急性一氧化碳中毒迟发性脑病与实验室及磁共振检查的相关性研究

发布时间：2018-03-10 22:32

  本文选题：急性一氧化碳中毒迟发性脑病　切入点：实验室　出处：《延安大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨实验室检查指标(同型半胱氨酸、髓鞘碱性蛋白、S100B蛋白、神经元特异性烯醇化酶)及磁共振成像技术(1H-MRS、DTI)在急性一氧化碳中毒的早期阶段判断中毒程度和评价预后、治疗效果及在早期预测可能发生迟发性脑病的临床价值。方法:1.回顾性分析137例急性一氧化碳中毒患者、43例一氧化碳中毒迟发性脑病患者及20例健康志愿者血浆Hcy含量,所有研究对象于肘静脉采血行t Hcy检测,统计所有研究对象血浆Hcy含量,探讨不同程度急性一氧化碳中毒患者t Hcy含量的变化情况、急性中毒患者与迟发性脑病患者间含量的变化情况以及t Hcy含量与一氧化碳中毒患者年龄间的关系。2.将60例ACOP患者与20例健康志愿者作为研究对象。(1).所有研究对象于肘静脉采血行MBP、S100B蛋白、NSE检测,分析迟发性脑病组、痊愈组及正常对照组在不同时期血清MBP、S100B蛋白、NSE含量的变化情况。(2).对所有受试对象于感兴趣区(ROI)行1H-MRS及DTI检查,分析迟发性脑病组、痊愈组及正常对照组间相应脑区NAA/Cr比值、Cho/Cr比值、FA值、ADC值的变化情况。结果:1.不同中毒程度ACOP患者血浆Hcy含量与正常对照组比较:ACOP患者t Hcy含量较正常对照组均有升高,差异有明显统计学意义(P0.01);随着中毒程度的加重t Hcy含量呈增高的趋势,血浆Hcy含量升高的水平为:重度中毒组中度中毒组轻度中毒组正常对照组。2.迟发性脑病组与急性中毒组血浆Hcy含量的比较:迟发性脑病组较急性中毒组血浆Hcy含量明显升高,其中男性高于女性,男性患者间差异有统计学意义(P0.05);女性患者间差异有明显统计学意义(P0.01),总体差异有明显统计学意义(P0.01)。3.一氧化碳中毒患者年龄与血浆Hcy含量的相关性分析:一氧化碳中毒患者的年龄与血浆Hcy含量呈正相关,但相关程度较低。4.ACOP患者血清MBP、S100B蛋白、NSE含量与正常对照组比较:ACOP患者血清MBP、S100B蛋白、NSE含量均较正常对照组明显升高,差异有明显统计学意义(P0.01);迟发性脑病组与痊愈组比较:迟发性脑病组血清S100B蛋白含量较痊愈组增高,差异有统计学意义(P0.05);血清MBP、NSE含量明显高于痊愈组,差异有明显统计学意义(P0.01)。5.迟发性脑病组患者血清MBP、S100B蛋白、NSE含量在急性中毒时与发生迟发性脑病时比较:发生迟发性脑病时血清MBP、S100B蛋白、NSE含量较急性中毒时有所增高,但差异无统计学意义(P0.05)。6.迟发性脑病组患者在恢复期与发生迟发性脑时比较:恢复期患者血清MBP、S100B蛋白、NSE含量较发生迟发性脑病时均明显降低,差异有明显统计学意义(P0.01)。7.迟发性脑病组患者在恢复期与正常对照组比较:迟发性脑病组患者在恢复期血清S100B蛋白、NSE含量较正常对照组略有增高,差异无统计学意义(P0.05);而血清MBP含量仍明显高于对照组,差异有统计学意义(P0.05)。8.行颅脑1H-MRS、DTI检查结果显示:(1).颅脑1H-MRS示:所有急性中毒患者在感兴趣区(基底节区、侧脑室旁白质、半卵圆中心)均出现不同程度的异常表现,主要表现为可检出不等的乳酸峰,NAA峰减低,NAA/Cr比值降低,Cho峰升高,Cho/Cr比值增高,而迟发性脑病组患者极少数可检出乳酸峰,但NAA/Cr比值、Cho/Cr比值较急性中毒时变化更明显。(2).颅脑DTI示:迟发性脑病患者颅脑诸纤维走行有局限性肿胀,部分走行稀疏或中断。选取该异常信号区作为感兴趣区进行测量结果显示:FA值明显降低,ADC值局部升高或降低。9.ACOP患者不同测量部位NAA/Cr、Cho/Cr比值与正常对照组比较:ACOP患者较正常对照组NAA/Cr比值均降低,Cho/Cr比值均升高,迟发性脑病组变化更明显。痊愈组与正常对照组比较:侧脑室旁白质NAA/Cr、Cho/Cr比值差异有统计学意义(P0.05);半卵圆中心NAA/Cr比值、Cho/Cr比值差异有明显统计学意义(P0.01),基底节区NAA/Cr比值差异有明显统计学意义(P0.01);Cho/Cr比值差异无统计学意义(P0.05)。迟发性脑病组与正常对照组NAA/Cr、Cho/Cr比值比较:差异均有明显统计学意义(P0.01)。迟发性脑病组与痊愈组NAA/Cr、Cho/Cr比值比较,差异均有统计学意义(P0.05);基底节区和侧脑室旁白质差异更显著(P0.01)。10.迟发性脑病组在急性中毒时与发生迟发性脑病时不同测量部位NAA/Cr比值、Cho/Cr比值比较:发生迟发性脑病时不同测量部位较急性中毒时NAA/Cr比值均有降低,Cho/Cr比值均升高,而基底节区变化显著,差异有明显统计学意义(P0.05)。11.迟发性脑病组不同测量部位NAA/Cr、Cho/Cr比值比较:不同测量部位间NAA/Cr、Cho/Cr比值差异无统计学意义(P0.05)。12.ACOP患者不同测量部位FA值与正常对照组比较:ACOP患者不同测量部位FA值较正常对照组均有降低,差异均有明显统计学意义(P0.01);迟发性脑病组在急性中毒时与痊愈组比较降低更明显,差异有明显统计学意义(P0.01)。13.ACOP患者不同测量部位ADC值与正常对照组比较:基底节区ADC值较正常对照组升高,侧脑室旁白质及半卵圆中心较对照组均降低,迟发性脑病组变化更明显。痊愈组与正常对照组比较:基底节区差异有明显统计学意义(P0.01);侧脑室旁白质及半卵圆中心差异无统计学意义(P0.05)。迟发性脑病组与正常对照组比较:差异均有明显统计学意义(P0.01)。迟发性脑病组在急性中毒时与痊愈组比较:基底节区差异有明显统计学意义(P0.01);侧脑室旁白质及半卵圆中心差异均有统计学意义(P0.05)。结论:1.ACOP患者血浆Hcy含量在急性中毒时较对照组均有增高,且随中毒程度2.的增加而明显增高,推测通过检测血浆Hcy含量可作为临床判定ACOP患者中毒程度的指标之一。血浆Hcy含量与年龄有关。检测血浆Hcy含量是否可以作为早期预测DEACMP的指标有待进一步研究。3.ACOP患者血清MBP、S100B蛋白、NSE含量较正常对照组均有升高,且发生迟发性脑病患者较痊愈组升高更明显,以MBP、NSE含量升高为瞩,DEACMP组恢复期血清MBP仍高于正常对照组,推测监测MBP、NSE含量对于预测迟发性脑病的发生更有意义。4.发生迟发性脑病时血清MBP、S100B蛋白、NSE含量较急性中毒时仍略有增高。5.ACOP患者不同测量部位NAA/Cr比值较正常对照组均减低,Cho/Cr比值均增高,各测量部位间无明显差异。6.颅脑DTI技术可直观脑白质纤维束的走行;ACOP患者不同测量部位FA值较正常对照组均降低;基底节区ADC值升高,侧脑室旁白质及半卵圆中心ADC值均降低。FA、ADC值的变化情况对于预测DEACMP的发生或评价预后,有待进一步探讨。
[Abstract]:Objective: To investigate the laboratory indexes (homocysteine, myelin basic protein, S100B protein, neuron specific enolase) and magnetic resonance imaging (1H-MRS, DTI) in the early stage of judgement on the severity and prognosis of acute carbon monoxide poisoning, treatment effect and forecast the possible clinical value of delayed encephalopathy in early stage methods: 1. patients were retrospectively analyzed in 137 patients with acute poisoning of carbon monoxide, 43 cases of delayed encephalopathy after carbon monoxide poisoning patients and 20 healthy volunteers plasma Hcy content, all of the subjects in venous blood T Hcy detection, the Hcy content of all the research objects to investigate the changes of plasma statistics, different degree of t Hcy in patients with acute carbon monoxide poisoning the changes of patients with acute poisoning with delayed encephalopathy patients between the content and the relationship between.2. age T and Hcy content among the 60 patients with carbon monoxide poisoning Patients with ACOP and 20 healthy volunteers as the research object. (1). All subjects from the elbow vein blood MBP, S100B protein, NSE detection and analysis of delayed encephalopathy group, recovery group and normal control group at different times of serum MBP, S100B protein, the changes of the NSE content. (2). Of all subjects in the region of interest (ROI) underwent 1H-MRS and DTI examination, analysis of delayed encephalopathy group, recovery group and normal control group NAA/Cr corresponding brain area ratio, Cho/Cr ratio, FA value, the change of ADC value. Results: compared with the normal control group of 1. different degrees of poisoning in patients with ACOP Hcy content: ACOP t Hcy in patients were higher than normal control group, there was significant difference (P0.01); with the severity of poisoning t Hcy content showed an increasing trend, and increase the content of plasma Hcy level: normal control group.2. severe group, moderate poisoning group mild poisoning group poisoning Comparison of delayed encephalopathy group and acute poisoning group serum Hcy content: delayed encephalopathy group, plasma Hcy content was significantly increased in acute poisoning, the male is higher than female, the difference was statistically significant between male patients (P0.05); there was a significant difference between female patients (P0.01), there was significant difference (P0.01) analysis of the correlation between age and plasma Hcy content of.3. carbon monoxide poisoning: the content of plasma Hcy was positively related with age of patients with carbon monoxide poisoning, but the low level of serum.4.ACOP in patients with MBP, S100B protein, compared with normal control group: the NSE content of serum ACOP in patients with MBP, S100B protein, NSE content were higher than the normal control group was significantly increased, there was significant difference (P0.01); delayed encephalopathy group and cure group: delayed encephalopathy group serum S100B protein content compared with the cured group, there was statistically significant difference Yi (P0.05); serum MBP, NSE were significantly higher than that of the cured group, there was significant difference (P0.01).5. delayed encephalopathy group serum MBP, S100B protein, NSE content in acute poisoning with delayed encephalopathy: delayed encephalopathy of serum MBP, S100B protein, NSE the content is acute poisoning has increased, but the difference was not statistically significant (P0.05).6. delayed encephalopathy group in patients with delayed brain during recovery period and recovery period occurs: serum MBP, S100B protein, the content of NSE is the occurrence of delayed encephalopathy were significantly decreased, there was significant difference (P0.01).7. delayed encephalopathy patients in the recovery period compared with the normal control group: delayed encephalopathy patients in convalescent serum S100B protein, NSE content increased slightly compared with the normal control group, the difference was not statistically significant (P0.05); the serum MBP contents were significantly higher than the control group, 宸�寮傛湁缁熻�″�︽剰涔�(P0.05).8.琛岄�呰劊�

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