盐酸法舒地尔注射液对急性脑梗死患者血清Hs-CRP、VEGF、IL-6水平和临床疗效影响的研究

发布时间：2018-03-10 16:50

本文选题：盐酸法舒地尔　切入点：急性脑梗死　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究盐酸法舒地尔注射液对急性脑梗死患者的临床疗效及其对血清中超敏-C反应蛋白(Hs-CRP)、血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)水平的影响,以及探讨该药在急性脑梗死炎症反应过程中可能的作用机制;探讨IL-6、VEGF与梗死体积之间的关系;探讨血清炎症因子如Hs-CRP、IL-6水平与神经缺损的程度和预后之间是否有关系。方法:选择于2016年3月至2016年10月在河北医科大学第二医院神经内科收入院的符合入选标准的急性脑梗死患者共有84例,其中女性28例,男性56例,年龄范围在30岁到80岁。将符合要求的所有患者按随机数字进行完全随机分组,分为盐酸法舒地尔治疗组(n=45)与对照组(n=39),收集期间将不符合要求的患者剔除,两组均以10d为一个疗程。两组患者在年龄、性别、基础疾病等方面无显著差异。所有的患者在入院时和第10天分别用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和ADL量表评估患者病情。所有的患者均行头颅CT或MRI检查,然后根据Pullicino公式计算梗死体积。分别于入院第2天和第10天采集肘静脉血,离心后分离血清,用ELISA试剂盒测定血清VEGF、IL-6水平,Hs-CRP由河北医科大学第二医院检验科完成。应用统计学软件SPSS进行统计分析:计量资料用均数±标准差表示,如果数据分布满足正态性和方差齐性条件者,可选择两独立样本t检验;如果数据分布不满足正态性和(或)方差齐性条件者,可选择两独立样本非参数Wilcoxon秩和检验。计数资料可选择R×C卡方检验。定义显著性水平α=0.05,并且认为P0.05时差别是有统计学意义的。相关性分析选用非参数检验Spearman秩相关,定义显著性水平α=0.01,且认为P0.01时两者之间是有相关关系的存在。结果:1治疗组(n=45)和对照组(n=39)两组患者在性别和年龄方面;血脂化验如甘油三酯、胆固醇、低密度脂蛋白等方面;主要基础疾病如高血压病史、冠心病史、糖尿病病史、陈旧性脑梗死病史方面;不良嗜好方面如吸烟史、饮酒史等各方面之间无统计学差异(p0.05)。血清同型半胱氨酸之间比较有统计学差异(p0.05)。2两组治疗前血清hs-crp水平无统计学差异(p=0.927,p0.05);治疗后hs-crp水平呈下降趋势,但两组之间无统计学差异(p=0.920,p0.05);3两组治疗前血清vegf有统计学差异(p=0.007,p0.05);治疗后血清vegf较治疗前增高,且两组之间有统计学差异(p=0.003,p0.05)。4两组治疗前血清il-6无统计学差异(p=0.114,p0.05),治疗后血清il-6较治疗前下降,且两组之间有统计学差异(p=0.043,p0.05)。5nihss评分之间的比较:两组试验对象治疗的显效率有统计学差异(p=0.000,p0.05);有效率无统计学差异(p=0.235,p0.05)。6血清hs-crp、il-6与神经功能相关性分析:治疗前后血清hs-crp均与同期nihss评分之间无相关关系(p0.01);治疗前后血清hs-crp均与同期adl评分之间无相关关系(p0.01);治疗前后血清il-6均与同期nihss评分之间无相关关系(p0.01);治疗前后血清il-6均与同期adl评分之间有相关关系(p0.01)。7不同梗死体积入院时血清il-6、vegf比较:随着梗死体积增大,血清il-6浓度增高,且大、中、小体积三者之间有差异统计学(p=0.025,p0.05);随着梗死体积的增大,大体积梗死血清vegf的水平高于小体积梗死水平,但不高于中体积梗死水平,三者之间无统计学差异(p=0.378,p0.05)。结论:1试验组和对照组相比,试验组有更强的抗炎能力和更高的临床治疗显效率。2白细胞介素-6作为可炎性血清的标记物,与梗死体积相关,并能评估预后,盐酸法舒地尔可显著降低其含量,说明盐酸法舒地尔有更强的抗炎能力和神经保护作用。3hs-crp可能并不适合作为急性脑梗死的血清学标记物,在评估病情和预后方面均无明显显著相关性。
[Abstract]:Objective: To study the clinical effect of Fasudil Hydrochloride Injection protein in patients with acute cerebral infarction and its response to serum high-sensitivity -C (Hs-CRP), vascular endothelial growth factor (VEGF), interleukin -6 (IL-6) levels, and to investigate the drug in acute cerebral infarction inflammatory reaction in the process of the possible mechanism of IL-6 relationship; between the VEGF and the infarction volume; to investigate the serum levels of inflammatory factors such as Hs-CRP, whether there is a relationship between IL-6 levels and the degree and prognosis of nerve defect. Methods: from March 2016 to October 2016 in the second hospital of Hebei Medical University admitted to hospital with acute cerebral infarction were included a total of 84 cases, there were 28 female and 56 male patients and in the age range of 30 to 80 years old. All patients will meet the requirements of the completely randomized randomly, divided into fasudil group (n=45) and the Control group (n=39), the collection period will not meet the requirements of patients were excluded, two groups were in 10d for a course of treatment. Two patients in age, gender, no significant differences in the underlying disease. All patients at admission and tenth days respectively by the National Institutes of Health Stroke Scale (National Institutes of Health Stroke Scale, NIHSS) score and ADL scale assessment of patients. All patients underwent head CT or MRI examination, and then calculate the infarct volume according to Pullicino formula respectively. On the second day after admission and tenth days to collect venous blood after centrifugal separation of serum, serum VEGF, ELISA IL-6 kit Hs-CRP, completed by the inspection department of the second hospital of Hebei Medical University. SPSS software was used for statistical analysis: measurement data with the mean standard deviation of that if the data distribution satisfies the normality and homogeneity of variances, can choose only two Independent samples t test; if the data does not meet the normal distribution and homogeneity of variance (or) conditions, can choose two independent samples of non parametric test and Wilcoxon test. Enumeration data can choose R * C chi square test. The definition of the confidence level =0.05, and that the P0.05 difference was statistically significant. Correlation analysis using Spearman rank correlation test, the definition of the confidence level =0.01, and that between P0.01 there is a correlation exists. Results: 1 treatment group (n=45) and control group (n=39 group) and two patients in the aspects of gender and age; blood lipid test such as triglycerides, cholesterol, low density lipoprotein protein; basic diseases such as hypertension, coronary heart disease history, diabetes history, aspects of old history of cerebral infarction; bad habits such as smoking, no significant difference between the various aspects of drinking history (P0.05). The serum homocysteine. Were statistically significant difference (P0.05) serum level of hs-CRP had no statistically significant difference in.2 before treatment in the two groups (p=0.927, P0.05); decreased the level of hs-CRP after treatment, but no significant difference between the two groups (p=0.920, P0.05); 3 of the two groups before treatment, there were significant differences in serum VEGF (p=0.007, P0.05) after treatment; the serum VEGF increased compared with that before treatment, and there were significant differences between the two groups (p=0.003, P0.05) of serum IL-6 had no significant difference between the two groups before treatment.4 (p=0.114, P0.05), serum levels of IL-6 after treatment than before treatment decreased, and there were significant differences between the two groups (p=0.043, P0.05).5nihss score between the two groups the test object treatment effective rate had significant difference (p=0.000, P0.05); there is no significant difference between the efficiency (p=0.235, P0.05).6 serum hs-CRP, correlation analysis between IL-6 and nerve function before and after the treatment of serum hs-CRP had no correlation with NIHSS score (P0.01) during the same period; The serum hs-CRP before and after treatment were not correlated with ADL scores over the same period (P0.01); serum IL-6 before and after treatment were not correlated with NIHSS scores over the same period (P0.01); serum IL-6 before and after treatment were correlated with ADL score (P0.01.7) from different infarct volume on admission serum IL-6, VEGF compared with infarction the volume increased, the concentration of serum IL-6 increased, and large, have significant differences between small volume three (p=0.025, P0.05); with the increase of infarct volume, the large volume of infarction serum VEGF levels higher than the small volume of stem flat but not higher than in stagnant water, the volume of infarction level, no significant differences between the three groups (p=0.378. P0.05). Conclusion: the 1 experimental group compared with the control group, the experimental group has stronger anti-inflammatory ability and higher clinical effect rate of treatment.2 interleukin -6 as a marker of inflammatory serum, correlated with infarct volume, and prognosis , fasudil hydrochloride can significantly reduce the content of that fasudil hydrochloride has stronger anti-inflammatory and neuroprotective effects of.3hs-crp may not be suitable as a serological marker of acute cerebral infarction, there were no obvious correlation in the evaluation of disease and prognosis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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