血清PCT与糖尿病不同病情程度相关性分析研究
发布时间：2019-05-28 02:54
【摘要】：背景:糖尿病(Diabetes mellitus,DM)的发病和治疗已经成为人类人口安全的重大问题,目前DM治疗难点是诊疗时的证据不足,导致治疗不足或过量。炎症和其功能的双向性在机体中扮演着防卫和破坏的作用,而DM在病程发生和发展的进程中持续性高基础水平的炎症已备受关注,虽然DM发生机制上的研究众多且深入,但仍然未能在临床应用中得到有效和广泛的应用,具体原因可能与炎症的参与种类数量众多且相互影响有关。血清降钙素原(procalcitonin,PCT)经研究发现是无激素活性的前肽物质,在体内外稳定性非常好。近年来PCT在临床上的应用价值主要是细菌感染、全身性炎症反应的早期预测和评估,临床资料证实PCT对于细菌性炎症的严重程度和抗菌预后效果的评估有重要的作用。由于其产生具有一定的组织特异性和表达广泛性,提示这一指标可能具有排除细菌感染诊疗以外的应用诊断价值,在近年的基础研究和临床观察发现,PCT还具有无菌炎症病情程度的判断以及组织损伤程度的评估价值,同时PCT与炎症因子的相关性研究发现,PCT还具有对炎症因子综合反映的能力。这些前人的研究发现提示PCT对炎症损伤的反映能力与糖尿病诊疗需求不谋而合。目的:通过分析不同病情程度的糖尿病(Diabetes Mellitus,DM)患者血清降钙素原(procalcitonin,PCT)的表达差异,比较PCT同糖尿病发病进程的相关性炎症、糖尿病病情程度的相关性,提示PCT对糖尿病病情判断有一定的价值。方法:选取878名糖尿病患者为研究对象,分析不同感染程度患者的PCTTNF-αIL-6INF-γ水平;联合感染诊断,空腹血糖(FBG)和糖化血红蛋白(Hb A1c)、尿微量白蛋白(UmAlb)、急性病生理学和长期健康评价II(APACHEII:Acute Physiology and Chronic Health Evaluation II)对DM早期无并发症、慢性并发症和急性并发症进行病情严重程度分组分级,评估病情与PCTTNF-αIL-6INF-γ的表达水平的相关性。结果:1.DM患者中PCT表达随着病程严重程度升高而升高DM患者的PCT基础表达水平高于正常健康人,且急性并发症型的患者PCT表达水平最高,而早期DM组PCT表达水平最低。PCT表达差异随着病情的加重明显上调,而其它的炎症指标TNF-αIL-6、INF-γ在DM的早期和慢性并发症严重程度较低的无感染和局部感染表现出上调,在慢性并发症严重程度较高和全身性感染的DM患者均未发现有较明显的变化趋势。2.DM患者中PCT表达水平与病情的严重程度存相关性DM患者PCT的表达水平均高于正常健康人水平(0.1±0.05ng/ml),联合不同分期的病情分级指标和PCT等相关炎症指标的相关性发现,在早期无并发症、慢性并发症和急性并发的DM患者中,PCTTNF-αIL-6均在各组中表现出表达差异;INF-γ仅在DM早期无并发症和慢性并发症的患者中(HbA1c%/FPG分级评分较低)表现出表达差异,而在全身性感染DM患者中表达水平均低于正常健康人水平(8.31±2.87pg/ml)。相关性分析发现,炎症因子PCTTNF-αIL-6INF-γ在不同病情程度表现出不同程度的相关性;PCT在不同病情分级DM患者中与TNF-αIL-6INF-γ存在相关性,其中与TNF-αIL-6存在正相关,而与INF-γ表现出负相关,但在炎症程度较高的慢性并发症和急性并发症DM患者的相关性统计分析较差。Hb A1c%/FPG分级严重程度较低的患者中,PCTTNF-αIL-6INF-γ与病情分级均存在相关性,其中与PCTTNF-αIL-6表现出正相关,与INF-γ表现出负相关。按照APACHEII评分的DM急性并发症患者中,评分小于15的患者PCTTNF-αIL-6INF-γ均表现出相关性,而在评分15的患者中相关性较差,PCT与评分表现出低相关性。结论:DM患者PCT的表达水平差异是对病情严重程度特别是炎症程度的反应,PCT可能对DM病情严重程度的诊疗具有重要的参考价值。
[Abstract]:BACKGROUND: The onset and treatment of diabetes (Diabetes Mellitus, DM) has become a major problem in the safety of human population, and the difficulty in the treatment of DM is insufficient evidence in diagnosis and treatment, resulting in insufficient or excessive treatment. The bidirectionality of inflammation and its function acts as a defensive and destructive role in the body, and the persistent high basal level of inflammation in the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the However, it is still not possible to have an effective and extensive application in clinical application, and the specific reason may be related to the number of involved types of inflammation and the interaction. Procalcitonin (PCT) has been found to be a pre-peptide substance without hormone activity, and the external stability of procalcitonin (PCT) is very good. In recent years, the clinical application value of PCT is mainly the early prediction and evaluation of bacterial infection and systemic inflammatory response, and the clinical data confirm that PCT has an important role in the assessment of the severity of bacterial inflammation and the evaluation of the effect of antibacterial and prognosis. due to the fact that it has certain tissue specificity and wide expression, it is suggested that this index may have the diagnostic value of the application other than the diagnosis and treatment of bacterial infection, and in recent years basic research and clinical observation have found, The PCT also has the value of the judgment of the degree of the condition of the aseptic inflammation and the evaluation value of the degree of tissue injury, and the correlation between the PCT and the inflammatory factors has found that the PCT also has the ability to comprehensively reflect the inflammatory factors. These previous studies have found that the ability of PCT to reflect the inflammatory injury and the need for diagnosis and treatment of diabetes do not match. Objective: To compare the expression of procalcitonin (PCT) in the patients with diabetes (Diabetes Mellitus, DM), and to compare the correlation between the correlation of PCT and the pathogenesis of diabetes and the degree of diabetes. It is suggested that PCT has a certain value for the diagnosis of diabetes. Methods:878 diabetic patients were selected to study the PCT? TNF-1 in patients with different degree of infection. IL-6? INF-1 level; combined infection diagnosis, fasting blood glucose (FBG) and glycosylated hemoglobin (Hb), urinary microalbumin (UmAlb), acute venereal disease physiology and long-term health evaluation II (AACHEII: Aute Physiology and Chronic Health Evaluation II) did not have complications in the early stage of DM, The severity of the chronic complications and the acute complications was graded, and the condition of the disease was assessed with PCT? TNF-1? The expression level of IL-6? INF-1. Results:1. PCT expression in DM patients increased with the severity of the course of the disease, and the level of PCT basal expression in DM patients was higher than that of normal controls, and the level of PCT expression in patients with acute complication was the highest, while the level of PCT expression in early DM group was the lowest. The difference of PCT expression is up-regulated with the severity of the disease, and other inflammatory markers TNF-1? IL-6, INF-1 showed up-regulation of non-infection and local infections with a lower severity of early and chronic complications of DM, There were no significant changes in the level of PCT expression in DM patients and the severity of the disease, and the level of PCT in DM patients was higher than that of normal controls (0.1 to 0.05 ng/ ml). The correlation of the disease grade index and the PCT and other relevant inflammation indexes of different stages was found, in the early period of no complications, chronic complications and acute concurrent DM patients, PCT? TNF-1? IL-6 showed a difference in expression in each group; INF-6 showed a difference in expression only in patients with no complications and chronic complications in the early stage of DM (lower HbA1c%/ FPG grade score), while the level of expression in patients with systemic infection was lower than that of normal controls (8.31% 2.87 pg/ ml). The correlation analysis found that the inflammatory factor PCT? TNF-1? IL-6? INF-1 showed a different degree of correlation in different degree of disease. There is a correlation between IL-6? INF-1, which is associated with TNF-1? There was a positive correlation between IL-6 and negative correlation with INF-6, but the statistical analysis of the correlation between chronic and acute complications with high degree of inflammation was poor. In patients with lower levels of Hb%%/ FPG, PCT? TNF-1? There was a correlation between IL-6? INF-1 and the grade of the disease, which was related to PCT? TNF-1? IL-6 showed positive correlation and negative correlation with INF-6. In patients with DM acute complications according to the APACHEII score, patients with a score of less than 15 PCT? TNF-1? IL-6? INF-1 showed a correlation, whereas in patients with a score of 15, the correlation was poor and there was a low correlation between the PCT and the table. Conclusion: The level of PCT expression in DM patients is a response to the severity of the disease, especially the degree of inflammation, and PCT may be of great reference value to the diagnosis and treatment of the severity of the disease.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
本文编号：2486676
[Abstract]:BACKGROUND: The onset and treatment of diabetes (Diabetes Mellitus, DM) has become a major problem in the safety of human population, and the difficulty in the treatment of DM is insufficient evidence in diagnosis and treatment, resulting in insufficient or excessive treatment. The bidirectionality of inflammation and its function acts as a defensive and destructive role in the body, and the persistent high basal level of inflammation in the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the However, it is still not possible to have an effective and extensive application in clinical application, and the specific reason may be related to the number of involved types of inflammation and the interaction. Procalcitonin (PCT) has been found to be a pre-peptide substance without hormone activity, and the external stability of procalcitonin (PCT) is very good. In recent years, the clinical application value of PCT is mainly the early prediction and evaluation of bacterial infection and systemic inflammatory response, and the clinical data confirm that PCT has an important role in the assessment of the severity of bacterial inflammation and the evaluation of the effect of antibacterial and prognosis. due to the fact that it has certain tissue specificity and wide expression, it is suggested that this index may have the diagnostic value of the application other than the diagnosis and treatment of bacterial infection, and in recent years basic research and clinical observation have found, The PCT also has the value of the judgment of the degree of the condition of the aseptic inflammation and the evaluation value of the degree of tissue injury, and the correlation between the PCT and the inflammatory factors has found that the PCT also has the ability to comprehensively reflect the inflammatory factors. These previous studies have found that the ability of PCT to reflect the inflammatory injury and the need for diagnosis and treatment of diabetes do not match. Objective: To compare the expression of procalcitonin (PCT) in the patients with diabetes (Diabetes Mellitus, DM), and to compare the correlation between the correlation of PCT and the pathogenesis of diabetes and the degree of diabetes. It is suggested that PCT has a certain value for the diagnosis of diabetes. Methods:878 diabetic patients were selected to study the PCT? TNF-1 in patients with different degree of infection. IL-6? INF-1 level; combined infection diagnosis, fasting blood glucose (FBG) and glycosylated hemoglobin (Hb), urinary microalbumin (UmAlb), acute venereal disease physiology and long-term health evaluation II (AACHEII: Aute Physiology and Chronic Health Evaluation II) did not have complications in the early stage of DM, The severity of the chronic complications and the acute complications was graded, and the condition of the disease was assessed with PCT? TNF-1? The expression level of IL-6? INF-1. Results:1. PCT expression in DM patients increased with the severity of the course of the disease, and the level of PCT basal expression in DM patients was higher than that of normal controls, and the level of PCT expression in patients with acute complication was the highest, while the level of PCT expression in early DM group was the lowest. The difference of PCT expression is up-regulated with the severity of the disease, and other inflammatory markers TNF-1? IL-6, INF-1 showed up-regulation of non-infection and local infections with a lower severity of early and chronic complications of DM, There were no significant changes in the level of PCT expression in DM patients and the severity of the disease, and the level of PCT in DM patients was higher than that of normal controls (0.1 to 0.05 ng/ ml). The correlation of the disease grade index and the PCT and other relevant inflammation indexes of different stages was found, in the early period of no complications, chronic complications and acute concurrent DM patients, PCT? TNF-1? IL-6 showed a difference in expression in each group; INF-6 showed a difference in expression only in patients with no complications and chronic complications in the early stage of DM (lower HbA1c%/ FPG grade score), while the level of expression in patients with systemic infection was lower than that of normal controls (8.31% 2.87 pg/ ml). The correlation analysis found that the inflammatory factor PCT? TNF-1? IL-6? INF-1 showed a different degree of correlation in different degree of disease. There is a correlation between IL-6? INF-1, which is associated with TNF-1? There was a positive correlation between IL-6 and negative correlation with INF-6, but the statistical analysis of the correlation between chronic and acute complications with high degree of inflammation was poor. In patients with lower levels of Hb%%/ FPG, PCT? TNF-1? There was a correlation between IL-6? INF-1 and the grade of the disease, which was related to PCT? TNF-1? IL-6 showed positive correlation and negative correlation with INF-6. In patients with DM acute complications according to the APACHEII score, patients with a score of less than 15 PCT? TNF-1? IL-6? INF-1 showed a correlation, whereas in patients with a score of 15, the correlation was poor and there was a low correlation between the PCT and the table. Conclusion: The level of PCT expression in DM patients is a response to the severity of the disease, especially the degree of inflammation, and PCT may be of great reference value to the diagnosis and treatment of the severity of the disease.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
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