本文選題：尤瑞克林 + 急性腦梗死��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:急性腦梗死是神經(jīng)系統(tǒng)常見的急癥之一,其引起的神經(jīng)功能缺損嚴(yán)重影響著患者的日常生活。腦缺血后,細(xì)胞氧化代謝中斷,神經(jīng)元線粒體功能障礙,能量產(chǎn)生不足,微血管受損,隨后,神經(jīng)炎性級聯(lián)反應(yīng)被激活,導(dǎo)致腦損傷進(jìn)一步加重。其中血腦屏障(blood-brain barrier,BBB)通透性的改變在急性腦梗死中發(fā)揮了關(guān)鍵作用。本實驗通過觀察急性腦梗死患者血漿中高遷移率族蛋白B1(high mobility group box 1,HMGB1)、基質(zhì)金屬蛋白酶9(matrix metalloproteinase 9,MMP-9)、基質(zhì)金屬蛋白酶組織抑制劑1(tissue inhibitor of matrix metalloproteinase-1,TIMP-1)在不同時期的濃度變化,研究尤瑞克林對血腦屏障的保護(hù)作用,并探討其中可能的機制。方法:1收集2015年1月至2015年10月期間河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科收治的首次發(fā)病的急性腦梗死病人100例。隨機分為尤瑞克林組和常規(guī)治療組。2分別對兩組患者在入院后第1天、14天和3月時進(jìn)行NHISS評分。并抽取第1天和第14天的空腹靜脈血5ml,用酶聯(lián)免疫吸附法檢測血漿中HMGB1,MMP-9,TIMP-1的濃度。結(jié)果:1研究對象分布:本實驗共納入100例急性腦梗死患者,均符合入組標(biāo)準(zhǔn),隨機分為兩組,每組各50例,但由于病情變化和患者依從性差等情況共計22例患者脫組,最終共納入尤瑞克林組45例,常規(guī)治療組33例。2基線資料比較:兩組患者在年齡、性別、文化程度、用藥前的NHISS評分等方面均無統(tǒng)計學(xué)差異(P0.05),兩組患者具有可比性。3臨床療效評價:入院第1天,尤瑞克林組及常規(guī)治療組的NHISS評分無統(tǒng)計學(xué)差異(P0.05);隨訪3個月,兩組的NHISS評分均進(jìn)行性下降,并且在入院14天及3個月時,兩組的NHISS評分均有統(tǒng)計學(xué)差異(P0.05)。4血漿MMP-9含量的測定:兩組患者M(jìn)MP-9含量在入院1天時相比無統(tǒng)計學(xué)差異(P0.05),而在14天時有統(tǒng)計學(xué)差異(P0.05)。與入院1天時相比,尤瑞克林組患者血漿MMP-9的水平在14天時有明顯的下降(P0.05)。而常規(guī)治療組則無明顯的變化(P0.05)。5血漿TIMP-1含量的測定:兩組在入院第1天時相比無統(tǒng)計學(xué)差異(P0.05);在入院后14天相比仍無統(tǒng)計學(xué)差異(P0.05)。隨著病程的進(jìn)展,與入院1天時相比,兩組患者血漿中TIMP-1的含量在14天時均明顯升高(P0.05)。且在入院后14天時包括兩組患者在內(nèi)的觀察總體TIMP-1水平與入院第1天時相比也有顯著的統(tǒng)計學(xué)差異(P0.05)。6血漿HMGB1含量的測定:兩組在住院1天時相比無統(tǒng)計學(xué)差異(P0.05),在入院14天時相比有統(tǒng)計學(xué)差異(P0.05)。隨著病程的進(jìn)展,尤瑞克林組患者血漿中HMGB1含量在14天時比入院1天時有明顯的下降(P0.05)。而常規(guī)治療組中患者HMGB1含量并無明顯的改變(P0.05)。7血漿TIMP-1、MMP-9相關(guān)性的測定:入院第1天測得的觀察病人總體的TIMP-1與MMP-9具有正相關(guān)性(P0.05,r=0.277),而在入院14天,TIMP-1和MMP-9不具有相關(guān)性(P0.05)。8血漿HMGB1、MMP-9相關(guān)性測定:入院第1天測得的觀察病人總體的HMGB1與MMP-9不具有相關(guān)性(P0.05),而在入院后14天測得的HMGB1與MMP-9具有正相關(guān)性(P0.05,r=0.276)。結(jié)論:1尤瑞克林能夠顯著改善急性腦梗死患者的近期及遠(yuǎn)期神經(jīng)功能評分。2尤瑞克林能夠降低血漿MMP-9和HMGB1的水平,而對TIMP-1的影響并不大。3尤瑞克林可能通過降低血漿MMP-9、HMGB1的水平,從而保護(hù)血腦屏障、減輕腦損傷。
[Abstract]:Objective: acute cerebral infarction is one of the most common acute neuropathy in the nervous system. The impairment of nerve function seriously affects the daily life of the patients. After cerebral ischemia, cell oxidative metabolism interrupts, neuron mitochondrial dysfunction, energy production deficiency, microvascular damage, then the neuroinflammatory cascade is activated, leading to further brain damage. The changes in the permeability of blood-brain barrier (BBB) have played a key role in acute cerebral infarction. In this experiment, the high mobility group protein B1 (high mobility group box 1, HMGB1), matrix metalloproteinase 9 (matrix metalloproteinase 9, MMP-9), matrix metalloproteinase group were observed in the patients with acute cerebral infarction. The changes in the concentration of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) at different periods were used to study the protective effect of Yuri klin on the blood brain barrier and to explore the possible mechanisms. Methods: 1 the acute onset of the first onset of the neurology department of the second hospital of Hebei Medical University from January 2015 to October 2015 was collected. 100 patients with cerebral infarction were randomly divided into the Yuri klin group and the routine treatment group (.2). The two groups were divided into two groups at first days, 14 days and March respectively. The fasting venous blood 5ml of first days and fourteenth days was extracted. The concentration of HMGB1, MMP-9 and TIMP-1 in plasma was detected by enzyme linked immunosorbent assay. Results: 1 subjects were distributed: this experiment was in total 100 cases of acute cerebral infarction were in accordance with the standard of entry group, which were randomly divided into two groups, 50 cases in each group, but 22 patients were removed from the group because of the change of the condition and the poor compliance of the patients. Finally, 45 cases were included in the Yuri klin group. The baseline data of 33 cases of.2 in the routine treatment group were compared: the two groups were in age, sex, educational level, NHI before medication. There was no statistical difference in the SS score (P0.05). The two groups had comparable clinical efficacy evaluation of.3: the NHISS score of the Yuri klin group and the conventional treatment group was not statistically significant (P0.05) at first days of admission; the two groups were followed up for 3 months, and the two groups of NHISS scores were all in the 14 and 3 months. P0.05.4 plasma MMP-9 content determination: the MMP-9 content in the two groups was not statistically significant at 1 days (P0.05), but there was a statistical difference at 14 days (P0.05). The plasma MMP-9 level of the Yuri klin group was significantly decreased at 14 days (P0.05), but there was no significant change in the conventional treatment group. (P0.05).5 plasma TIMP-1 content: there was no statistical difference between the two groups at first days (P0.05), and there was no statistical difference between the 14 days after admission (P0.05). With the progression of the hospital, the level of TIMP-1 in the plasma of the two groups increased significantly (P0.05) at 14 days compared with the admission process (P0.05), and included two groups at 14 days after admission. The total TIMP-1 level, compared with the first days of admission, was also significantly different (P0.05).6 plasma HMGB1 content determination: there was no statistical difference between the two groups at 1 days of hospitalization (P0.05), and there was a statistically significant difference (P0.05) at the time of admission (P0.05). The plasma HMGB1 content of the Yuri klin group was 14 along with the progression of the disease. The day time was significantly lower than that at 1 days (P0.05). But there was no significant change in the content of HMGB1 in the routine treatment group (P0.05).7 plasma TIMP-1, MMP-9 correlation: the overall TIMP-1 and MMP-9 had a positive correlation (P0.05, r= 0.277) on the first day of admission (P0.05, r= 0.277), while TIMP-1 was not associated with MMP-9 in the hospital (14 days). 5).8 plasma HMGB1, MMP-9 correlation determination: the total HMGB1 of the observed patients at the first day of admission was not associated with MMP-9 (P0.05), and the HMGB1 and MMP-9 measured on the 14 day after admission (P0.05, r=0.276). Conclusion: 1 Yuri Clin can significantly improve the short-term and long term neurological function score of patients with acute cerebral infarction,.2 Yuri Colin can reduce the level of plasma MMP-9 and HMGB1, but the effect on TIMP-1 is not.3 Yuri Colin may reduce the level of plasma MMP-9, HMGB1, thus protecting the blood brain barrier and alleviating brain damage.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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