尿酸与脑梗死预后相关性的临床研究

发布时间：2018-03-10 06:33

  本文选题：高尿酸血症　切入点：脑梗死　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨血尿酸水平与脑梗死患者急性期治疗效果及预后的相关性,干预尿酸后,患者能否获益。探讨血尿酸在脑梗死患者急性期及恢复期中的作用机制。方法:选取2016年1月至2016年12月在淄博市临淄区人民医院神经内科一病区住院治疗的急性脑梗死患者207例为研究对象,根据血尿酸水平分为高尿酸血症组(n=119)与血尿酸正常组(对照组)(n=88),并将高尿酸血症的患者随机分为干预组(主要应用别嘌呤醇等降尿酸药物)(n=60)及未干预组(n=59),三组脑梗死患者分别在入院的当天、治疗1周、治疗2周、治疗3个月进行神经功能缺损评分及尿酸检查,对结果进行统计学分析。比较患者治疗1周、2周时三组患者治疗效果、神经功能缺损改善程度,即NIHSS评分改善率,比较治疗3个月时三组患者的预后、神经功能恢复改善程度,即m RS评分改善率,m RS评分≤2判断为脑梗死预后良好组;m RS量表评分2判断为脑梗死预后不良组(死亡病例统计到预后不良组)。结果:1.对照组、干预组、未干预组治疗1周时NIHSS评分改善率(即NIHSS评分下降率)分别为12.48±4.54%、10.24±4.78%、-1.22±3.51%。对照组、干预组、未干预组治疗2周时NIHSS评分改善率分别为28.03±4.44%、25.20±3.81%、-4.38±3.52%。治疗1周、2周时,干预组较未干预组患者NIHSS评分改善率显著升高(p=0.002,p=0.002),对照组较未干预组NIHSS评分改善率显著升高,有显著差异性(p=0.001,p=0.001)。2.对照组、干预组、未干预组三组患者治疗3个月时m RS评分改善率(即m RS评分下降率)分别为57.83±8.91%、52.26±7.90%、27.52±7.52%。治疗3个月时,干预组较未干预组患者的m RS评分改善率显著提高(p=0.001),对照组较未干预组m RS评分改善率显著提高(p=0.001),差异有统计学意义(P0.01)。3.干预组预后良好率88.33%,显著高于未干预组的预后良好率59.32%,有显著差异性(χ2=21.113,P=0.002)。对照组预后良好率是93.18,显著高于未干预组预后良好率59.31%,有显著差异性(χ2=24.929,P=0.002)。而对照组与干预组预后良好率比较差异无统计学意义(χ2=1.047,P0.05)。结论:1.与血尿酸正常的脑梗死患者相比,伴有高尿酸血症的脑梗死患者其神经功能损害程度相对较重,治疗效果及预后相对较差。血尿酸水平升高可能与急性脑梗死的发生发展、治疗效果及临床预后密切相关。2.伴高尿酸血症的脑梗死患者降低血尿酸治疗后可能会改善临床预后,降低疾病致残率。应重视血尿酸水平的变化,高尿酸血症可促进动脉粥样硬化发生,可能进一步加重患者的代谢紊乱,而且在脑梗死急性期参与颅脑组织损伤的级联反应,同时引起脑梗死急性期氧自由基的大量释放,故高尿酸血症可能与急性脑梗死疾病的进展有着密切关系,高尿酸血症可能增大患者发生脑梗死的危险性,增加脑梗死复发率,增加脑梗死的不良预后。可将此指标作为独立预测因素加以检测并干预,指导脑梗死治疗及二级预防。
[Abstract]:Objective: to investigate the correlation between serum uric acid level and the therapeutic effect and prognosis of patients with acute cerebral infarction. To explore the mechanism of serum uric acid in acute and convalescent stage of cerebral infarction patients. Methods: from January 2016 to December 2016, the patients were hospitalized in the Department of Neurology, Renmin Hospital, Zibo City. 207 cases of cerebral infarction were studied. According to the level of serum uric acid, the patients were divided into two groups: hyperuricemia group (n = 119) and control group (control group). Patients with hyperuricemia were randomly divided into two groups: intervention group (mainly treated with allopurinol) and non-intervention group (n = 59). The patients with infarction were admitted to hospital on the same day, After 1 week, 2 weeks and 3 months of treatment, the neurological function defect score and uric acid were evaluated, and the results were analyzed statistically, and the results were compared between the three groups after 1 week and 2 weeks of treatment, and the degree of improvement of nerve function defect was compared. That is, the improvement rate of NIHSS score, the prognosis of the three groups after 3 months of treatment, and the degree of improvement of nerve function. That is to say, the improvement rate of MRS score and the mRS score 鈮，

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