本文選題：急性腦梗死 + 腦出血��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景與目的急性腦卒中是神經(jīng)系統(tǒng)最常見疾病,其發(fā)病率相當(dāng)高,很容易遺留殘疾后遺癥,嚴(yán)重者死亡率也很高,對人類的健康危害極大,早期合理的治療能明顯改善預(yù)后。一種準(zhǔn)確的、迅速的急性腦梗死的診斷方法尤為重要,直接影響這些患者的療效和后期恢復(fù)。目前腦卒中的診斷方法仍以病史、臨床癥狀及影像結(jié)果為主,且與初次接診醫(yī)生的臨床經(jīng)驗(yàn)和醫(yī)療水平有很大關(guān)系。這些因素多方面的影響急性期的診斷及其后續(xù)的治療。因此,探索一種新式的、迅速、容易操作可行的、靈敏性及特異性均很高的方法勢在必行,能及早辨別和準(zhǔn)確分類急性腦卒中。血清泛素C末端水解酶-1(UCH-L1)是一種半胱氨酸水解酶,廣泛介入細(xì)胞周期的調(diào)控、細(xì)胞的凋亡、炎癥反應(yīng)、基因表達(dá)和信息傳導(dǎo)等許多生理病理反應(yīng)進(jìn)程。其在大腦中的含量非常之多,具有很高的表達(dá)特異性,經(jīng)常成為神經(jīng)系統(tǒng)損傷的標(biāo)志物。本研究目標(biāo)是探索血清UCH-L1在急性腦卒中患者中的診斷價(jià)值。方法前瞻性連續(xù)納入自2015年03月至2016年03月就診于河南省人民醫(yī)院、輝縣市人民醫(yī)院、周口市中心醫(yī)院等11家醫(yī)院的發(fā)病12h以內(nèi)的急性腦卒中患者,根據(jù)疾病不同分為急性腦梗死(AIS)組,腦出血(ICH)組和短暫性腦缺血發(fā)作(TIA)組。記錄患者性別、年齡、病史、入院情況及影像學(xué)特點(diǎn)等臨床資料。另外選取2016年3月至2016年7月于河南省人民醫(yī)院體檢中心進(jìn)行體檢的健康人作為對照組。對所有研究對象進(jìn)行靜脈血采集,集中采用直接酶聯(lián)免疫吸附法行血清UCH-L1水平定量檢測。采納SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料用(x±SD)或中位數(shù)(四分位數(shù))[M(Q1,Q3)]表示,計(jì)數(shù)資料用百分比(%)表示。兩組間分類變采納χ2檢驗(yàn)或Fisher精確檢驗(yàn),連續(xù)變量采納Student’s t檢驗(yàn)或Mann Whitney U檢驗(yàn);三組間對比采納Kruskal-Wallis檢驗(yàn)。非參數(shù)Spearman相關(guān)性檢驗(yàn)用于UCH-L1與臨床數(shù)據(jù)之間相關(guān)性分析。P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果共納入732例卒中患者,男449例,女283例,平均年齡(62.2±11.2)歲。其中AIS患者440例、ICH患者243例和TIA患者49例。AIS組與ICH組患者血清UCH-L1水平比較差異無統(tǒng)計(jì)學(xué)意義[431.71±230.83ng/L vs 414.70±204.15ng/L,P=0.31],但是兩組UCH-L1水平顯著高于TIA組和健康對照組[269.31±216.46ng/L和275.67±162.70 ng/L,P0.01],而血清UCH-L1水平在TIA組和健康對照組間相似。血清UCH-L1水平與卒中患者初始NIHSS評分和發(fā)病時(shí)間均無相關(guān)性(z=-0.837,P=0.402和z=-0.48,P=0.631;χ2=0.662,P=0.718和χ2=0.662,P=0.718)。血清UCH-L1水平與卒中危險(xiǎn)因素?zé)o關(guān)(P0.05)。血清UCH-L1識別卒中患者和TIA患者的AUC為0.77(95%CI0.687-0.856),當(dāng)血清UCH-L1取307.25ng/L時(shí),預(yù)測卒中的敏感性和特異性分別為67.9%和76%。而鑒別ICH患者和AIS患者的AUC為0.48(95%CI0.438-0.528)。結(jié)論血清UCH-L1可以作為鑒別卒中和TIA的生物標(biāo)記物,但是與卒中危險(xiǎn)因素、疾病嚴(yán)重程度和發(fā)病時(shí)間均無明確相關(guān)性,且不能鑒別急性腦梗死和腦出血。
[Abstract]:Background and objective Acute stroke is the most common disease of nervous system, its incidence is very high, it is easy to leave disability sequelae, the death rate of severe stroke is also very high, it is very harmful to human health, early and reasonable treatment can obviously improve the prognosis.An accurate and rapid diagnostic method for acute cerebral infarction is particularly important, directly affecting the outcome and late recovery of these patients.At present, the diagnostic methods of stroke are still mainly history, clinical symptoms and imaging results, and have a great relationship with the clinical experience and medical level of the first-time doctor.These factors affect the diagnosis and subsequent treatment of acute stage.Therefore, it is imperative to explore a new, rapid, easy to operate, sensitive and specific method to identify and classify acute stroke as early as possible.Serum ubiquitin C-terminal hydrolase (UCH-L1) is a cysteine hydrolase, which is involved in many physiological and pathological processes, such as cell cycle regulation, cell apoptosis, inflammatory reaction, gene expression and information transmission.It has high expression specificity and is often used as a marker of nervous system injury.The aim of this study was to explore the diagnostic value of serum UCH-L1 in patients with acute stroke.Methods from March 2015 to March 2016, patients with acute stroke were included in 11 hospitals, including Henan Provincial people's Hospital, Huixian people's Hospital, Zhoukou Central Hospital and so on.The patients were divided into acute cerebral infarction (AIS) group, cerebral hemorrhage (ICH) group and transient ischemic attack (TIA) group.Gender, age, history, admission and imaging features were recorded.In addition, healthy persons from March 2016 to July 2016 in Henan Provincial people's Hospital physical examination were selected as the control group.Venous blood samples were collected from all subjects and serum UCH-L1 levels were detected quantitatively by direct enzyme-linked immunosorbent assay (Elisa).SPSS17.0 statistical software was used to analyze the data. The measurement data were expressed in terms of x 鹵SD) or median (quartile) [MNQ1Q3], and the counting data were expressed in percentage).蠂 2 test or Fisher accurate test was adopted for classification between the two groups, Student's t test or Mann Whitney U test was adopted for continuous variables, and Kruskal-Wallis test was adopted for comparison among the three groups.Nonparametric Spearman correlation test was used to analyze the correlation between UCH-L1 and clinical data.Results there were 732 stroke patients (449 males and 283 females) with an average age of 62.2 鹵11.2 years.The levels were similar between TIA group and healthy control group.There was no correlation between the level of serum UCH-L1 and the initial NIHSS score and onset time of stroke patients. There was no correlation between serum UCH-L1 level and the initial NIHSS score and onset time of stroke patients, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time, and there was no correlation between serum UCH-L1 level and stroke patients' initial NIHSS score and onset time.Serum UCH-L1 level was not correlated with stroke risk factors (P 0.05).The AUC of serum UCH-L1 in patients with stroke and TIA was 0.77 ~ 95CI 0.687-0.856. The sensitivity and specificity of predicting stroke were 67.9% and 76.9%, respectively, when serum UCH-L1 was taken for 307.25ng/L.The AUC for differentiating ICH patients from AIS patients was 0.48C 95 CI 0.438-0.528%.Conclusion Serum UCH-L1 can be used as a biomarker for differentiating stroke from TIA, but it is not correlated with risk factors, severity and duration of stroke, and can not distinguish acute cerebral infarction from cerebral hemorrhage.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 童峰;許耀強(qiáng);李斌;李磊;李曉峰;劉迎龍;;血清UCH-L1濃度在幼豬深低溫停循環(huán)模型中的變化[J];中華小兒外科雜志;2015年08期

2 李莉;古正濤;劉志鋒;蘇磊;;泛素羧基末端水解酶-1在重癥中暑小鼠腦損傷組織中的表達(dá)[J];醫(yī)學(xué)研究生學(xué)報(bào);2015年02期

3 蔣曙紅;王金秀;張一鳴;蔣惠芬;;亞低溫治療對缺氧缺血性腦病新生兒血清神經(jīng)膠質(zhì)酸性蛋白和泛素羧基末端水解酶L1的影響[J];中國當(dāng)代兒科雜志;2014年12期

4 張波;劉江偉;張東;黃潑潑;楊帆;;沙漠干熱環(huán)境中暑大鼠肺損傷相關(guān)研究[J];醫(yī)學(xué)研究生學(xué)報(bào);2014年11期

5 葛嶺;薛龍;黃曉偉;陳潔波;許靜;;輕型顱腦損傷患者血清UCH-L1變化的臨床意義和患者預(yù)后關(guān)系[J];醫(yī)學(xué)研究雜志;2014年07期

6 李俠;張磊;陳燕偉;羅鵬;田鈞;付建斌;胡學(xué)安;王毓;費(fèi)舟;;852例開放性顱腦損傷的臨床救治經(jīng)驗(yàn)[J];中華神經(jīng)醫(yī)學(xué)雜志;2014年05期

7 劉靜;張舒羽;曹建平;;蛋白酶體抑制劑在非小細(xì)胞肺癌靶向治療中的研究進(jìn)展[J];醫(yī)學(xué)研究生學(xué)報(bào);2014年02期

8 秦龍;黃書嵐;邢澤剛;;UCH-L1在癲癇患者腦脊液和血液中的表達(dá)及意義[J];中國臨床神經(jīng)外科雜志;2013年09期

9 李莉;劉志鋒;古正濤;蘇磊;;重癥中暑中樞神經(jīng)系統(tǒng)病變機(jī)制的研究進(jìn)展[J];中華危重病急救醫(yī)學(xué);2013年09期

10 張煒;蘇萍;鄺兆威;;泛素C末端水解酶-1在急性缺血性腦血管病早期鑒別中的應(yīng)用價(jià)值[J];山東醫(yī)藥;2013年24期

，

本文編號：1739663