脑小血管病与血清胱抑素C、尿酸、高敏C反应蛋白相关性研究

发布时间：2018-12-31 15:55

【摘要】：目的:通过检测脑小血管病组(CSVD)及正常对照组患者的血清胱抑素C(Cys C)、尿酸(UA)、高敏C反应蛋白(H-CRP)的水平,分析这些血清学指标在病例组与对照组之间是否存在统计学差异,探讨血清胱抑素C、尿酸、高敏C反应蛋白的水平与脑小血管病的发病有无相关性,为临床提供预测可能引起脑小血管病发病的危险因素,为进一步探究脑小血管病发病机制的研究提供一些方向。方法:选取蚌埠医学院第二附属医院神经内科住院的205例脑小血管病患者作为脑小血管病组(CSVD组)。同时选取与脑小血管病组同期在神经内科住院并行头颅核磁共振检查正常及符合排除标准的129例患者作为对照组。根据磁共振(MRI)检查结果将CSVD组分为腔隙性脑梗死组(LI)和白质疏松组(LA),根据蒙特利尔认知评估表(Mo CA)对CSVD患者进行评分,依据评分是否大于等于26分将CSVD组又分为认知功能正常组与认知功能异常组,收集所有受试者空腹12h的静脉血,血清胱抑素C(CYS-C)、高敏C反应蛋白(H-CRP)采用胶乳增强免疫比浊法测定,UA采用酶法测定,对脑小血管病组和对照组纳入病例的一般资料、既往病史和生化指标进行统计分析,筛选出脑小血管病的可疑危险因素,然后对可疑危险因素进行多因素Logistic回归分析。结果:本研究共纳入CSVD病例205例,根据影像学表现,分为腔隙性脑梗死组(LI组)81例和脑白质疏松组(LA组)124例。其中LI组平均年龄66.93±9.59岁,男性44名,女性37名;LA组平均年龄72.92±8.23岁,男性71例,女性53例。对照组129例,对照组平均年龄65.53±8.59岁,男性69名,女性60名。通过对比对照组与脑小血管病组的各个项目可以发现,脑小血管病组的病患年龄(71.81±9.32岁)、合并高血压比例(58.5%)、脂蛋白a水平(409.74±580.36 mg/L)、尿酸水平(275.23±81.45 umol/L)、血清胱抑素C水平(1.1±0.28 mgl/L)、高敏C反应蛋白水平(5.52±8.45 mg/L)、等项目均显著高于对照组(p0.05)。根据单因素分析筛选出的结果,将病患年龄、合并高血压比例、糖尿病比例、脂蛋白(a)、尿酸、血清胱抑素C、高敏C反应蛋白等可疑危险因素作为自变量,脑小血管病组、腔隙性脑梗死组和脑白质疏松组与对照组分别为因变量,进行Binary Logistic回归分析。研究发现血清高CYS-C以及H-CRP是CSVD的主要危险因素,罹患CSVD的可能性分别是正常个体的122.152倍以及1.687倍;血清高Cys C、H-CRP是LI的主要危险因素,罹患LI的可能性分别是正常个体的40.485倍及1.593倍;研究发现合并糖尿病、血清高CYS-C以及H-CRP是LA的主要危险因素,罹患LA的可能性分别是正常个体的0.200倍、272.728倍、1.651倍;尿酸在Logstic回归分析中被剔除,考虑尿酸可能受其他危险因素的影响,是脑小血管病发病的混杂因素。以认知功能是否异常为因变量,CSVD可疑危险因素为自变量进行多因素Binary Logistic分析后发现血清胱抑素C、高敏C反应蛋白水平升高与脑小血管病患者认知功能是否异常没有相关性。结论:1)脑小血管病病患的的年龄、合并高血压比例、脂蛋白(a)、尿酸、血清胱抑素C、高敏C反应蛋白等指标通常显著高于非脑小血管病病患。2)血清胱抑素C、高敏C反应蛋白指标高的个体,较其他人群更容易罹患脑小血管病。但血清胱抑素C、高敏C反应蛋白水平升高与脑小血管病患者认知功能是否异常没有相关性。3)脑小血管病类型不同其危险因素不尽相同,本研究结果提示尿酸可能是脑小血管病发病的混杂因素。4)通过监测血清胱抑素C、高敏C反应蛋白等指标,将有助于预测脑小血管病的患病风险。
[Abstract]:Objective: To study the level of serum cystatin C (Cys C), uric acid (UA) and high-sensitivity C-reactive protein (H-CRP) in patients with small brain tissue (CVD) and normal control group, and to analyze whether there was a statistical difference between the case group and the control group. Objective To study the correlation between the level of serum cystatin C, uric acid and high-sensitivity C-reactive protein and the pathogenesis of small brain and to provide some direction for the further study of the pathogenesis of the small brain. Methods: 205 cases of cerebral microangiopathy in the Department of Neurology of the second Affiliated Hospital of Bengbu Medical College were selected as the small cerebral vascular group (CSVD group). In the same time, 129 patients with normal and corresponding exclusion criteria were selected as the control group. The CVD component was graded as a lacunar cerebral infarction group (LI) and a white matter loosening group (LA) according to a magnetic resonance (MRI) test, and the CSVD patient was scored according to the Montreal Cognitive Assessment Form (Mo CA), according to whether the score is greater than or equal to 26, the CVD group is divided into the normal group of the cognitive function and the abnormal group of the cognitive function, and the venous blood, the serum cystatin C (CYS-C) and the high-sensitive C-reactive protein (H-CRP) of the fasting 12h of all the subjects are collected, The general data, the past medical history and the biochemical indexes of the small brain and the control group were statistically analyzed, the suspicious risk factors of the small brain were selected, and the multi-factor logistic regression analysis was carried out on the suspicious risk factors. Results: A total of 205 cases of CVD were included in the study. According to the imaging performance, there were 81 cases of lacunar cerebral infarction (LI group) and 124 cases of leukoaraiosis group (LA group). The mean age of LI group was 66. 93, 9. 59, 44 in male and 37 in female. The mean age of LA group was 72. 92, 8. 23, 71 in male and 53 in female. In the control group, 129 cases, the average age of the control group was 65. 53%, the age of 59, the male was 69, and the female was 60. By comparing the control group and the small group of the brain, it was found that the age of the patients in the small brain group (71.81 to 9.32 years), the proportion of the combined hypertension (58. 5%), the level of the lipoprotein a (409.74% 580. 36 mg/ L) and the uric acid level (275.23-81.45uml/ L). The levels of serum cystatin C (1. 1-0. 28 mg/ L) and high-sensitivity C-reactive protein (5.52-8.45 mg/ L) were significantly higher in the control group than in the control group (p0.05). according to the results of the single-factor analysis, the patient age, the proportion of the combined hypertension, the proportion of the diabetes, the lipoprotein (a), the uric acid, the serum cystatin C, the high-sensitivity C-reactive protein and the like are taken as independent variables, and the brain small-scale group, The patients with lacunar cerebral infarction and the group of leukoaraiosis and the control group were the dependent variables, and the binary logistic regression analysis was performed. The study found that serum high CYS-C and H-CRP were the main risk factors of CSVD. The probability of CSVD was 122. 152-fold and 1.687-fold respectively in the normal individuals; the serum high-Cys-C and H-CRP were the main risk factors of LI, and the possibility of LI was 40. 485-fold and 1. 593-fold, respectively, of the normal individuals. The study found that combined diabetes, high serum CYS-C and H-CRP were the main risk factors of LA, and the possibility of LA was 0.200, 272.728 and 1.651, respectively, and uric acid was eliminated in the logistic regression analysis, and it was considered that uric acid may be affected by other risk factors. It's a confounding factor in the pathogenesis of the brain. It was found that the level of serum cystatin C and high-sensitivity C-reactive protein was not correlated with the abnormal cognitive function of the patients with small cerebral vascular disease. Conclusion: 1) The age, combined high blood pressure ratio, lipoprotein (a), uric acid, serum cystatin C, high-sensitivity C-reactive protein, etc. of the patients with small brain depression are generally higher than those of non-brain small-scale patients (2) individuals with high levels of cystatin C and high-sensitivity C-reactive protein, The rest of the population is more likely to have a small brain. but the level of the serum cystatin C, the high-sensitivity C-reactive protein and the cognitive function of the patients with small blood vessels are not correlated with each other. The results of this study suggest that uric acid may be a confounding factor in the pathogenesis of the small brain. 4) By monitoring the levels of serum cystatin C, high-sensitivity C-reactive protein, it will be helpful to predict the risk of the small brain.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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