糖尿病病人血清SP、CGRP、NE、cTnI水平与围术期不良心血管事件相关性研究
发布时间：2018-03-21 23:26
本文选题：糖尿病 切入点：P物质 出处：《山西医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:通过测定行不同类型手术的糖尿病患者与非糖尿病患者围术期血浆P物质(Substance P,SP)、降钙素基因相关肽(Calcitonin gene-related peptide,CGRP)、肌钙蛋白I(Cardiac troponin I,cTnI)的变化,探讨糖尿病患者体内SP、CGRP改变与其围术期心肌损伤的相关性。方法:55例择期行腹腔镜下胆囊切除术(Laparoscopic cholecystectomy,LC)、61例择期行腰椎后路减压植骨融合内固定术(Posterior lumbar interbody fusion,PLIF)的患者按是否患有糖尿病(diabetes mellitus,DM)分为糖尿病组(DM)和非糖尿病组(NDM)。观察并记录术中血压、心率、心律、ST-T段、脉搏血氧饱和度、手术时间、输液量及出血量;测定患者术前、术毕血糖值;选用酶联免疫法测定患者血浆术前、术毕SP、CGRP、去甲肾上腺素(norepinephrine,NE)的含量以及术前、术后24小时血浆cTnI的含量。结果:按照术中有无发生不良心血管事件(Adverse Cardiovascular Event,ACVE)分类,发生ACVE者术前、术毕24小时血浆cTnI含量(3.82±0.60ng/mL,6.24±1.01ng/m L)较未发生者(3.46±0.31ng/mL,5.99±0.91ng/mL)高(P0.05),且其术前、术毕血浆CGRP浓度(61.37±11.45ng/mL,61.91±11.52ng/mL)、SP浓度(3.19±0.48ng/mL,2.96±0.43ng/mL)较未发生者(64.21±14.01ng/mL,64.55±14.06ng/mL)、(3.53±0.70ng/mL,3.37±0.63ng/mL)低(P0.05);DM组术中ACVE发生率(52%)较NDM(43%)高(P0.05),术前、术毕CGRP含量DM组(58.00±15.90ng/mL,57.93±16.00ng/mL)较NDM组(66.89±7.54ng/mL,67.32±7.08ng/mL)低(P0.05);术前、术毕SP含量DM组(3.13±0.41ng/mL,2.98±0.45ng/mL)较NDM组(3.58±0.70ng/mL,3.33±0.65ng/mL)低(P0.05)且DM组术前、术毕24小时cTnI含量(4.88±0.94ng/mL,5.64±1.16ng/mL)较NDM(4.18±0.53ng/mL,4.19±1.73ng/m L)组高(P0.05)。DM、NDM组术前术毕CGRP浓度无显著变化(P0.05),DM、NDM组术毕SP浓度较术前降低(P0.05),但NDM组行腰椎后路减压融合术患者术毕SP、CGRP的变化(0.91±0.23ng/mL;0.84±0.16ng/mL)较行LC的患者(0.11±0.09ng/mL;0.19±0.11ng/mL)大(P0.05ng/mL),DM组未看到这种改变。结论:本研究结果提示糖尿病患者血浆SP、CGRP降低与其围术期心肌损伤有关。
[Abstract]:Objective: through the peri operation period of diabetic patients with plasma P substance determination for different types of surgery and non diabetic patients (Substance P, SP), calcitonin gene related peptide (Calcitonin gene-related peptide CGRP I (Cardiac troponin), troponin I, cTnI) to investigate the changes of SP in diabetic patients, CGRP change and Wai correlation of perioperative myocardial injury. Methods: 55 cases of patients undergoing laparoscopic cholecystectomy (Laparoscopic cholecystectomy, LC), 61 cases of patients undergoing posterior lumbar interbody fusion surgery (Posterior lumbar interbody fusion, PLIF) of the patients according to whether suffering from diabetes (diabetes mellitus, DM) were divided into diabetic group (DM) and non diabetes group (NDM). Observe and record the intraoperative blood pressure, heart rate, heart rate, ST-T, SpO2, operative time, transfusion volume and blood; Determination of patients before operation, postoperative blood glucose; using ELISA 娉曟祴瀹氭偅鑰呰娴嗘湳鍓，
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