本文選題：同型半胱氨酸 + 藥物性腎損傷��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分別采集各年齡段初治和復(fù)診結(jié)核病人空腹血清標(biāo)本,檢測血清中的同型半胱氨酸含量水平,探討同型半胱氨酸水平因年齡性別等原因?qū)е碌娜巳悍植际欠褚策m應(yīng)于結(jié)核病人這一人群,評估結(jié)核病患者是否因感染結(jié)核病而導(dǎo)致體內(nèi)的同型半胱氨酸水平出現(xiàn)異常,結(jié)核病有可能導(dǎo)致的脂類代謝異常以及結(jié)核藥物性腎損傷是否對其水平也會產(chǎn)生影響,本研究從性別、年齡、初復(fù)治三個因素分析結(jié)核病人體內(nèi)的同型半胱氨酸水平,評估結(jié)核病人這一人群初步整體的血清同型半胱氨酸水平。方法:使用德國的羅氏診斷公司cobas 6000全自動型生化儀儀器,采用開放式通道進(jìn)行試劑安裝并測定,試劑選用北京萬泰德瑞公司所出品的同型半胱氨酸血清測定試劑。同型半胱氨酸血清學(xué)檢測方法選用改良循環(huán)酶法,方法學(xué)機(jī)制為氧化型HCY被轉(zhuǎn)變成未結(jié)合的HCY,未結(jié)合的HCY在CBS的催化反應(yīng)下和絲氨酸進(jìn)行結(jié)合并且生成L-胱硫酰醚。L-胱硫醚在CBL氧化下又生成HCY、丙酮酸和NH3。該過程所生成的丙酮酸能夠用乳酸脫氫酶NADH和LDH測定到,NAD轉(zhuǎn)化成NADH的速度與樣本中HCY的濃度成正向比值。結(jié)果:使用統(tǒng)計(jì)學(xué)方法對144例檢測的結(jié)果數(shù)值進(jìn)行分別解析。按照性別分組,男性組96例,女性48例,比較HCY值是否有差異,首先檢驗(yàn)方差齊性,F=1.647,P0.05,方差不齊;于是采用welch t檢驗(yàn),t’=0.9165,P0.05,無統(tǒng)計(jì)學(xué)意義。即男性與女性之間的HCY值無明顯統(tǒng)計(jì)學(xué)差異(圖1)。以年齡為橫坐標(biāo),HCY值為縱坐標(biāo),繪制出散點(diǎn)圖。由圖可以看出,年齡與HCY值無線性關(guān)系。進(jìn)一步進(jìn)行皮爾遜相聯(lián)性檢驗(yàn),關(guān)聯(lián)的系數(shù)r=0.097,P=0.247,P0.05,年齡與HCY值無關(guān)聯(lián)關(guān)系。按初復(fù)診分成兩組,對比HCY值是否有差異,首先檢驗(yàn)方差齊性,F=1.616,P0.05,方差齊;于是采用t檢驗(yàn),t=2.062,P=0.0410.05,具有統(tǒng)計(jì)學(xué)意義。即初診與復(fù)診兩者的HCY值具有統(tǒng)計(jì)學(xué)差異。討論:本研究檢測的結(jié)果顯示,結(jié)核病人的性別及年齡對血清內(nèi)同型半胱氨平高低不具有統(tǒng)計(jì)學(xué)上的差異,復(fù)診結(jié)核病人與初治結(jié)核病人的血清同型半胱氨酸水平有統(tǒng)計(jì)學(xué)上的顯著差異性,說明隨著疾病的進(jìn)展與服用抗結(jié)核藥所導(dǎo)致的肝腎損傷,都有機(jī)會成為造成HCY血清含量增高的因素。同型半胱氨酸血清含量的升高與心腦血管病患、孕期的合并癥、認(rèn)知缺陷和骨質(zhì)疏松癥等很多疾病的發(fā)生存在非常緊密的聯(lián)系,且被認(rèn)為為冠心病的獨(dú)立危險因子,因此結(jié)核病人監(jiān)測血清同型半胱氨酸水平并采取相應(yīng)的治療措施也應(yīng)該成為我們結(jié)核科臨床醫(yī)生需要去考慮的問題。
[Abstract]:Objective: to collect fasting serum samples from patients with tuberculosis at different ages and to detect the level of homocysteine in serum. To investigate whether the distribution of homocysteine due to age and sex is suitable for TB patients, and to assess whether TB patients have abnormal homocysteine levels due to tuberculosis infection. The abnormal lipid metabolism caused by tuberculosis and whether the renal injury induced by tuberculosis drugs will also affect its level. This study analyzed homocysteine levels in TB patients from three factors: sex, age, and initial relapse. Evaluate the initial overall serum homocysteine levels in TB patients. Methods: the cobas 6000 automatic biochemical instrument of Roche Diagnostic Company of Germany was used to install and determine the reagent with open channel. The reagent was determined with homocysteine serum produced by Beijing Wantaideri Company. The method of homocysteine serological detection was modified circular enzyme method. The mechanism is that the oxidized HCY is transformed into unbound HCY, which binds to serine in the catalytic reaction of CBS and produces L- cysteyl ether. L- cystathyl sulfide is oxidized by CBL to form HCY, pyruvate and NH _ 3. The pyruvate produced in this process can be determined by lactate dehydrogenase nadh and LDH to determine the rate of conversion of nadh to nadh and the positive ratio of HCY concentration to the concentration of HCY in the sample. Results: 144 cases were analyzed by statistical method. According to the sex group, 96 males and 48 females were divided into male group and female group. Whether there were differences in HCY values, the variance was not uniform at first by testing the homogeneity of variance (F = 1.647) P0.05, then the welch t test was used to test 0.9165 (P 0.05), which had no statistical significance. There was no significant difference in HCY between men and women (Fig. 1). Taking the age as the ordinate and the HCY value as the ordinate, the scattered plot is drawn. As can be seen from the figure, age and HCY value wireless sex relationship. Furthermore, Pearson correlation test showed that the coefficient of correlation was 0. 097 and 0. 247, and there was no correlation between age and HCY value. The patients were divided into two groups according to the initial visit, and the difference of HCY value was compared. First, the homogeneity of variance was tested, and the variance was the same, and then the t test was used to test 2.062 and 0.0410.05, which was statistically significant. That is to say, the HCY value of first diagnosis and follow-up are statistically different. Discussion: the results of this study showed that there was no statistical difference between sex and age in patients with tuberculosis on the level of homotypic cysteamine in serum. There were significant differences in serum homocysteine levels between rediagnosed and newly treated TB patients, indicating that with the progression of the disease and the liver and kidney injury caused by anti-tuberculosis drugs, Both have the opportunity to be a factor in the increase in HCY serum levels. The increase of homocysteine serum level is closely associated with cardiovascular and cerebrovascular disease, complications during pregnancy, cognitive impairment and osteoporosis, and is considered as an independent risk factor for coronary heart disease. Therefore, it should be considered by our TB clinicians to monitor the serum homocysteine level and take appropriate treatment measures.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R521;R446.1

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