肌萎缩侧索硬化患者脑脊液胱抑素C与临床指标关系探讨及血清肌酐水平的研究

发布时间：2018-05-09 17:35

  本文选题：肌萎缩侧索硬化 + 胱抑素C　； 参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：目的：第一部分：应用免疫比浊法测定实验组和对照组脑脊液（CSF）胱抑素C（Cys-C）水平。对实验组CSF Cys-C水平与发病年龄、性别、起病部位、进展速率和修订版肌萎缩侧索硬化功能评分（revised amyotrophic lateral sclerosisfunctional rating scale, ALSFRS-R）等临床指标进行相关性分析；探讨体质指数（BMI）与CSF和血清Cys-C水平及散发性肌萎缩侧索硬化（sALS）患者各临床指标的相关性。第二部分：探讨sALS患者血清肌酐（SCr）水平及其与临床指标的关系。 方法:第一部分：纳入121例确诊或很可能sALS患者，同时纳入22例多系统萎缩（MSA）患者和18例年龄匹配健康对照者（HC），测定CSF Cys-C水平并进行分析；对Cys-C水平与起病年龄、起病部位、BMI、病程、ALSFRS-R、用力肺活量（FVC）和进展速率之间的关系进行分析。第二部分：测定sALS、MSA和紧张型头痛（TTH）各80例患者的SCr水平，探讨sALS患者SCr水平与ALSFRS-R、FVC、起病部位、病程和疾病进展速率之间的关系。 结果:第一部分：（1）CSF Cys-C测定发现sALS (4.17±1.32) mg/L、HC (4.58±1.97) mg/L和MSA (4.05±1.18) mg/L之间差异无统计学意义。sALS患者CSFCys-C水平与起病年龄、起病部位、BMI、病程、ALSFRS-R、FVC和疾病进展速率间无明显相关性。（2）血清Cys-C测定发现sALS (1.03±0.18) mg/L、HC (1.10±0.54) mg/L和MSA (1.10±0.21) mg/L之间差异无统计学意义。相关分析发现sALS患者血清Cys-C水平与ALSFRS-R成负相关(r=-0.355, P=0.007)，而与起病部位成正相关(r=0.274, P=0.041)。（3）sALS患者CSF和血清Cys-C水平差异有统计学意义(P0.001)，分析发现CSF和血清Cys-C之间无线性相关(r=0.071,P=0.605)。（4）相关性分析发现sALS患者BMI与FVC有相关性(Pearson r=0.321,P=0.003)，与CSF和血清Cys-C水平及其他临床指标则无相关性。第二部分：（1）sALS患者SCr水平明显低于MSA和TTH组，差异有统计学意义[（60.86±16.80）μmol/L vs.（70.05±12.79）μmol/L vs.（66.97±14.14）μmol/L, P0.01]。（2）球部起病与肢体起病的sALS患者间SCr水平差异无统计学意义[（62.82±10.62）μmol/L vs.（60.64±13.26）μmol/L, P=0.544]；病程较短与病程较长的sALS患者间SCr水平差异无统计学意义[（62.38±13.57）μmol/L vs（.58.24±11.09）μmol/L,P=0.168]。（3）sALS患者SCr水平与ALSFRS-R成正相关（r=0.315, P=0.005），而与FVC、起病部位、病程和疾病进展速率之间无明显相关性。 结论：第一部分：CSF Cys-C尚不足作为ALS生物学标志物。在相关指标测定过程中需积极排除相关影响因素并结合适当的统计学方法进行分析。第二部分：SCr是sALS的一项重要生化指标，，对监测疾病进展可能具有重要的作用。
[Abstract]:Objective: to determine the level of cystatin Cy Cys-Cin in cerebrospinal fluid (CSF) of experimental group and control group by immunoturbidimetric method. The correlation between CSF Cys-C level and onset age, sex, location of onset, progression rate and revised amyotrophic lateral sclerosis score were analyzed in the experimental group, such as the age of onset, sex, location of onset, rate of progression and the revised score of amyotrophic lateral sclerosis (ALSFRS-R). To investigate the correlation between BMI and the levels of CSF, serum Cys-C and sporadic amyotrophic lateral sclerosis (ALS). Part two: to investigate the relationship between serum creatinine (creatinine) and clinical indexes in patients with sALS. Methods: in the first part, CSF Cys-C levels were measured and analyzed in 121 confirmed or probable sALS patients, 22 patients with multiple system atrophy and 18 age-matched healthy controls. The relationship between BMI, ALSFRS-R, forced vital capacity (RV) and progression rate was analyzed. The second part: the SCr levels of 80 patients with sALS and 80 patients with sALS were measured, and the relationship between SCr level and ALSFRS-RV FVC, the location of onset, the course of disease and the rate of disease progression were investigated. Results: in the first part, there was no significant difference between sALS 4.17 卤1.32 mg / L sALS 4.58 卤1.97 mg/L and MSA 4.05 卤1.18 mg/L. There was no significant correlation between the onset site of BMI, the course of ALSFRS-RV and the disease progression rate. The serum Cys-C analysis showed that there was no significant difference between sALS 1.03 卤0.18) mg / L HC 1.10 卤0.54 mg/L and MSA 1.10 卤0.21) mg/L. Correlation analysis showed that there was a negative correlation between serum Cys-C level and ALSFRS-R in patients with sALS, but there was a positive correlation between serum Cys-C level and onset site (P = 0.274). There was a significant difference in CSF and Cys-C levels between P=0.041).(3)sALS patients and patients with P=0.041).(3)sALS (P 0.001). The results showed that there was a wireless correlation between CSF and serum Cys-C. Correlation analysis showed that there was a correlation between BMI and FVC in sALS patients, but no correlation with CSF, serum Cys-C level and other clinical indexes. In the second part, the level of SCr in the patients with SALS was significantly lower than that in the MSA and TTH groups. 宸�寮傛湁缁熻�″�︽剰涔塠(60.86卤16.80)渭mol/L vs.(70.05卤12.79)渭mol/L vs.(66.97卤14.14)渭mol/L, P0.01].(2)鐞冮儴璧风梾涓庤偄浣撹捣鐥呯殑sALS鎮ｈ

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