缺血性脑血管血清C肽与非糖尿病颈动脉内中膜厚度关系的研究

发布时间：2018-03-11 18:12

  本文选题：血清C肽　切入点：缺血性脑血管病　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过对非糖尿病的缺血性脑血管病患者行颈动脉超声检测颈动脉内-中膜厚度(IMT)及血清C肽检测,探讨在缺血性脑血管病中血清C肽水平与非糖尿病患者颈动脉内中膜厚度(IMT)的相关性。方法筛选自2013年9月至2014年4月在东阿县人民医院住院的所有非糖尿病的缺血性脑血管病患者115例。包括男性56例,女性59例,患者的年龄介于49岁至71岁之间,平均年龄为64.2±8.9岁。缺血性脑血管病包括短暂性脑缺血发作(TIA)和脑梗塞(PCI),短暂性脑缺血发作(TIA)是指颅内动脉病变引起的一过性或短暂性、局灶性脑或视网膜功能障碍,临床症状一般持续10至15分钟,多在1小时内恢复,不超过24小时。不遗留神经功能缺损的症状和体征,影像学(CT、MRI)检查无责任病灶。脑梗塞(PCI)指脑部血液循环障碍,缺血、缺氧导致的局限性脑组织的缺血性坏死或软化。所有病人均符合短暂性脑缺血发作(TIA)及脑梗塞(PCI)的标准,并排除年龄大于80岁,糖尿病患者、脑出血患者、恶性肿瘤、在过去的2月内有手术及严重的外伤史、严重的心肺肝肾疾病、感染性疾病、自身免疫性疾病、一氧化碳中毒、安眠药物中毒、农药中毒的患者,所有入选患者均由有5年以上工作经验的超声医师行颈部血管超声检查测颈动脉内中膜厚度,并根据内中膜厚度进行分组,入选患者并行空腹血清C肽、血糖、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血同型半胱氨酸(Hcy)检查,统计所有患者的性别、年龄、吸烟及饮酒情况,房颤病史、高血压的分级,血清C肽、血同型半胱氨酸(Hcy)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及颈动脉内中膜厚度(IMT);2比较各组的临床资料和C肽水平,利用统计学分析在缺血性脑血管病中血清C肽与非糖尿病患者颈动脉内中膜厚度(IMT)关系。应用SPSS 18.0软件进行数据分析,计量资料采用均数±标准差(sx±)表示,通过两独立样本t检验统计对两组间均数进行比较,采用方差分析的方法比较多组间均数并进行均数的两两比较。采用卡方检验统计分析组间构成比的比较。采用Person相关分析对指标间相关性进行统计学分析,采用多元线性回归分析探索C肽含量的影响因素。检验水准a=0.05,P≤0.05为两组之间的差异有统计学意义。结果1、三组CIMT分组间与C肽、年龄、LDL、HDL、Hcy指标的比较:CIMT0.9mm组、0.9≤CIMT1.1mm组、CIMT≥1.1mm组的平均年龄差异有统计学意义(P0.05),随着年龄的增加,CIMT厚度增加;CIMT0.9mm组、0.9≤CIMT1.1mm组的Hcy均数较CIMT≥1.1mm的Hcy均数明显降低,差异有统计学意义((P0.05);CIMT三组间在C肽、LDL、HDL方面的差异均无统计学意义(P0.05)。2、性别与CIMT分组的关系:在CIMT0.9mm组、CIMT≥1.1mm组女性占得比例较男性高,0.9≤CIMT1.1mm组男性占的比例较高,不同性别的CIMT差异有统计学意义(P0.05)。3、不同性别间和C肽、LDL、HDL、Hcy指标的比较:女性LDL均数较男性LDL均数高,差异有统计学意义(P0.05),但由于两者均数均在正常范围内,故差异无临床意义;不同性别间在Hcy、C肽、HDL差异无统计学意义(P0.05)。4、有无吸烟与C肽、LDL、HDL、Hcy指标的比较:吸烟者LDL的均数较不吸烟者LDL的均数低,LDL的差异有统计学意义(P0.05),但由于两者的均数在正常值范围内,故差异无临床意义;有无吸烟在C肽、HDL、Hcy方面的差异无统计学意义(P0.05)。5、有无饮酒与C肽、LDL、HDL、Hcy指标的比较:无饮酒者Hcy的均数较饮酒者Hcy的均数低,Hcy的差异有统计学意义(P0.05);有无饮酒在C肽、HDL、LDL方面的差异无统计学意义(P0.05)。6、有无房颤与年龄、C肽、LDL、HDL、Hcy指标的比较:患者有无房颤,在年龄、C肽、LDL、HDL、Hcy方面的差异无统计学意义(P0.05)。7、高血压分级与年龄、C肽、LDL、HDL、Hcy指标的比较:1级高血压HDL的均数较2级和无高血压HDL均数低,差异有统计学意义(P0.05),但三者的HDL均数在正常值范围内,差异无临床意义;在年龄、C肽、LDL、Hcy方面差异无统计学意义(P0.05)。8、研究对象血清中C肽的含量与颈部血管内膜厚度呈负相关(r值为-0.273,P值为0.003),血清中C肽的含量与LDL、HDL、Hcy之间无相关性。9、除年龄外,将C肽、LDL、HDL、Hcy四项指标进入回归方程中,Hcy的P值为0.038,与颈动脉内中膜厚度有线性回归关系,C肽、LDL、HDL与颈动脉内中膜厚度无线性回归关性。结论在缺血性脑血管病中血清C肽可减少非糖尿病颈动脉内中膜厚度,说明C肽在预防颈动脉粥样硬化的发生发展中可能起到保护性的作用。
[Abstract]:The purpose of this study is based on the non diabetic patients with ischemic cerebrovascular disease carotid ultrasound detection of carotid artery intima-media thickness (IMT) and detection of serum C peptide, serum C peptide level and non diabetic patients with carotid intima-media thickness in ischemic cerebrovascular disease (IMT). The correlation method of screening from September 2013 to April 2014 in Dong'e County People's Hospital of all 115 patients with ischemic cerebrovascular disease in non diabetic patients. Including male 56 cases, female 59 cases, age of the patients ranged from 49 to 71 years old, the average age was 64.2 + 8.9 years. Ischemic cerebrovascular disease including transient ischemic attack (TIA) and cerebral infarction (PCI), transient ischemic attack (TIA) is caused by intracranial arterial lesions in a transient or transient focal cerebral or retinal dysfunction, clinical symptoms usually lasts for 10 to 15 minutes, the recovery in 1 hours, not more than 24 When not. Left neurological defect symptoms and signs, imaging (CT, MRI). Check without responsible lesions of cerebral infarction (PCI) refers to the brain blood circulation disorder, ischemia, limitation of brain tissue hypoxia leads to necrosis or softening. All of the patients with transient ischemic attack (TIA) and brain infarction (PCI) standard, and the exclusion of older than 80, patients with diabetes, patients with cerebral hemorrhage, malignant tumor, surgery and severe trauma history in the past February, severe cardiopulmonary liver and kidney disease, infectious diseases, autoimmune diseases, carbon monoxide poisoning, hypnotic drug poisoning, poisoning the patients, measuring the intima-media thickness of carotid artery in all patients were selected from more than 5 years working experience in ultrasound doctors for neck vascular ultrasound, and were grouped according to the intima-media thickness of the patients, parallel fasting serum C peptide, blood glucose, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) examination, statistics of all patients with gender, age, smoking and drinking, history of atrial fibrillation, hypertension grade, serum C peptide, plasma homocysteine (Hcy), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) and carotid intima-media thickness (IMT); the 2 groups were compared the clinical data and C peptide level, using statistical analysis of serum C peptide and non diabetic carotid intima-media thickness in patients with ischemic cerebrovascular disease (IMT). SPSS 18 software was used for data analysis. The measurement data using the mean and standard deviation (SX +) said on the two groups were compared by two independent samples t test statistics, analysis of variance was used to compare Multi-X group and comparison were the number 22. The constituent ratio of the chi square statistic analysis between groups. The statistical analysis of the correlation between indicators by Person correlation analysis, multiple regression analysis was used to explore the influencing factors of C peptide content. The inspection level a=0.05, P = 0.05, there was statistically significant difference between the two groups. The 1 group, three CIMT group and C peptide, LDL, age, HDL, Hcy index CIMT0.9mm group, 0.9 CIMT1.1mm group, the average age was statistically significant difference of CIMT than 1.1mm group (P0.05), with the increase of age, the increase of the thickness of CIMT; CIMT0.9mm group, 0.9 CIMT1.1mm group of Hcy compared with the number of CIMT was 1.1mm Hcy were significantly decreased, the difference was statistically significant ((P0.05); the CIMT between the three groups in the C peptide, LDL, HDL differences were not statistically significant (P0.05.2), the relation between gender and CIMT group: in group CIMT0.9mm, CIMT = 1.1mm group of female proportion is higher than the male group, 0.9 CIMT1.1mm men accounted for a higher proportion of different gender difference CIMT 寮傛湁缁熻�″�︽剰涔，

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