【摘要】：目的：觀察急性腦梗死患者外周血單核細(xì)胞比例（MONO%）及單核細(xì)胞（MONO）計數(shù)的動態(tài)變化，及其與血清C反應(yīng)蛋白（CRP）水平、神經(jīng)功能缺損程度的關(guān)系，探討MONO在急性腦梗死中的作用及其可能的病理生理機(jī)制。并進(jìn)一步研究鹽酸小檗堿及阿托伐他汀鈣對急性腦梗死患者M(jìn)ONO%及MONO計數(shù)的影響，探討鹽酸小檗堿及阿托伐他汀鈣對急性腦梗死的作用及其可能的病理生理機(jī)制。 方法：選擇健康體檢者75例為對照組，發(fā)病48小時內(nèi)的急性腦梗死患者119例為腦梗死組，均符合入組標(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。采用對照研究的方法，將腦梗死組隨機(jī)分為常規(guī)組（51例），，小檗堿組（32例），他汀組（36例）。三組在年齡、性別構(gòu)成及病情嚴(yán)重程度方面具有可比性。采用日本SysmexXE型全自動血細(xì)胞分析儀及配套試劑檢測外周血MONO%及MONO計數(shù)（×109/L），用速率散射比濁法檢測血清CRP水平（mg/L），觀察腦梗死組發(fā)病48小時內(nèi)（治療前）及入院后第10天（治療后）外周血MONO%及MONO計數(shù)的變化。并于治療前后應(yīng)用美國國立衛(wèi)生研究院的卒中量表（NIHSS）對腦梗死組患者的神經(jīng)功能缺損程度進(jìn)行評定。第一次結(jié)果記為“1”，第二次結(jié)果記為“2”，第一次結(jié)果減第二次結(jié)果的差值記“差”。所有數(shù)據(jù)采用SPSS20.0統(tǒng)計軟件進(jìn)行處理，檢驗的顯著性水準(zhǔn)為雙側(cè)檢驗P0.05。 結(jié)果： 1．腦梗死組外周血MONO%1（6.30±2.44）與對照組（6.61±2.76）比較略有降低，MONO計數(shù)1（0.44±0.18）與對照組（0.40±0.18）比較略有增高，差異均不顯著。腦梗死組外周血MONO%2（7.53±2.21）、MONO計數(shù)2（0.50±0.20）與對照組比較顯著增高（P0.05，P0.01）。腦梗死組外周血MONO%2、MONO計數(shù)2較MONO%1、MONO計數(shù)1明顯升高（P0.01，P0.01）。 2．腦梗死組外周血MONO%1、MONO計數(shù)1與兩次NIHSS評分（4.07±2.46，2.58±2.34）及NIHSS差（1.49±2.00）無顯著相關(guān)；MONO%2與NIHSS2無顯著相關(guān)，MONO計數(shù)2與NIHSS2呈顯著正相關(guān)（r=0.238，P0.05）；MONO%差、MONO計數(shù)差與兩次NIHSS評分及NIHSS差無顯著相關(guān)。 3．腦梗死組兩次外周血MONO%與兩次血清CRP水平（2.47±3.40，3.47±5.27）無顯著相關(guān)；MONO%差與CRP2呈顯著負(fù)相關(guān)（r=-0.233，P0.05）、與CRP差（-0.96±6.08）呈顯著正相關(guān)（r=0.257，P0.05），而與CRP1無顯著相關(guān)。腦梗死組外周血MONO計數(shù)1與CRP1呈顯著正相關(guān)（r=0.285，P0.01），而與CRP2、CRP差無顯著相關(guān)；MONO計數(shù)2與CRP2呈顯著正相關(guān)（r=0.228，P0.05），而與CRP1、CRP差無顯著相關(guān)；MONO計數(shù)差與CRP差呈顯著正相關(guān)（r=0.245，P0.05），而與CRP1、CRP2無顯著相關(guān)。 4．常規(guī)組、小檗堿組及他汀組治療前外周血MONO%（6.52±2.28，6.06±2.07，6.57±2.80）、MONO計數(shù)（0.47±0.19，0.43±0.13，0.43±0.20）及NIHSS評分（4.16±2.50，4.34±3.01，3.69±1.82）無顯著差異。 常規(guī)組外周血MONO%、MONO計數(shù)治療后（8.13±2.33，0.52±0.18）較治療前升高明顯（P0.01，P0.05），他汀組外周血MONO%、MONO計數(shù)治療后（7.52±1.82，0.50±0.20）較治療前升高明顯（P0.05，P0.05），小檗堿組外周血MONO%、MONO計數(shù)治療后（6.73±2.15，0.47±0.24）較治療前升高不明顯。 常規(guī)組、小檗堿組、他汀組治療后NIHSS評分（3.00±2.70，2.53±1.72，2.03±2.20）較治療前比顯著降低，差異有統(tǒng)計學(xué)意義（P0.01，P0.01，P0.01）。 結(jié)論： 1．急性腦梗死患者外周血MONO%、MONO計數(shù)顯著升高，提示MONO可能參與了急性腦梗死的病理生理過程。 2．急性腦梗死患者外周血MONO計數(shù)可以反映腦梗死病情的嚴(yán)重程度，MONO計數(shù)高者神經(jīng)功能缺損程度較重。 3．急性腦梗死患者外周血MONO計數(shù)可以反映腦梗死的炎癥反應(yīng)程度，外周血MONO計數(shù)高者腦梗死的炎癥反應(yīng)程度較重，提示MONO可能與急性腦梗死的炎癥反應(yīng)過程關(guān)系密切。 4．鹽酸小檗堿可以抑制急性腦梗死患者外周血MONO%、MONO計數(shù)的升高，阿托伐他汀鈣則無此作用，提示急性腦梗死患者應(yīng)用鹽酸小檗堿比應(yīng)用阿托伐他汀鈣治療可能獲益更多。
[Abstract]:AIM: To observe the dynamic changes of peripheral blood mononuclear cell ratio (MONO%) and mononuclear cell (MONO) count in patients with acute cerebral infarction and their relationship with serum C-reactive protein (CRP) level and neurological impairment, and to explore the role of MONO in acute cerebral infarction and its possible pathophysiological mechanism. To investigate the effect of atorvastatin calcium on MONO% and MONO count in patients with acute cerebral infarction and the possible pathophysiological mechanism of berberine hydrochloride and atorvastatin calcium on acute cerebral infarction.
Methods: 75 healthy subjects were selected as control group, 119 patients with acute cerebral infarction within 48 hours after onset were selected as cerebral infarction group, which met the criteria of inclusion and exclusion. The age and sex composition of the two groups were comparable. The cerebral infarction group was randomly divided into routine group (51 cases), berberine group (32 cases) and statin group. The three groups were comparable in age, sex composition and severity of the disease. The MONO% and MONO count in peripheral blood were measured by Japanese Sysmex XE automatic blood cell analyzer and matching reagents ( Changes of MONO% and MONO count in peripheral blood on the 10th day after treatment were assessed with the National Institutes of Health Stroke Scale (NIHSS). All data were processed by SPSS20.0 statistical software. The significant level of the test was bilateral test P0.05..
Result:
1. The MONO% 1 (6.30+2.44) in peripheral blood of cerebral infarction group was slightly lower than that of control group (6.61+2.76), and the MONO count 1 (0.44+0.18) was slightly higher than that of control group (0.40+0.18). The MONO% 2 (7.53+2.21) and MONO 2 (0.50+0.20) in peripheral blood of cerebral infarction group were significantly higher than that of control group (P 0.05, P 0.01). MONO%2, MONO count 2 was significantly higher than MONO%1 and MONO count 1 (P0.01, P0.01).
2. There was no significant correlation between MONO% 1, MONO count 1 and two NIHSS scores (4.07+2.46, 2.58+2.34) and NIHSS difference (1.49+2.00) in cerebral infarction group; MONO% 2 was not significantly correlated with NIHSS2, MONO count 2 was positively correlated with NIHSS2 (r = 0.238, P 0.05); MONO% difference, MONO count was not significantly correlated with two NIHSS scores and NIHSS difference.
3. There was no significant correlation between MONO% in peripheral blood and serum CRP level (2.47 65 MONO count 2 was positively correlated with CRP 2 (r = 0.228, P 0.05), but not with CRP 1 and CRP; MONO count difference was positively correlated with CRP difference (r = 0.245, P 0.05), but not with CRP 1 and CRP 2.
4. There was no significant difference in peripheral blood MONO (6.52+2.28, 6.06+2.07, 6.57+2.80), MONO count (0.47+0.19, 0.43+0.13, 0.43+0.20) and NIHSS score (4.16+2.50, 4.34+3.01, 3.69+1.82) between the conventional group, berberine group and statin group before treatment.
MONO and MONO in peripheral blood of statin group were significantly increased after treatment (P 0.01, P 0.05). MONO and MONO in peripheral blood of statin group were significantly increased after treatment (P 0.05, P 0.05). MONO and MONO in peripheral blood of berberine group were not significantly increased after treatment (P 6.73 + 2.15, 0.47 + 0.24). Obviously.
The NIHSS scores of the conventional group, berberine group and statin group were significantly lower than those before treatment (P 0.01, P 0.01, P 0.01).
Conclusion:
1. MONO and MONO counts in peripheral blood of patients with acute cerebral infarction increased significantly, suggesting that MONO may participate in the pathophysiological process of acute cerebral infarction.
2. The MONO count in peripheral blood of patients with acute cerebral infarction can reflect the severity of cerebral infarction. The neurological deficit is more serious in patients with high MONO count.
3. The MONO count in peripheral blood of patients with acute cerebral infarction can reflect the degree of inflammation in cerebral infarction. The higher the MONO count in peripheral blood, the more severe the degree of inflammation in cerebral infarction, suggesting that MONO may be closely related to the inflammatory process of acute cerebral infarction.
4. Berberine hydrochloride can inhibit the increase of MONO and MONO counts in peripheral blood of patients with acute cerebral infarction, but Atorvastatin calcium has no such effect, suggesting that berberine hydrochloride may benefit more than Atorvastatin calcium treatment in patients with 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】：2013
【分類號】：R743.33

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