水平、Cre水平均无显著差异。 5.在LRIC操作过程中有25例患者诉有肢体轻微胀痛感、2例患者有头部轻微胀痛感，均于每次操作后30分钟内完全消失，无其他不适主诉。 结论： 1.急性脑梗死患者血清CysC水平显著升高，且其水平可以反映急性脑梗死病情的严重程度，提示CysC可能参与了急性脑梗死的病理生理过程。 2.LRIC可显著降低急性脑梗死患者的血清CysC水平及神经功能缺损程度，提示LRIC可能对急性脑梗死的预后有改善作用。 3.LRIC可能对改善肾脏功能有益。 4.LRIC可能是治疗急性脑梗死安全有效的方法。
[Abstract]:Objective: To observe the changes of serum cystatin C (Cystatin C, CysC) in patients with acute cerebral infarction, the effect of Limb remote ischemic conditioning (LRIC) on the level of serum CysC and the degree of nerve function defect in patients with acute cerebral infarction, and to explore the relationship between serum CysC and acute cerebral infarction and the acute cerebral infarction. The role of infarction and its possible pathophysiological mechanism.
Method:
1. the healthy persons were selected as the normal control group, with 81 cases of acute cerebral infarction as the case group, which conformed to the standard and exclusion criteria. The two groups were comparable in age and gender. According to the different treatment methods, the case groups were randomly divided into case control group (48 cases) and group LRIC (33 cases), two. Two The group was comparable in age, sex composition, onset time and severity.
2. the level of serum CysC (immunoturbidimetry mg/L), urea nitrogen (Blood urea nitrogen, BUN) (urease rate method, mmol/L) and creatinine (Creatinine, Cre) (HMMPS method, micrmol/L) were detected by Hitachi automatic biochemical analyzer and related reagents.
3. the changes in serum CysC, BUN, Cre levels and the National Institutes of health apoplexy (National Instituteof Health stroke scale, NIHSS) were used to assess the degree of deity impairment in the case group before and after treatment. The first time (before treatment) was recorded. The results of "1" and second times (after treatment) were recorded as "2", and the difference between the first and second results was "difference value". The adverse reaction of the RLIC operation was observed and recorded. All the data were analyzed by SPSS20.0 software, and the significant level of the test was P0.05. test.
Result:
The level of serum CysC (0.993 + 0.249,0.971 + 0.256) before and after treatment in 1. cases group was significantly higher than that in normal control group (0.836 + 0.161) (all P0.01). The serum level of BUN (5.503 + 1.372,4.556 + 1.394) before and after treatment in the case group was lower than that of the normal control group (5.701 + 2.438). There was no significant difference between the normal control group and the normal control group before treatment, and the difference after treatment was different. There were statistical significance (P0.01); the level of serum Cre (63.722 + 21.067) before treatment in the case group was higher than that of the normal control group (59 + 13.954), and after treatment (56.120 + 16.866), the difference was lower than that of the normal control group, and the difference was not statistically significant.
There was a significant positive correlation between the serum CysC1 level and the NIHSS2 score in 2. cases (r=0.239, P0.05), and there was no significant correlation between the NIHSS1 score and the CysC2 level (r=0.288, P0.05), and there was no significant correlation with the NIHSS2 score. The serum CysC1 level of the case group was positively correlated with the BUN1 water level, and there was no significant correlation with the level of BUN1 water. There was a significant positive correlation between the level of CysC2 and the level of BUN1 and BUN2 (r=0.369,0.296, P0.05), and the level of CysC1 had a significant positive correlation with the level of Cre1 and Cre2 (r=0.497,0.483, all P0.01), and the CysC2 level had a significant positive correlation with the level of Cre1.
3. the NIHSS score (2 + 2.467,1.180 + 1.310) before treatment in the case control group and the LRIC group had no significant difference, and the NIHSS score (1.630 + 2.340,0.610 + 1.088) in the case control group and the LRIC group was significantly lower than that before the treatment (P0.05, P0.01), and the NIHSS score difference (0.580 + 0.663) in the LRIC group was significantly higher than that in the case control group (0.290 + 0.944) (P0.05). ).
4. the level of serum CysC (0.972 + 0.249) and 0.969 + 0.272 after treatment in the case control group and the LRIC group were lower than those before the treatment (0.973 + 0.228,1.019 + 0.274), but the decrease in the LRIC group was more obvious and statistically significant (P0.01). The level of BUN in the case control group and the LRIC group was (4.581 + 1.254,4.515 + 1.632), and the Cre level was 57.452 + 17.226. 53.947 + 16.487) compared with the level of BUN before treatment (5.343 + 1.334,5.736 + 1.415), Cre level (64.031 + 22.166,63.273 + 19.687) significantly decreased, the difference was statistically significant (P0.01), LRIC group CysC difference (0.046 + 0.065), BUN difference (1.129 + 1.020) and Cre difference level (10.368 + 10.243) compared with the case control group CysC difference (0.030 + 0.742), BUN difference (0.829 + 1.437) and Cre difference level (7.597 + 9.694) decreased significantly, but the difference was not statistically significant. There was no significant difference in serum CysC level, BUN level and Cre level between the case control group and the LRIC group before treatment.
5. during the operation of LRIC, 25 patients complained of mild distention and pain in the extremities, and 2 patients had a slight distention and pain in the head, all disappeared within 30 minutes after each operation, and no other discomfort complained.
Conclusion:
1. the level of serum CysC in patients with acute cerebral infarction is significantly higher, and its level can reflect the severity of acute cerebral infarction, suggesting that CysC may be involved in the pathophysiological process of acute cerebral infarction.
2.LRIC can significantly reduce serum CysC level and neurological deficit in patients with acute cerebral infarction, suggesting that LRIC may improve the prognosis of acute cerebral infarction.
3.LRIC may be beneficial to improving the function of the kidney.
4.LRIC may be a safe and effective treatment for acute cerebral infarction.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
本文编号：2128770
[Abstract]:Objective: To observe the changes of serum cystatin C (Cystatin C, CysC) in patients with acute cerebral infarction, the effect of Limb remote ischemic conditioning (LRIC) on the level of serum CysC and the degree of nerve function defect in patients with acute cerebral infarction, and to explore the relationship between serum CysC and acute cerebral infarction and the acute cerebral infarction. The role of infarction and its possible pathophysiological mechanism.
Method:
1. the healthy persons were selected as the normal control group, with 81 cases of acute cerebral infarction as the case group, which conformed to the standard and exclusion criteria. The two groups were comparable in age and gender. According to the different treatment methods, the case groups were randomly divided into case control group (48 cases) and group LRIC (33 cases), two. Two The group was comparable in age, sex composition, onset time and severity.
2. the level of serum CysC (immunoturbidimetry mg/L), urea nitrogen (Blood urea nitrogen, BUN) (urease rate method, mmol/L) and creatinine (Creatinine, Cre) (HMMPS method, micrmol/L) were detected by Hitachi automatic biochemical analyzer and related reagents.
3. the changes in serum CysC, BUN, Cre levels and the National Institutes of health apoplexy (National Instituteof Health stroke scale, NIHSS) were used to assess the degree of deity impairment in the case group before and after treatment. The first time (before treatment) was recorded. The results of "1" and second times (after treatment) were recorded as "2", and the difference between the first and second results was "difference value". The adverse reaction of the RLIC operation was observed and recorded. All the data were analyzed by SPSS20.0 software, and the significant level of the test was P0.05. test.
Result:
The level of serum CysC (0.993 + 0.249,0.971 + 0.256) before and after treatment in 1. cases group was significantly higher than that in normal control group (0.836 + 0.161) (all P0.01). The serum level of BUN (5.503 + 1.372,4.556 + 1.394) before and after treatment in the case group was lower than that of the normal control group (5.701 + 2.438). There was no significant difference between the normal control group and the normal control group before treatment, and the difference after treatment was different. There were statistical significance (P0.01); the level of serum Cre (63.722 + 21.067) before treatment in the case group was higher than that of the normal control group (59 + 13.954), and after treatment (56.120 + 16.866), the difference was lower than that of the normal control group, and the difference was not statistically significant.
There was a significant positive correlation between the serum CysC1 level and the NIHSS2 score in 2. cases (r=0.239, P0.05), and there was no significant correlation between the NIHSS1 score and the CysC2 level (r=0.288, P0.05), and there was no significant correlation with the NIHSS2 score. The serum CysC1 level of the case group was positively correlated with the BUN1 water level, and there was no significant correlation with the level of BUN1 water. There was a significant positive correlation between the level of CysC2 and the level of BUN1 and BUN2 (r=0.369,0.296, P0.05), and the level of CysC1 had a significant positive correlation with the level of Cre1 and Cre2 (r=0.497,0.483, all P0.01), and the CysC2 level had a significant positive correlation with the level of Cre1.
3. the NIHSS score (2 + 2.467,1.180 + 1.310) before treatment in the case control group and the LRIC group had no significant difference, and the NIHSS score (1.630 + 2.340,0.610 + 1.088) in the case control group and the LRIC group was significantly lower than that before the treatment (P0.05, P0.01), and the NIHSS score difference (0.580 + 0.663) in the LRIC group was significantly higher than that in the case control group (0.290 + 0.944) (P0.05). ).
4. the level of serum CysC (0.972 + 0.249) and 0.969 + 0.272 after treatment in the case control group and the LRIC group were lower than those before the treatment (0.973 + 0.228,1.019 + 0.274), but the decrease in the LRIC group was more obvious and statistically significant (P0.01). The level of BUN in the case control group and the LRIC group was (4.581 + 1.254,4.515 + 1.632), and the Cre level was 57.452 + 17.226. 53.947 + 16.487) compared with the level of BUN before treatment (5.343 + 1.334,5.736 + 1.415), Cre level (64.031 + 22.166,63.273 + 19.687) significantly decreased, the difference was statistically significant (P0.01), LRIC group CysC difference (0.046 + 0.065), BUN difference (1.129 + 1.020) and Cre difference level (10.368 + 10.243) compared with the case control group CysC difference (0.030 + 0.742), BUN difference (0.829 + 1.437) and Cre difference level (7.597 + 9.694) decreased significantly, but the difference was not statistically significant. There was no significant difference in serum CysC level, BUN level and Cre level between the case control group and the LRIC group before treatment.
5. during the operation of LRIC, 25 patients complained of mild distention and pain in the extremities, and 2 patients had a slight distention and pain in the head, all disappeared within 30 minutes after each operation, and no other discomfort complained.
Conclusion:
1. the level of serum CysC in patients with acute cerebral infarction is significantly higher, and its level can reflect the severity of acute cerebral infarction, suggesting that CysC may be involved in the pathophysiological process of acute cerebral infarction.
2.LRIC can significantly reduce serum CysC level and neurological deficit in patients with acute cerebral infarction, suggesting that LRIC may improve the prognosis of acute cerebral infarction.
3.LRIC may be beneficial to improving the function of the kidney.
4.LRIC may be a safe and effective treatment for acute cerebral infarction.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
【参考文献】
相关期刊论文 前10条
1 赵德强;潘速跃;陈建辉;杨文俊;;脑梗死与胱抑素C的关系[J];南方医科大学学报;2009年04期
2 刘俊峰;杨浏;;Cystatin C评价肾小球滤过功能的临床应用进展[J];国际检验医学杂志;2008年05期
3 林伟华;陈华英;洪流;陈康荣;;血清和脑脊液胱抑素C检测在4种脑疾病患者中的临床意义[J];国际检验医学杂志;2010年11期
4 刘亚普;张新梅;王美玲;吴海霞;;高血压患者外周血胱抑素C水平的检测[J];国际检验医学杂志;2013年04期
5 冯建芳，汪淑荣，李平，赵一鸣，孙诠，师树古，陈明哲;急性心肌梗塞病人血清巯基蛋白酶抑制肽C的变化[J];基础医学与临床;1995年04期
6 方军;洪灵敏;;急性脑出血患者血清和脑脊液胱抑素C变化及临床意义[J];实验与检验医学;2008年02期
7 程道宾;王进;秦超;郑金瓯;罗杰峰;曾丽;;脑缺血预处理降低大鼠脑一氧化氮水平抗脑缺血损伤的实验研究[J];脑与神经疾病杂志;2007年03期
8 刘惠卿;孟丽;冯荣芳;孟笑梅;郭宗成;刘昌林;肖向建;齐亚超;段瑞生;;脑缺血预处理对大鼠海马CA1区细胞凋亡的影响及一氧化氮在其中的作用[J];脑与神经疾病杂志;2011年06期
9 叶明;李淮玉;朱余友;王国平;丁小灵;马筱玲;;缺血性卒中急性期患者血清半胱氨酸蛋白酶抑制剂C水平的变化[J];中国脑血管病杂志;2012年01期
10 孔维;康永刚;赵锦华;鱼丽萍;;血清胱抑素C、C反应蛋白与短暂性脑缺血发作的相关性[J];中国实用神经疾病杂志;2012年21期
本文编号：2128770
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2128770.html
最近更新
教材专著
