血清S100β蛋白及GDNF表达与体外循环下心脏瓣膜置换术后认知功能障碍相关性及诊断意义的研究

发布时间：2018-01-30 10:01

本文关键词： S100β蛋白 GDNF POCD 体外循环心脏瓣膜置换　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察体外循环下心脏手术患者血清中胶质源性神经营养因子(glial cell line-derived neurotrophic,GDNF)、S100β蛋白的表达水平与体外循环术后认知功能障碍(postoperative congnitive dysfunction,POCD)的关系,并探讨、评价GDNF、S100β蛋白在体外循环后POCD诊断中的价值。方法:选择在本院拟行体外循环下瓣膜置换术的风湿性心脏病患者43例,于术前1天及术后第7天根据简易精神状态量表(Mini-mental State Examination Scale,MMSE)将纳入患者分为P组(POCD组)、NP组(non-POCD组)。采用酶联接免疫吸附剂测定(ELISA)法检测患者术前半小时(T1)、术毕即刻(T2)、术后1天(T3)、术后3天(T4)、术后7天(T5)各时间点静脉血清中GDNF、S100β蛋白水平。通过Pearson相关性分析法,分析血清GDNF、S100β蛋白水平与POCD的相关性,并通过ROC曲线分析法,评价血清中GDNF、S100β蛋白水平对体外循环后POCD的诊断价值,为体外循环后POCD的诊断寻找新的、合理的、客观的生物学指标提供思路。结果:根据POCD判定标准,体外循环下行换瓣手术患者术后第7天POCD发生率为37.5%(15/43,例)。在T1时间点,P组与NP组患者血清GDNF及S100β蛋白表达水平无统计学差异(p0.05),在T2~T5时间点,与NP组患者相比,P组患者血清S100β蛋白表达明显升高、血清GDNF表达显著降低(p0.05)。P组中,血清S100β蛋白表达与MMSE评分呈负相关,血清GDNF表达与MMSE评分呈正相关;血清S100β蛋白表达也与血清GDNF表达呈负相关(p0.05)。P组中,血清S100β蛋白的曲线下面积(AUC)=0.853,敏感性为77.6%,特异性为75.4%;血清GDNF的曲线下面积(AUC)=0.901,敏感性为80.9%,特异性为83.3%;血清S100β蛋白结合血清GDNF的曲线下面积(AUC)=0.953,敏感性为87.5%,特异性为88.6%(p0.05)。结论:作为体外循环下心脏手术患者术后POCD诊断的生物学标志物,术后血清S100β蛋白表达明显升高或血清GDNF表达显著降低在体外循环后POCD的诊断中具有一定价值;两者结合用于诊断POCD更有意义。
[Abstract]:Objective: to observe the glial cell line-derived neurotrophic in serum of patients undergoing cardiopulmonary bypass (CPB). Expression of S100 尾 protein and postoperative congnitive dysfunction after cardiopulmonary bypass. The relationship between POCDs and the evaluation of GDNF. The value of S100 尾 protein in the diagnosis of POCD after cardiopulmonary bypass methods: 43 patients with rheumatic heart disease undergoing valve replacement under cardiopulmonary bypass were selected. Minimental State Examination Scale was performed 1 day before operation and 7 days after operation. MMSE was divided into P group (P group) and P group (POCD group). In NP group, non-POCD group, enzyme linked immunosorbent assay (Elisa) was used to detect T1D before operation and T2 + T3 was performed at the end of operation (1 day after operation). The levels of GDNF S100 尾 protein in venous serum at 3 days after operation and 7 days after operation were analyzed by Pearson correlation analysis. The correlation between S100 尾 protein level and POCD was evaluated by ROC curve analysis to evaluate the diagnostic value of serum GDNF S100 尾 protein level after cardiopulmonary bypass (CPB). To find a new, reasonable and objective biological index for the diagnosis of POCD after cardiopulmonary bypass. Results: according to the criteria of POCD. The incidence of POCD in patients undergoing valve replacement under cardiopulmonary bypass was 37.5 / 43 on the 7th day after operation. There was no significant difference in the expression of GDNF and S100 尾 protein between P group and NP group. In P group, the expression of serum S100 尾 protein was significantly increased, and the expression of serum GDNF was significantly decreased in P group. In group P, the expression of serum S100 尾 protein was negatively correlated with MMSE score. The expression of serum GDNF was positively correlated with the MMSE score. There was also a negative correlation between the expression of serum S100 尾 protein and the expression of serum GDNF. In group P, the area under the curve of serum S100 尾 protein was 0.853. The sensitivity was 77.6 and the specificity was 75.4; The area under the curve of serum GDNF was 0.901, the sensitivity was 80.9 and the specificity was 83.3; The area under the curve of serum S100 尾 protein binding to serum GDNF was 0.953 and the sensitivity was 87.5%. Conclusion: it is a biomarker for the diagnosis of postoperative POCD in patients undergoing cardiopulmonary bypass (CPB). The increase of serum S100 尾 protein expression or the decrease of serum GDNF expression were valuable in the diagnosis of POCD after cardiopulmonary bypass (CPB). The combination of the two is more meaningful in the diagnosis of POCD.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

【参考文献】