血清铁蛋白、尿酸水平与脑出血患者预后的关系
发布时间：2019-07-04 15:03
【摘要】：目的：脑出血(intracerebral hemorrhage，ICH)是常见的急性脑血管病之一，在我国其发病率占全部脑卒中的20%~30%，有研究显示不低于30%患者终身遗留神经功能障碍。其根本原因为：一方面是血肿压迫其周围脑组织导致神经功能缺损，更重要的是脑出血后迟发性水肿作用以及其它毒性物质对脑组织产生的损伤。因此，研究脑出血继发性神经损伤机制，进行有目的性的治疗，对有效治疗脑出血及改善预后有着重要意义。研究表明铁离子在脑出血后迟发性水肿形成和神经损伤中起到重要作用。血清铁蛋白(serum ferritin, SF)是人体内铁的主要储存形式，它能否作为衡量脑水肿的一个指标，是否与脑出血的预后相关，这方面研究较少。最近研究显示，急性脑血管病患者，其尿酸水平与其预后相关，但是没有达成一致结论。本文旨在探讨脑出血患者血清铁蛋白、尿酸水平变化及其与预后相关性，为临床脑出血患者早期评估预后、有效提高治疗率、降低致残率提供可靠依据。 方法：本研究通过观察2012年10月到2013年10月神经内科住院治疗的32例自发性脑出血患者，均符合我国2010年颁布的《成人自发性脑出血诊断标准》，并经头颅CT证实。其中男性20例，女性12例，平均年龄65.09±11.95岁。病人入院后即刻采集临床资料（包括危险因素和NIHSS评分）、计算血肿体积、采集血液标本，检测血清铁蛋白、尿酸、生化全项、血糖、白细胞等指标；应用美国BECKMANCOULTER公司生产的Unicle800生化分析仪，，采用尿酸酶法分别于入院、7d、14d测定尿酸水平变化；应用德国罗氏公司生产的E601电化学发光仪，采用ECLIA免疫发光法分别于入院后、3d、7d、14d检测血清铁蛋白水平变化，并与30例健康人作对照；如患者病情允许，于第3d复查头颅CT，采用多田公式计算血肿及水肿体积；于患病90d随访患者，评定NIHSS评分及改良Rankin评分（MRS）以评估神经功能恢复情况及生活能力，根据MRS评分将患者分为预后良好组（≤2分者）及不良组（2分者）。应用SPSS13.0统计软件进行数据分析，符合正态分布的计量资料采用t检验，不符合者采用非参数检验，相关性采用Spearman相关分析，多因素分析采用多元线性回归。 结果： 1影响脑出血预后的危险因素：本研究在排除出血部位对脑出血预后的影响后，年龄、入院时血压、血糖、白细胞数、出血量、血清铁蛋白水平是影响脑出血预后的危险因素。 2临床预后：32例患者预后良好组（MRS评分≤2分）18例，预后不良组（MRS评分2分）14例，其中死亡2例，死亡原因1例为中枢性呼吸循环衰竭，1例为多脏器功能衰竭。 3血清铁蛋白水平变化：32例患者血清铁蛋白在第3d开始升高（232.34±106.62ng/ml），在第7d达高峰水平（245.11±109.52ng/ml），14d时有所下降（224.40±106.34ng/ml），与对照组（163.54±59.41ng/ml）相比，有显著性差异（P值分别为0.003，0.001，0.007）。 4血清铁蛋白水平与预后关系：预后良好组与预后不良组的血清铁蛋白平比较在各个观察点均有显著统计学差异，血清铁蛋白越高，预后越差。预后良好组入院、3d、7d、14d血清铁蛋白分别为：141.47±82.09ng/ml，181.77±97.29ng/ml，198.17±96.63ng/ml，159.59±72.43ng/ml；预后不良组：211.79±100.26ng/ml，297.36±81.48ng/ml，305.45±97.05ng/ml，307.74±82.54ng/ml，经统计学处理有显著性差异（P值均0.05）。将影响脑出血预后的危险因素纳入多元线性回归分析发现血清铁蛋白是影响脑出血预后的独立危险因素（P=0.040）。 5血清铁蛋白水平与血肿、周围水肿体积关系：入院血清铁蛋白与水肿体积无明显相关（r=0.276，P=0.127），与血肿体积亦无相关关系（r=0.28，P=0.121）；3d后血清铁蛋白水平上升，与水肿体积呈正相关(r=0.402，P=0.022)，与血肿体积呈正相关（r=0.520，P=0.002）。 6尿酸水平变化及与脑出血预后关系：32例患者入院、7d、14d的尿酸水平分别为239.38±69.74umol/L、245.26±76.52umol/L、220.18±58.26umol/L，预后良好组与预后不良组的尿酸水平无明显统计学差异（P值分别为0.627、0.453、0.498）。尿酸各时间点的水平变化，与对照组比较，无统计学差异（P0.05）。结论： 1脑出血患者预后与年龄、入院时血压、血糖、白细胞数、出血量、血清铁蛋白水平等多因素相关。 2血清铁蛋白水平是影响脑出血患者预后的独立危险因素，可早期评估预后，血清铁蛋白越高，预后越差，其机制可能与氧化应激损害作用有关。 3脑出血后血清铁蛋白变化规律为：3d时开始快速上升，在第7d达高峰水平，14d时仍较对照组高，为进一步研究临床干预措施提供了客观依据。 4血清尿酸水平与脑出血预后无相关性。
[Abstract]:Objective: The cerebral hemorrhage (ICH) is one of the most common acute cerebrovascular diseases. In our country, the incidence of cerebral hemorrhage is 20% ~ 30% of the total stroke, and the study shows that it is not less than 30% of the patients with long-life residual neurological function. The root cause is that, on the one hand, the hematoma presses the surrounding brain tissue to cause a neurological deficit, and more importantly, the delayed edema after the cerebral hemorrhage and the damage of other toxic substances to the brain tissue. Therefore, it is of great significance to study the mechanism of the secondary nerve injury of the cerebral hemorrhage and to have the purpose of treatment, which is of great significance to the effective treatment of the cerebral hemorrhage and the improvement of the prognosis. The study indicated that iron ions play an important role in the formation of delayed edema and nerve injury after cerebral hemorrhage. Serum ferritin (SF) is the main storage form of iron in human body. It can be used as an index to measure brain edema. It is related to the prognosis of cerebral hemorrhage. Recent studies have shown that the levels of uric acid in patients with acute cerebrovascular disease are associated with their prognosis, but do not reach a consistent conclusion. The purpose of this study is to study the changes of serum ferritin and uric acid levels in patients with cerebral hemorrhage and their relationship with the prognosis. Methods: The study of 32 patients with spontaneous intracerebral hemorrhage from October 2012 to October 2013 was in accordance with the criteria for diagnosis of spontaneous cerebral hemorrhage in adults, which was promulgated in China in 2010. Real. There were 20 males and 12 females, with an average age of 65.09 and 11.95. The clinical data (including risk factors and NIHSS score) were collected immediately after the patient was admitted, the volume of the hematoma was calculated, blood samples were collected, serum ferritin, uric acid, biochemical whole-item, blood sugar and white blood cell were collected, and the Biole800 biochemical analysis produced by BECKMANTER was applied. The changes of serum ferritin levels were measured by using the uricase method in hospital, 7d and 14d, respectively. The changes of serum ferritin levels were detected by ECLIA immunoluminescent method after admission,3 days,7 days, and 14 days after admission. According to the condition of the patient, the skull CT was reviewed on the third day, and the volume of the hematoma and edema was calculated using the multi-field formula; the NIHSS score and the modified Rankin score (MRS) were evaluated for the 90-day follow-up of the patient to assess the neurological function recovery and the life energy The patient was divided into a good group of prognosis (2 score) and an adverse group (2) according to the MRS score. ). The data analysis is carried out by using the SPSS 13.0 statistical software. The measurement data in accordance with the normal distribution is t-checked. The non-compliance test is adopted. The correlation is the Spearman correlation analysis. The multi-factor analysis adopts the multi-element linear regression. Return to. Results:1. The risk factors that affect the prognosis of the cerebral hemorrhage: this study, after excluding the effect of the bleeding part on the prognosis of the cerebral hemorrhage, the age, the blood pressure, the blood sugar, the white blood cell number, the blood loss, the serum ferritin level, the prognosis of the cerebral hemorrhage, are the factors that affect the prognosis of the cerebral hemorrhage. The risk factors of clinical prognosis:32 patients with good prognosis (2 scores of MRS),14 patients with poor prognosis (2 scores of MRS),2 with death,1 case of central respiratory cycle failure and 1 case The level of serum ferritin in 32 patients increased (232.34 to 106.62 ng/ ml) at the third day, and decreased at the peak level of day 7 (245.11, 109.52 ng/ ml) and 14 days (224.40 to 106.34 ng/ ml), and there was a significant difference (P-value of 0.003, 0.0, respectively) compared with the control group (163.54, 59.41 ng/ ml). 01, 0.007).4. The serum ferritin level and the prognosis were related to the level of serum ferritin in the group with good prognosis and poor prognosis. There was a significant difference in the serum ferritin level between the good prognosis group and the poor prognosis group, and the blood serum ferritin level was significantly different from each observation point. The higher the serum ferritin, the worse the prognosis. The serum ferritin in the group was 141.47, 82.09 ng/ ml, 181.77, 97.29 ng/ ml, 198.17, 96.63 ng/ ml, 159.59 and 72.43 ng/ ml, respectively. The prognosis of the group was: 211.79, 100.26 ng/ ml, 297.36, 81.48 ng/ ml, 305.45, 97.05 ng/ ml, 307.74 and 82.54 ng/ ml. The difference (P <0.05). The risk factors that affect the prognosis of the cerebral hemorrhage were included in the multivariate linear regression analysis to find that the serum ferritin is an independent risk that affects the prognosis of the cerebral hemorrhage Factor (P = 0.040). The level of serum ferritin and the volume of the hematoma and the surrounding edema: There was no significant correlation between the serum ferritin and the volume of edema (r = 0.276, P = 0.127), and there was no correlation with the volume of the hematoma (r = 0.28, P = 0.121), and the level of serum ferritin in the post-3 day was positively correlated with the volume of edema (r = 0. .402, P = 0.022), positive correlation to hematoma volume (r = 0 The levels of uric acid in 32 patients were 239.38 and 69.74 umol/ L, 245.26, 76.52 umol/ L, 220.18 and 58.26 umol/ L, respectively. There was no significant difference in the levels of uric acid in the group with good prognosis and poor prognosis (P = 0.6, respectively). 27, 0.453, 0.498). The level of uric acid in each time point was changed in comparison with the control group. No, no Conclusion: The prognosis and age of the patients with cerebral hemorrhage, blood pressure, blood sugar and white blood cell count at the time of admission, the serum ferritin level is an independent risk factor that affects the prognosis of the patients with cerebral hemorrhage, and the prognosis can be assessed at an early stage. The higher the serum ferritin, the prognosis The difference was that the mechanism could be related to the effect of oxidative stress. The change of serum ferritin in 3 days of cerebral hemorrhage began to increase rapidly, and at the peak level of the 7th day, the control group was still in the control group at 14 days. High, to further study the clinical intervention measures to provide the custome
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34
本文编号：2510007
[Abstract]:Objective: The cerebral hemorrhage (ICH) is one of the most common acute cerebrovascular diseases. In our country, the incidence of cerebral hemorrhage is 20% ~ 30% of the total stroke, and the study shows that it is not less than 30% of the patients with long-life residual neurological function. The root cause is that, on the one hand, the hematoma presses the surrounding brain tissue to cause a neurological deficit, and more importantly, the delayed edema after the cerebral hemorrhage and the damage of other toxic substances to the brain tissue. Therefore, it is of great significance to study the mechanism of the secondary nerve injury of the cerebral hemorrhage and to have the purpose of treatment, which is of great significance to the effective treatment of the cerebral hemorrhage and the improvement of the prognosis. The study indicated that iron ions play an important role in the formation of delayed edema and nerve injury after cerebral hemorrhage. Serum ferritin (SF) is the main storage form of iron in human body. It can be used as an index to measure brain edema. It is related to the prognosis of cerebral hemorrhage. Recent studies have shown that the levels of uric acid in patients with acute cerebrovascular disease are associated with their prognosis, but do not reach a consistent conclusion. The purpose of this study is to study the changes of serum ferritin and uric acid levels in patients with cerebral hemorrhage and their relationship with the prognosis. Methods: The study of 32 patients with spontaneous intracerebral hemorrhage from October 2012 to October 2013 was in accordance with the criteria for diagnosis of spontaneous cerebral hemorrhage in adults, which was promulgated in China in 2010. Real. There were 20 males and 12 females, with an average age of 65.09 and 11.95. The clinical data (including risk factors and NIHSS score) were collected immediately after the patient was admitted, the volume of the hematoma was calculated, blood samples were collected, serum ferritin, uric acid, biochemical whole-item, blood sugar and white blood cell were collected, and the Biole800 biochemical analysis produced by BECKMANTER was applied. The changes of serum ferritin levels were measured by using the uricase method in hospital, 7d and 14d, respectively. The changes of serum ferritin levels were detected by ECLIA immunoluminescent method after admission,3 days,7 days, and 14 days after admission. According to the condition of the patient, the skull CT was reviewed on the third day, and the volume of the hematoma and edema was calculated using the multi-field formula; the NIHSS score and the modified Rankin score (MRS) were evaluated for the 90-day follow-up of the patient to assess the neurological function recovery and the life energy The patient was divided into a good group of prognosis (2 score) and an adverse group (2) according to the MRS score. ). The data analysis is carried out by using the SPSS 13.0 statistical software. The measurement data in accordance with the normal distribution is t-checked. The non-compliance test is adopted. The correlation is the Spearman correlation analysis. The multi-factor analysis adopts the multi-element linear regression. Return to. Results:1. The risk factors that affect the prognosis of the cerebral hemorrhage: this study, after excluding the effect of the bleeding part on the prognosis of the cerebral hemorrhage, the age, the blood pressure, the blood sugar, the white blood cell number, the blood loss, the serum ferritin level, the prognosis of the cerebral hemorrhage, are the factors that affect the prognosis of the cerebral hemorrhage. The risk factors of clinical prognosis:32 patients with good prognosis (2 scores of MRS),14 patients with poor prognosis (2 scores of MRS),2 with death,1 case of central respiratory cycle failure and 1 case The level of serum ferritin in 32 patients increased (232.34 to 106.62 ng/ ml) at the third day, and decreased at the peak level of day 7 (245.11, 109.52 ng/ ml) and 14 days (224.40 to 106.34 ng/ ml), and there was a significant difference (P-value of 0.003, 0.0, respectively) compared with the control group (163.54, 59.41 ng/ ml). 01, 0.007).4. The serum ferritin level and the prognosis were related to the level of serum ferritin in the group with good prognosis and poor prognosis. There was a significant difference in the serum ferritin level between the good prognosis group and the poor prognosis group, and the blood serum ferritin level was significantly different from each observation point. The higher the serum ferritin, the worse the prognosis. The serum ferritin in the group was 141.47, 82.09 ng/ ml, 181.77, 97.29 ng/ ml, 198.17, 96.63 ng/ ml, 159.59 and 72.43 ng/ ml, respectively. The prognosis of the group was: 211.79, 100.26 ng/ ml, 297.36, 81.48 ng/ ml, 305.45, 97.05 ng/ ml, 307.74 and 82.54 ng/ ml. The difference (P <0.05). The risk factors that affect the prognosis of the cerebral hemorrhage were included in the multivariate linear regression analysis to find that the serum ferritin is an independent risk that affects the prognosis of the cerebral hemorrhage Factor (P = 0.040). The level of serum ferritin and the volume of the hematoma and the surrounding edema: There was no significant correlation between the serum ferritin and the volume of edema (r = 0.276, P = 0.127), and there was no correlation with the volume of the hematoma (r = 0.28, P = 0.121), and the level of serum ferritin in the post-3 day was positively correlated with the volume of edema (r = 0. .402, P = 0.022), positive correlation to hematoma volume (r = 0 The levels of uric acid in 32 patients were 239.38 and 69.74 umol/ L, 245.26, 76.52 umol/ L, 220.18 and 58.26 umol/ L, respectively. There was no significant difference in the levels of uric acid in the group with good prognosis and poor prognosis (P = 0.6, respectively). 27, 0.453, 0.498). The level of uric acid in each time point was changed in comparison with the control group. No, no Conclusion: The prognosis and age of the patients with cerebral hemorrhage, blood pressure, blood sugar and white blood cell count at the time of admission, the serum ferritin level is an independent risk factor that affects the prognosis of the patients with cerebral hemorrhage, and the prognosis can be assessed at an early stage. The higher the serum ferritin, the prognosis The difference was that the mechanism could be related to the effect of oxidative stress. The change of serum ferritin in 3 days of cerebral hemorrhage began to increase rapidly, and at the peak level of the 7th day, the control group was still in the control group at 14 days. High, to further study the clinical intervention measures to provide the custome
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34
【引证文献】
相关期刊论文 前2条
1 郭强;李会琪;;血清尿酸和铁蛋白水平在预测脑出血预后中的应用价值[J];中华神经外科疾病研究杂志;2015年06期
2 邢淑芳;李玉生;李海明;胡福广;;依达拉奉联合醒脑静治疗脑出血的研究[J];现代中西医结合杂志;2015年29期
本文编号：2510007
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