遠(yuǎn)隔肢體缺血適應(yīng)對急性腦梗死患者血清胱抑素水平的影響
發(fā)布時間：2018-07-17 03:17
【摘要】：目的：觀察急性腦梗死患者血清胱抑素C(Cystatin C,CysC)水平的變化，遠(yuǎn)隔肢體缺血適應(yīng)（Limb remote ischemic conditioning,LRIC）對急性腦梗死患者血清CysC水平及神經(jīng)功能缺損程度的影響，探討血清CysC水平與急性腦梗死的關(guān)系以及LRIC對急性腦梗死的作用及可能的病理生理機(jī)制。 方法： 1.選擇健康體檢者51例為正常對照組，急性腦梗死患者81例為病例組，符合制定的入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)，兩組在年齡、性別構(gòu)成方面具有可比性。通過對照研究方法，依據(jù)治療方案的不同將病例組隨機(jī)分為病例對照組（48例）及LRIC組（33例），兩組在年齡、性別構(gòu)成、發(fā)病時間、病情嚴(yán)重程度方面具有可比性。 2.應(yīng)用日立全自動生化分析儀及相關(guān)試劑檢測血清CysC（免疫比濁法測定mg/L）、尿素氮（Blood urea nitrogen，BUN）（脲酶速率法測定，mmol/L）及肌酐（Creatinine，Cre）（HMMPS法測定，μmol/L）水平。 3.觀察病例組入院第2日（治療前）及入院第7日（治療后）血清CysC、BUN、Cre水平的變化并于治療前后應(yīng)用美國國立衛(wèi)生研究院卒中量表（National Instituteof Health stroke scale，NIHSS）對病例組患者的神經(jīng)功能缺損程度進(jìn)行評定。第一次（治療前）結(jié)果記為“1”，第二次（治療后）結(jié)果記為“2”，第一次結(jié)果與第二次結(jié)果的差記為“差值”。觀察并記錄RLIC操作的不良反應(yīng)。所有資料采用SPSS20.0統(tǒng)計(jì)軟件進(jìn)行分析處理，檢驗(yàn)的顯著性水準(zhǔn)為雙側(cè)檢驗(yàn)P0.05。 結(jié)果： 1.病例組治療前后血清CysC水平（0.993±0.249，，0.971±0.256）較正常對照組（0.836±0.161）顯著升高（均為P0.01）；病例組治療前后血清BUN水平（5.503±1.372，4.556±1.394）均低于正常對照組（5.701±2.438），治療前較正常對照組差異無統(tǒng)計(jì)學(xué)意義，治療后差異具有統(tǒng)計(jì)學(xué)意義（P0.01）；病例組治療前血清Cre水平（63.722±21.067）較正常對照組（59.000±13.954）高，治療后（56.120±16.866）較正常對照組低，差異均無統(tǒng)計(jì)學(xué)意義。 2.病例組血清CysC1水平與NIHSS2評分均呈顯著正相關(guān)(r=0.239，P0.05)與NIHSS1評分無顯著相關(guān)； CysC2水平與NIHSS1評分呈顯著正相關(guān)（r=0.288,P0.05），與NIHSS2評分無顯著相關(guān)；病例組血清CysC1水平與BUN1水平呈顯著正相關(guān)（r=0.459，P0.01），與BUN2水平無顯著相關(guān)；CysC2水平與BUN1、BUN2水平均呈顯著正相關(guān)（r=0.369、0.296，均為P0.05）；CysC1水平與Cre1、Cre2水平均呈顯著正相關(guān)（r=0.497、0.483，均為P0.01）；CysC2水平與Cre1、Cre2水平均呈顯著正相關(guān)（r=0.632、0.643，均為P0.01）。 3.病例對照組與LRIC組治療前NIHSS評分（2.000±2.467，1.180±1.310）無顯著性差異；病例對照組與LRIC組治療后NIHSS評分（1.630±2.340，0.610±1.088）均較治療前顯著降低（P0.05，P0.01），且LRIC組NIHSS評分差值（0.580±0.663）較病例對照組（0.290±0.944）顯著增大（P0.05）。 4.病例對照組及LRIC組治療后血清CysC水平（0.972±0.249），0.969±0.272）均較治療前CysC水平（0.973±0.228，1.019±0.274）降低，但LRIC組降低更明顯且具有統(tǒng)計(jì)學(xué)意義（P0.01）；病例對照組與LRIC組治療后血清BUN水平（4.581±1.254，4.515±1.632）、Cre水平（57.452±17.226，53.947±16.487）均較治療前BUN水平（5.343±1.334，5.736±1.415）、Cre水平（64.031±22.166，63.273±19.687）顯著降低，差異均具有統(tǒng)計(jì)學(xué)意義（均為P0.01）；LRIC組CysC差值（0.046±0.065）、BUN差值（1.129±1.020）與Cre差值水平（10.368±10.243）較病例對照組CysC差值（0.030±0.742）、BUN差值（0.829±1.437）與Cre差值水平（7.597±9.694）降低幅度大，但差異無統(tǒng)計(jì)學(xué)意義。病例對照組與LRIC組治療前血清CysC水平、BUN水平、Cre水平均無顯著差異。 5.在LRIC操作過程中有25例患者訴有肢體輕微脹痛感、2例患者有頭部輕微脹痛感，均于每次操作后30分鐘內(nèi)完全消失，無其他不適主訴。 結(jié)論： 1.急性腦梗死患者血清CysC水平顯著升高，且其水平可以反映急性腦梗死病情的嚴(yán)重程度，提示CysC可能參與了急性腦梗死的病理生理過程。 2.LRIC可顯著降低急性腦梗死患者的血清CysC水平及神經(jīng)功能缺損程度，提示LRIC可能對急性腦梗死的預(yù)后有改善作用。 3.LRIC可能對改善腎臟功能有益。 4.LRIC可能是治療急性腦梗死安全有效的方法。
[Abstract]:Objective: To observe the changes of serum cystatin C (Cystatin C, CysC) in patients with acute cerebral infarction, the effect of Limb remote ischemic conditioning (LRIC) on the level of serum CysC and the degree of nerve function defect in patients with acute cerebral infarction, and to explore the relationship between serum CysC and acute cerebral infarction and the acute cerebral infarction. The role of infarction and its possible pathophysiological mechanism.
Method:
1. the healthy persons were selected as the normal control group, with 81 cases of acute cerebral infarction as the case group, which conformed to the standard and exclusion criteria. The two groups were comparable in age and gender. According to the different treatment methods, the case groups were randomly divided into case control group (48 cases) and group LRIC (33 cases), two. Two The group was comparable in age, sex composition, onset time and severity.
2. the level of serum CysC (immunoturbidimetry mg/L), urea nitrogen (Blood urea nitrogen, BUN) (urease rate method, mmol/L) and creatinine (Creatinine, Cre) (HMMPS method, micrmol/L) were detected by Hitachi automatic biochemical analyzer and related reagents.
3. the changes in serum CysC, BUN, Cre levels and the National Institutes of health apoplexy (National Instituteof Health stroke scale, NIHSS) were used to assess the degree of deity impairment in the case group before and after treatment. The first time (before treatment) was recorded. The results of "1" and second times (after treatment) were recorded as "2", and the difference between the first and second results was "difference value". The adverse reaction of the RLIC operation was observed and recorded. All the data were analyzed by SPSS20.0 software, and the significant level of the test was P0.05. test.
Result:
The level of serum CysC (0.993 + 0.249,0.971 + 0.256) before and after treatment in 1. cases group was significantly higher than that in normal control group (0.836 + 0.161) (all P0.01). The serum level of BUN (5.503 + 1.372,4.556 + 1.394) before and after treatment in the case group was lower than that of the normal control group (5.701 + 2.438). There was no significant difference between the normal control group and the normal control group before treatment, and the difference after treatment was different. There were statistical significance (P0.01); the level of serum Cre (63.722 + 21.067) before treatment in the case group was higher than that of the normal control group (59 + 13.954), and after treatment (56.120 + 16.866), the difference was lower than that of the normal control group, and the difference was not statistically significant.
There was a significant positive correlation between the serum CysC1 level and the NIHSS2 score in 2. cases (r=0.239, P0.05), and there was no significant correlation between the NIHSS1 score and the CysC2 level (r=0.288, P0.05), and there was no significant correlation with the NIHSS2 score. The serum CysC1 level of the case group was positively correlated with the BUN1 water level, and there was no significant correlation with the level of BUN1 water. There was a significant positive correlation between the level of CysC2 and the level of BUN1 and BUN2 (r=0.369,0.296, P0.05), and the level of CysC1 had a significant positive correlation with the level of Cre1 and Cre2 (r=0.497,0.483, all P0.01), and the CysC2 level had a significant positive correlation with the level of Cre1.
3. the NIHSS score (2 + 2.467,1.180 + 1.310) before treatment in the case control group and the LRIC group had no significant difference, and the NIHSS score (1.630 + 2.340,0.610 + 1.088) in the case control group and the LRIC group was significantly lower than that before the treatment (P0.05, P0.01), and the NIHSS score difference (0.580 + 0.663) in the LRIC group was significantly higher than that in the case control group (0.290 + 0.944) (P0.05). ).
4. the level of serum CysC (0.972 + 0.249) and 0.969 + 0.272 after treatment in the case control group and the LRIC group were lower than those before the treatment (0.973 + 0.228,1.019 + 0.274), but the decrease in the LRIC group was more obvious and statistically significant (P0.01). The level of BUN in the case control group and the LRIC group was (4.581 + 1.254,4.515 + 1.632), and the Cre level was 57.452 + 17.226. 53.947 + 16.487) compared with the level of BUN before treatment (5.343 + 1.334,5.736 + 1.415), Cre level (64.031 + 22.166,63.273 + 19.687) significantly decreased, the difference was statistically significant (P0.01), LRIC group CysC difference (0.046 + 0.065), BUN difference (1.129 + 1.020) and Cre difference level (10.368 + 10.243) compared with the case control group CysC difference (0.030 + 0.742), BUN difference (0.829 + 1.437) and Cre difference level (7.597 + 9.694) decreased significantly, but the difference was not statistically significant. There was no significant difference in serum CysC level, BUN level and Cre level between the case control group and the LRIC group before treatment.
5. during the operation of LRIC, 25 patients complained of mild distention and pain in the extremities, and 2 patients had a slight distention and pain in the head, all disappeared within 30 minutes after each operation, and no other discomfort complained.
Conclusion:
1. the level of serum CysC in patients with acute cerebral infarction is significantly higher, and its level can reflect the severity of acute cerebral infarction, suggesting that CysC may be involved in the pathophysiological process of acute cerebral infarction.
2.LRIC can significantly reduce serum CysC level and neurological deficit in patients with acute cerebral infarction, suggesting that LRIC may improve the prognosis of acute cerebral infarction.
3.LRIC may be beneficial to improving the function of the kidney.
4.LRIC may be a safe and effective treatment for acute cerebral infarction.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
本文編號：2128770
[Abstract]:Objective: To observe the changes of serum cystatin C (Cystatin C, CysC) in patients with acute cerebral infarction, the effect of Limb remote ischemic conditioning (LRIC) on the level of serum CysC and the degree of nerve function defect in patients with acute cerebral infarction, and to explore the relationship between serum CysC and acute cerebral infarction and the acute cerebral infarction. The role of infarction and its possible pathophysiological mechanism.
Method:
1. the healthy persons were selected as the normal control group, with 81 cases of acute cerebral infarction as the case group, which conformed to the standard and exclusion criteria. The two groups were comparable in age and gender. According to the different treatment methods, the case groups were randomly divided into case control group (48 cases) and group LRIC (33 cases), two. Two The group was comparable in age, sex composition, onset time and severity.
2. the level of serum CysC (immunoturbidimetry mg/L), urea nitrogen (Blood urea nitrogen, BUN) (urease rate method, mmol/L) and creatinine (Creatinine, Cre) (HMMPS method, micrmol/L) were detected by Hitachi automatic biochemical analyzer and related reagents.
3. the changes in serum CysC, BUN, Cre levels and the National Institutes of health apoplexy (National Instituteof Health stroke scale, NIHSS) were used to assess the degree of deity impairment in the case group before and after treatment. The first time (before treatment) was recorded. The results of "1" and second times (after treatment) were recorded as "2", and the difference between the first and second results was "difference value". The adverse reaction of the RLIC operation was observed and recorded. All the data were analyzed by SPSS20.0 software, and the significant level of the test was P0.05. test.
Result:
The level of serum CysC (0.993 + 0.249,0.971 + 0.256) before and after treatment in 1. cases group was significantly higher than that in normal control group (0.836 + 0.161) (all P0.01). The serum level of BUN (5.503 + 1.372,4.556 + 1.394) before and after treatment in the case group was lower than that of the normal control group (5.701 + 2.438). There was no significant difference between the normal control group and the normal control group before treatment, and the difference after treatment was different. There were statistical significance (P0.01); the level of serum Cre (63.722 + 21.067) before treatment in the case group was higher than that of the normal control group (59 + 13.954), and after treatment (56.120 + 16.866), the difference was lower than that of the normal control group, and the difference was not statistically significant.
There was a significant positive correlation between the serum CysC1 level and the NIHSS2 score in 2. cases (r=0.239, P0.05), and there was no significant correlation between the NIHSS1 score and the CysC2 level (r=0.288, P0.05), and there was no significant correlation with the NIHSS2 score. The serum CysC1 level of the case group was positively correlated with the BUN1 water level, and there was no significant correlation with the level of BUN1 water. There was a significant positive correlation between the level of CysC2 and the level of BUN1 and BUN2 (r=0.369,0.296, P0.05), and the level of CysC1 had a significant positive correlation with the level of Cre1 and Cre2 (r=0.497,0.483, all P0.01), and the CysC2 level had a significant positive correlation with the level of Cre1.
3. the NIHSS score (2 + 2.467,1.180 + 1.310) before treatment in the case control group and the LRIC group had no significant difference, and the NIHSS score (1.630 + 2.340,0.610 + 1.088) in the case control group and the LRIC group was significantly lower than that before the treatment (P0.05, P0.01), and the NIHSS score difference (0.580 + 0.663) in the LRIC group was significantly higher than that in the case control group (0.290 + 0.944) (P0.05). ).
4. the level of serum CysC (0.972 + 0.249) and 0.969 + 0.272 after treatment in the case control group and the LRIC group were lower than those before the treatment (0.973 + 0.228,1.019 + 0.274), but the decrease in the LRIC group was more obvious and statistically significant (P0.01). The level of BUN in the case control group and the LRIC group was (4.581 + 1.254,4.515 + 1.632), and the Cre level was 57.452 + 17.226. 53.947 + 16.487) compared with the level of BUN before treatment (5.343 + 1.334,5.736 + 1.415), Cre level (64.031 + 22.166,63.273 + 19.687) significantly decreased, the difference was statistically significant (P0.01), LRIC group CysC difference (0.046 + 0.065), BUN difference (1.129 + 1.020) and Cre difference level (10.368 + 10.243) compared with the case control group CysC difference (0.030 + 0.742), BUN difference (0.829 + 1.437) and Cre difference level (7.597 + 9.694) decreased significantly, but the difference was not statistically significant. There was no significant difference in serum CysC level, BUN level and Cre level between the case control group and the LRIC group before treatment.
5. during the operation of LRIC, 25 patients complained of mild distention and pain in the extremities, and 2 patients had a slight distention and pain in the head, all disappeared within 30 minutes after each operation, and no other discomfort complained.
Conclusion:
1. the level of serum CysC in patients with acute cerebral infarction is significantly higher, and its level can reflect the severity of acute cerebral infarction, suggesting that CysC may be involved in the pathophysiological process of acute cerebral infarction.
2.LRIC can significantly reduce serum CysC level and neurological deficit in patients with acute cerebral infarction, suggesting that LRIC may improve the prognosis of acute cerebral infarction.
3.LRIC may be beneficial to improving the function of the kidney.
4.LRIC may be a safe and effective treatment for acute cerebral infarction.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3
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