急性缺血性脑卒中患者血清Sestrin2水平变化及临床意义

发布时间：2018-04-03 05:36

本文选题：Sestrin2蛋白　切入点：超敏C反应蛋白　出处：《延边大学》2017年硕士论文

【摘要】：目的:检测急性缺血性脑卒中患者血清Sestrin2含量,探讨Sestrin2对急性缺血性脑卒中患者的病程评估及预后价值。方法:①连续收集2016年9月至2017年1月就诊于延边大学附属医院神经内科住院的急性缺血性脑卒中患者,共88例,其中男性为45例,女性为43例,平均年龄(59.06±3.41)岁。②对照组随机选取相同时期年龄和性别相匹配的非脑卒中个体,共88例,其中男性为46例,女性为42例,平均年龄(58.68±3.36)岁。对急性缺血性脑卒中患者严重程度的评估,入院当天依据美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分评估神经功能缺损程度,根据评分结果分为轻型组(NIHSS≤3分),中型组(NIHSS 4-8分),重型组(NIHSS≥8分)。根据急性卒中治疗低分子肝素试验(Trial of Org 10172 in Acute Stroke Treatment,TOSAT)分型将缺血性脑卒中患者分为4个亚型:大动脉粥样硬化型、小动脉闭塞型、心源性栓塞型、不明原因型。根据改良Rankin(mRS)评分标准对出院后3个月缺血性脑卒中患者进行日常生活能力评估,分为预后良好组(mRS 0-2分)和预后不良组(mRS 3-5分)。采用ELISA方法检测血清Sestrin2(SESN2)的浓度。结果:1.缺血性脑卒中组与对照组一般资料比较结果显示,缺血性脑卒中患者高血压、糖尿病、血脂异常、吸烟、饮酒、TG、LDL-L、GLU、Hey、Hs-CRP水平均明显高于对照组(P0.05);然而,HDL-L水平明显低于对照组(P0.05);两组的性别、年龄、BMI、脉搏、TC水平无明显差异(P0.05)。2.与对照组相比,缺血性脑卒中患者血清Sestrin2水平明显升高(13.85±3.00 ng/ml vs.11.91±1.95ng/m1,P=0.001)。3.血清Sestrin2含量与缺血性脑卒中严重程度相关性结果显示,血清SESN2含量在NHISS评分轻、中、重型三组之间比较无明显差异(F=1.700,P=0.189);在TOSAT分型的四组分型之间血清Sestrin2含量比较无明显差异(F=0.728,P=0.538)。4.血清Sestrin2含量与缺血性脑卒中预后相关性结果显示,血清Sesn2含量在预后良好组与预后不良组之间比较差异无统计学意义(T=1.096,P=0.276)。5.血清Sestrin2水平与各参数的相关分析结果显示,无论是缺血性脑卒中患者还是对照组的血清Sestrin2水平均与血糖呈正相关,分别为(r=0.254,P=0.017;r=0.229,P=0.032)。在缺血性脑卒中患者中,血清Sestrin2水平有糖尿病史、吸烟史、饮酒史均明显高于无病史(P=0.015,P=0.011,P=0.009)。6.多因素Logistic回归模型分析显示血清Sestrin2(OR=0.791,95%CI[0.647-0.966],P =0.022)、Hs-CRP(OR=0.485,95%CI[0.329-0.717],P0.001)、血脂异常(OR=4.290,95%CI[1.517-12.131],P =0.006)是缺血性脑卒中的独立危险因素。7.根据Logistic模型结果,用Sestrin2、Hs-CRP、HCY构建的ROC曲线表明,①Se6trn2曲线下面积(0.705,95%CI[0.628-0.782],P0.001);cut off值为13.15,灵敏度为77.3%,特异性为55.7%。②Hs-CRP曲线下面积(0.767,95%CI[0.697-0.837],P0.001);cut off 值为 1.245,灵敏度为 81.8%,特异性为 64.8%。③HCY曲线下面积(0.580,95%CI[0.495-0.666],P=0.065);cut off 值为 12.245,灵敏度为44.6%,特异性为71.6%。结论:1.急性缺血性脑卒中血清Sestrin2含量明显升高,提示Sestrin2参与急性缺血性脑卒中病理机制。2.无论是对照组还是缺血性脑卒中组的血清Sestrin2含量均与血糖呈正相关。3.有糖尿病史、吸烟史、饮酒史的缺血性脑卒中患者血清Sestrin2水平明显高于无病史的患者。4.血清Sestrin2是缺血性脑卒中的独立危险因素。5.血清Sestrin2是缺血性脑卒中潜在的诊断及预防的生物标志物。
[Abstract]:Objective: to detect the acute ischemic stroke patients serum Sestrin2 content, investigate the value of Sestrin2 in the course of evaluation and prognosis of patients with acute ischemic stroke. Methods: 1. From September 2016 to January 2017 in the Affiliated Hospital of Yanbian University Department of Neurology in acute ischemic stroke patients, a total of 88 cases, including 45 cases of male, female 43 cases, the average age (59.06 + 3.41). The control group were randomly selected non stroke individuals of the same age and sex matched, a total of 88 cases, including 46 cases of male, female 42 cases, average age (58.68 + 3.36) years old. To evaluate the severity of patients with acute ischemic stroke. On the day of admission, according to the National Institutes of Health Stroke Scale (National Institute of Health Stroke Scale, NIHSS) was evaluated according to the degree of neurologic impairment were divided into mild group (NIHSS = 3) Medium sized group (NIHSS, 4-8), severe group (NIHSS = 8). According to the test of low molecular weight heparin for the treatment of acute stroke (Trial of Org 10172 in Acute Stroke Treatment, TOSAT) type of the ischemic stroke patients were divided into 4 subtypes: large artery atherosclerosis, arterial occlusion, cardioembolism type of unknown type. According to the modified Rankin (mRS) standard for evaluation of evaluation of the ability of daily life in patients with ischemic stroke 3 months after discharge, divided into good prognosis group (mRS 0-2) and poor prognosis group (mRS 3-5). ELISA method was used to detect serum Sestrin2 (SESN2) concentration. 1.: ischemic stroke group and control group data comparison showed that hypertension, ischemic stroke in patients with diabetes, dyslipidemia, smoking, alcohol, TG, LDL-L, GLU, Hey, Hs-CRP were significantly higher than the control group (P0.05); however, the level of HDL-L was significantly lower than the control group (P0 .05); two groups of gender, age, BMI, pulse, no significant differences in the level of TC (P0.05).2. compared with the control group, ischemic stroke patients serum Sestrin2 level increased significantly (13.85 + 3 ng/ml vs.11.91 + 1.95ng/m1, P=0.001).3. content of serum Sestrin2 and ischemic stroke severity, correlation analysis showed that serum SESN2 the content of NHISS scores in the light, heavy, there were no significant difference between the three groups (F=1.700, P=0.189); between four groups of type TOSAT type serum Sestrin2 content had no significant difference (F=0.728, P=0.538).4. serum Sestrin2 content and prognosis of ischemic stroke related results show that the content of serum Sesn2 in good prognosis group and poor prognosis group had no significant difference (T=1.096, P=0.276).5. correlation analysis of serum Sestrin2 level and the parameters of the results showed that both in patients with ischemic stroke or control The serum level of Sestrin2 group were positively correlated with blood glucose, respectively (r=0.254, P=0.017; r=0.229, P=0.032). In ischemic stroke patients, the serum level of Sestrin2 had a history of diabetes, smoking history, drinking history were significantly higher than those without history (P=0.015, P=0.011, P=0.009) regression analysis showed that serum Sestrin2.6. multi factor Logistic (OR=0.791,95%CI[0.647-0.966], P, =0.022) Hs-CRP (OR=0.485,95%CI[0.329-0.717], P0.001), dyslipidemia (OR=4.290,95%CI[1.517-12.131] P, =0.006.7.) is an independent risk factor for ischemic stroke according to the result of Logistic model, Sestrin2, Hs-CRP, ROC curve constructed by HCY showed that the area under the Se6trn2 curve (0.705,95%CI[0.628-0.782], P0.001); cut off = 13.15, the sensitivity was 77.3%, specificity was 55.7%. the area under the Hs-CRP curve (0.767,95%CI[0.697-0.837], P0.001 cut); the off value is 1.245, the sensitivity was 81.8 %, the specificity was 64.8%., the area under the HCY curve (0.580,95%CI[0.495-0.666], P=0.065); cut off = 12.245, the sensitivity was 44.6%, specificity was 71.6%. conclusion: 1. patients with acute ischemic stroke and serum Sestrin2 levels were significantly increased, suggesting that Sestrin2 involved in the pathological mechanism of acute ischemic stroke.2. both in control group and ischemic stroke group serum Sestrin2 levels were positively correlated with blood glucose.3. have a history of diabetes, smoking history, drinking history of ischemic stroke in patients with Sestrin2 were higher than the patients with a history of.4. serum Sestrin2 is an independent risk factor of.5. Sestrin2 in serum of ischemic stroke is a biomarker for diagnosis and prevention of ischemic stroke potential.

【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R446.1

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