动脉瘤性蛛网膜下腔出血患者血清中sICAM-1含量动态变化的临床研究

发布时间：2018-05-02 05:56

  本文选题：动脉瘤性蛛网膜下腔出血（aSAH） + 脑血管痉挛（CVS）　； 参考：《桂林医学院》2014年硕士论文

【摘要】：目的：本课题旨在通过对动脉瘤性蛛网膜下腔出血患者血清中sICAM-1含量变化的动态检测，比较动脉瘤性蛛网膜下腔出血患者与正常健康成人血清中sICAM-1浓度含量差异，分析动脉瘤性蛛网膜下腔出血患者血清中的sICAM-1浓度含量变化与脑血管痉挛发生的时项、程度的相关性，探讨其作为病情判断、疗效观察、临床治疗及预后的有效指标的可行性，以降低动脉瘤性蛛网膜下腔出血后脑血管痉挛发生率以及致死、致残率。 方法:收集桂林医学院附属医院神经外科自2012年3月至2013年5月之间收治的动脉瘤性蛛网膜下腔出血患者30例（实验组）。对照组为同期来我院健康成人体检者10例。实验组患者入院后，于发病后1～3d(术前),7～9d,11～13d清晨空腹抽取外周静脉血10ml，对照组抽取静脉血的数量、方法同上，集中检测。收集年龄、性别、Hunt分级、Fisher分级、各项检查报告资料等，患者入院后均在72h内予以血管内栓塞治疗。在患者发病后1～3d(术前),7～9d分别用TCD检测大脑中动脉平均血流速度(VMCA)，利用所测得的血流速度来判断有无脑血管痉挛的发生。将任何一次大脑中动脉血流速度(VMCA)120cm/s判定为脑血管痉挛。采用酶联免疫吸附剂测定分析方法(ELISA)检测所采集血清中sICAM-1浓度，术后预后（6～12月复查或电话回访）进行GOS评分。统计学处理方法应用spss12.0统计包进行分析数据，计量资料以均数±标准差表示,两组之间比较采用t检验,如P0.05判定为差异无统计学意义, P 0.05判定为差异有统计学意义。 结果： 1.动脉瘤性蛛网膜下腔出血患者血清sICAM-1浓度明显高正常成人，尤以发病后7～9d变化最明显，，动脉瘤性蛛网膜下腔出血患者出血后sICAM-1浓度水平与对照组相比，(发病后1～3d：实验组314.21±94.92ng/ml，对照组218.14±64.33ng/ml，P值0.05；发病后7～9d：实验组486.62±83.38ng/ml，对照组224.45±59.89ng/ml，P值0.05；发病后11～13d：实验组295.94±64.67ng/ml，对照组231.83±76.46ng/ml，P值0.05。)统计学上差异有显著性意义。 2.动脉瘤性蛛网膜下腔出血患者早期Hunt-Hess分级为III～IV级组血清sICAM-1含量(384.45±59.89ng/ml)高于I～II级组(288.14±64.33ng/ml)(P0.05)，统计学上差异有显著性意义。 3.动脉瘤性蛛网膜下腔出血患者早期Fisher分级为III~IV级组血清sICAM-l含量(416.62±83.38ng/ml)高于I~II级组(294.21±94.92ng/ml)(P 0.05),统计学上差异有显著性意义。 4.动脉瘤性蛛网膜下腔出血患者轻度脑血管痉挛组患者血清sICAM-l含量(363.51土85.32ng/ml)；中度脑血管痉挛组患者血清sICAM-l含量(543.10土79.13ng/ml)；轻重度脑血管痉挛组患者血清sICAM-l含量(694.12土77.21ng/ml)。与非痉挛组相比P 0.05，统计学上差异有显著性意义。 5.动脉瘤性蛛网膜下腔出血患者GOS评分1～3分早期血清中的sICAM-l含量(587.00±73.55ng/ml)明显高于4～5分组(284.07±62.34ng/ml)(P0.05),统计学上差异有显著意义。 结论:动脉瘤性蛛网膜下腔出血患者血清中的slCAM-1含量明显高于正常成人对照组，尤以发病后7～9d含量最高；脉瘤性蛛网膜下腔出血患者血清中slCAM-1含量变化可以反映患者脑血管痉挛病情的严重程度，脑血管痉挛程度越重, slCAM-1含量越高；动脉瘤性蛛网膜下腔出血早期（1～3d）Hunt-Hess分级及Fisher分级越高，血清中slCAM-1含量越高血清；动脉瘤性蛛网膜下腔出血早期患者血清slCAM-1含量可作为预后评估的重要指标，slCAM-1含量越高,患者预后越差。
[Abstract]:Objective : To investigate the changes of serum levels of serum soluble intercellular adhesion molecule - 1 ( ICAM1 ) in patients with aneurachnoid hemorrhage ( SAH ) and to compare the changes of the levels of ICAM1 in sera of patients with aneurachnoid hemorrhage and normal healthy adults .

Methods : 30 cases ( experimental group ) were collected from January 2012 to May 2013 in the Affiliated Hospital of Guilin Medical College from March 2012 to May 2013 .

Results :

1 . The levels of serum soluble intercellular adhesion molecule - 1 in patients with aneurachnoid hemorrhage were significantly higher than those in the control group ( 1 - 3 days after onset ) . The levels of serum soluble intercellular adhesion molecule - 1 were significantly higher than those in the control group ( 1 - 3 days after onset : 314.21 卤 94.92ng / ml in the experimental group ) , 218.14 卤 64.33ng / ml in the control group , and 0.05 in the control group ;
7 - 9 days after onset : 486.62 卤 83.38ng / ml in the experimental group , 224.45 卤 59.89ng / ml in the control group and 0.05 in the control group ;
11 - 13 days after onset : 295.94 卤 64.67ng / ml in the experimental group and 231.83 卤 76.46ng / ml in the control group ( P < 0.05 ) . There was significant difference in statistics .

2 . The early Hunt - Hess grade of patients with aneursmal subarachnoid hemorrhage was higher than that in group I ~ II ( 388.14 卤 64.33ng / ml ) ( P0.05 ) .

3 . The early Fisher classification of patients with aneurachnoid hemorrhage was higher than that in group I ~ II ( 416.62 卤 83.38ng / ml ) , which was higher than that in group I ~ II ( 294.21 卤 94.92ng / ml ) ( P 0.05 ) .

4 . The level of serum soluble intercellular adhesion molecule - 1 ( 363.51 卤 85.32ng / ml ) was measured in patients with mild cerebrovascular spasm in patients with aneurachnoid hemorrhage .
The levels of serum soluble intercellular adhesion molecule - 1 ( 543.10 卤 79.13ng / ml ) in patients with moderate cerebral vascular spasm were studied .
Compared with non - spasticity group , there was significant difference in serum levels of serum soluble intercellular adhesion molecule - l ( 694.12 卤 77.21 ng / ml ) .

5 . Compared with 4 - 5 groups ( 284.07 卤 62.34ng / ml ) ( P < 0.05 ) , the serum levels of ICAM1 - l ( 580.00 卤 73.55 ng / ml ) were significantly higher than those in 4 ~ 5 groups ( 284.07 卤 62.34ng / ml ) ( P0.05 ) .

Conclusion : The content of slCAM - 1 in serum of patients with aneursmal subarachnoid hemorrhage is significantly higher than that in normal adult control group , especially in 7 锝

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