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血清S100β在诊断脓毒症脑病中的意义

发布时间:2018-08-01 10:29
【摘要】:目的探讨S100β在脓毒症脑病大鼠体内的变化及意义。 方法30只SD大鼠安放脑电极10天后,随机分为正常组6只,假手术组6只,脓毒症组18只。脓毒症模型采用盲肠结扎穿孔法诱发,术后8h利用RM6240生理信号记录仪记录大鼠心率、血压、脑电图的变化,通过脑电图和神经反射变化判断脓毒症脑病的发生,并留取血清和脑组织标本,用双抗体夹心酶联免疫分析法检测血清和脑组织标本S100p的浓度,同时对脑组织含水量进行测定。对各组心率、平均动脉压、神经反射评分、脑组织含水量、血清S100β、脑组织匀浆S100p及脑组织匀浆/血清S100β采用单向方差分析进行统计学分析。 结果18只脓毒症模型鼠死亡3只,余分为脓毒症非脑病组8只,脓毒症脑病组7只。脓毒症脑病组血清和脑组织匀浆S100β浓度明显高于脓毒症非脑病组,差异有统计学意义(171.0ng/L vs116.8ng/L,306.8ng/L vs175.7ng/L,P0.05);脓毒症脑病组中脑组织匀浆/血清S100p比值高于脓毒症非脑病组,差异有统计学意义(1.79vs1.52,P0.05);假手术组血清S100p浓度高于正常组(112.4ng/L vs90.8ng/L, P0.05)。 结论1、脓毒症脑病大鼠血清S100p浓度明显升高; 2、穿刺、手术等创伤可引起非脑源性S100β浓度升高; 3、脓毒症脑病大鼠脑组织/血清S100β浓度比值升高。 目的研究血清S100β在诊断脓毒症脑病中的临床意义。 方法自2012.5-2013.4收集中心ICU脓毒症患者,记录入ICU24h内的实验室资料,观察患者每天意识变化,若出现意识变化,满足排除标准,视为脓毒症脑病发生,重新测量上述各实验室指标,用GCS评分和简化CAM-ICU评分评估意识情况,并最终记录患者治疗转归、ICU住院时间、总住院时间、28天生存时间。单因素分析中计量资料用两个样本t检验,计数资料用χ2检验,危险因素分析用Logstic回归分析,两因素相关性采用Pearon或Spearman相关分析,28天生存情况进行Kaplan-Meier生存分析。 结果112例患者纳入研究,脓毒症脑病的发病率为42.9%(48/112)。S100p在脓毒症脑病患者中明显升高(0.747μg/L vs0.168μg/L, P=0.001), GCS评分、简化CAM-ICU评分与S100p相关性较好(r=-0.595, r=0.591, p0.01)。s100β是出现脓毒症脑病的一个危险因素(OR=5.204,P=0.003),其诊断脓毒症脑病和预测预后的ROC工作曲线AUC面积分别达0.824和0.730。S100β诊断脓毒症脑病ROC工作曲线中最佳临界点(cutoff值)为0.131μg/L,对应灵敏度0.854,特异度0.672。 结论1、血清S100β在脓毒症脑病患者中明显升高,预测较差的临床预后; 2、血清S100β可反映脓毒症脑病意识障碍的严重程度; 3、高S100p是脓毒症脑病发生的一个危险因素; 4、血清S100β诊断脓毒症脑病的工作效能强,灵敏度强,特异度稍差。
[Abstract]:Objective to investigate the changes and significance of S 100 尾 in septic encephalopathy rats. Methods Thirty SD rats were randomly divided into normal group (n = 6), sham operation group (n = 6) and sepsis group (n = 18). The sepsis model was induced by cecal ligation and perforation. The changes of heart rate, blood pressure and electroencephalogram were recorded by RM6240 physiological signal recorder at 8 hours after operation. The occurrence of sepsis encephalopathy was judged by EEG and nerve reflex. The concentration of S100p in serum and brain tissue was detected by double antibody sandwich enzyme-linked immunosorbent assay (Elisa), and the water content of brain tissue was measured at the same time. The heart rate, mean arterial pressure, nerve reflex score, water content of brain tissue, serum S100 尾, brain tissue homogenate S100p and brain homogenate / serum S100 尾 were analyzed by one-way variance analysis. Results 18 sepsis model rats died 3 rats were divided into sepsis non-encephalopathy group (n = 8) and septic encephalopathy group (n = 7). The concentration of S100 尾 in serum and brain homogenate of septic encephalopathy group was significantly higher than that in septic non-encephalopathy group (171.0ng/L vs 116.8 ng / L = 306.8 ng / L vs 175.7 ng / L P 0.05), and the ratio of brain homogenate / serum S100p in septic encephalopathy group was higher than that in septic non-encephalopathy group. The difference was statistically significant (1.79 vs 1.52), and the serum S100p concentration in sham operation group was higher than that in normal group (112.4ng/L vs 90.8 ng / L, P0.05). Conclusion (1) the serum S100p concentration in septic encephalopathy rats was significantly increased; (2) the non-brain-derived S100 尾 concentration was increased after puncture and operation; and (3) the ratio of brain tissue to serum S100 尾 concentration was increased in septic encephalopathy rats. Objective to study the clinical significance of serum S 100 尾 in the diagnosis of septic encephalopathy. Methods the laboratory data of patients with ICU sepsis were recorded in ICU24h from May to March, 2012.The changes of consciousness were observed every day. If there were changes in consciousness and met the exclusion criteria, they were regarded as the occurrence of sepsis encephalopathy, and the laboratory indexes mentioned above were measured again. GCS score and simplified CAM-ICU score were used to evaluate the consciousness, and the time of hospitalization was recorded. The total hospitalization time was 28 days. In univariate analysis, two samples t test were used for measuring data, 蠂 2 test was used for counting data, Logstic regression analysis was used for risk factor analysis, and Pearon or Spearman correlation analysis was used for Kaplan-Meier survival analysis for 28 days. Results the incidence of sepsis encephalopathy was 42.9% (48 / 112). S100p was significantly higher in septic encephalopathy patients (0.747 渭 g / L vs0.168 渭 g / L, P0. 001), GCS score). The simplified CAM-ICU score had a good correlation with S100p (r-0.595, r-0.591, p0.01) .s100 尾 was a risk factor for septic encephalopathy (OR5.204mP0.003). The AUC area of ROC working curve for diagnosing septic encephalopathy and predicting prognosis of ROC work curve were 0.824 and 0.730.S100 尾 for the diagnosis of septic encephalopathy ROC, respectively. The optimal critical point (cutoff) in the line is 0.131 渭 g / L, corresponding sensitivity 0.854, specificity 0.672. Conclusion (1) Serum S100 尾 is significantly increased in patients with septic encephalopathy, and it can predict poor clinical prognosis, 2, serum S100 尾 can reflect the severity of septic encephalopathy consciousness disorder. 3, high S100p is a risk factor of sepsis encephalopathy, 4the work efficiency, sensitivity and specificity of serum S100 尾 in the diagnosis of septic encephalopathy are strong.
【学位授予单位】:中南大学
【学位级别】:硕士
【学位授予年份】:2013
【分类号】:R459.7

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