發(fā)布時間：2018-01-27 10:17

  本文關(guān)鍵詞： 腦梗死 血管性癡呆 血漿生長抑素 內(nèi)皮素 診斷價值　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過檢測血管性癡呆(Va D)患者血漿生長抑素(SS)和內(nèi)皮素(ET)水平,探討血漿SS和ET與Va D的關(guān)系,判斷血漿SS和ET對Va D的診斷價值,并探討腦梗死后Va D的危險因素,為Va D早期預(yù)防和診斷提供依據(jù)。方法收集2015年1月-2016年12月寧夏人民醫(yī)院神經(jīng)內(nèi)科住院的腦梗死后3個月患者作為研究對象,所選對象符合中華醫(yī)學(xué)會神經(jīng)病學(xué)分會制定的《中國急性缺血性腦卒中診療指南2014》的診斷標(biāo)準(zhǔn)。根據(jù)MMSE和Mo CA量表及相應(yīng)的納入標(biāo)準(zhǔn)將患者進(jìn)行分組,其中腦梗死后Va D組46例,腦梗死非癡呆組(N-Va D)42例;對照組(30例)選擇同期在性別、年齡、文化程度上無統(tǒng)計學(xué)差異的體檢者。記錄所有納入對象的一般情況,分析Va D主要危險因素;采用放射免疫法測定患者血漿SS和ET-1的濃度,探討血漿SS和ET-1對Va D的診斷價值。結(jié)果(1)Va D組、N-Va D組和對照組在年齡、性別和文化程度上無統(tǒng)計學(xué)差異(P0.05),具有可比性;Va D組患者M(jìn)o CA評分和MMSE評分均低于N-Va D組和對照組,差異均有統(tǒng)計學(xué)意義(P0.01)。(2)Va D組患者高血壓病、糖尿病和冠心病的發(fā)生率高于N-Va D組,差異有統(tǒng)計學(xué)意義(P0.05),兩組在高脂血癥、吸煙及飲酒史方面無統(tǒng)計學(xué)差異(P0.05);多因素回歸分析顯示高血壓病(OR=3.694,P=0.025)和糖尿病(OR=2.922,P=0.040)是Va D的主要危險因素。(3)Va D組患者血漿SS濃度為(104.83±18.67ng/L)明顯低于N-Va D組(138.36±11.19ng/L)和對照組(149.47±7.01ng/L),三組比較差異均有統(tǒng)計學(xué)意義(P0.01);Va D組患者血漿ET-1濃度(85.76±6.75 pg/ml)顯著高于N-Va D組(72.95±7.72pg/ml)和對照組(62.37±6.34pg/ml),三組比較差異均有統(tǒng)計學(xué)意義(P0.01)。(4)Va D組中(輕、中、重度)各組血漿SS水平隨著癡呆嚴(yán)重程度的加重而降低,ET-1水平隨著癡呆嚴(yán)重程度的加重而增高,差異均有統(tǒng)計學(xué)意義(P0.01)。(5)經(jīng)Spearman相關(guān)性分析,血漿SS與MMSE評分成正相關(guān)(r=0.473,P0.01);血漿ET-1與MMSE評分存在負(fù)相關(guān)(r=-0.438,P0.01)。結(jié)論(1)高血壓病和糖尿病是Va D的主要危險因素。(2)Va D患者血漿SS水平降低,血漿ET-1水平增高,且血漿SS和ET-1水平與癡呆程度有關(guān),血漿SS水平越低,ET-1水平越高,對Va D的診斷價值越大。
[Abstract]:Objective to investigate the relationship between plasma SS, et and Vad by detecting plasma somatostatin (SS) and endothelin (et) levels in patients with vascular dementia (VD). To evaluate the diagnostic value of plasma SS and et in patients with Vad and to explore the risk factors of Vad after cerebral infarction. Methods from January 2015 to December 2016, three months after cerebral infarction in Department of Neurology, Ningxia people's Hospital, were selected as the study objects. The selected subjects were in accordance with the diagnostic criteria of the guidelines for the diagnosis and treatment of Acute Ischemic Stroke in China developed by the Neurology Branch of the Chinese Medical Association. According to MMSE and Mo. Patients were grouped with CA scale and corresponding inclusion criteria. There were 46 cases of Va D group and 42 cases of N-Va D group after cerebral infarction. In the control group (30 cases), the subjects who had no statistical difference in sex, age and education level were selected. The general situation of all the subjects was recorded and the main risk factors of Vad were analyzed. The plasma levels of SS and ET-1 were measured by radioimmunoassay, and the diagnostic value of plasma SS and ET-1 in Vad was discussed. There was no significant difference in age, sex and education between N-Va D group and control group (P 0.05). The scores of MoCA and MMSE in group Va D were lower than those in group N-Va D and control group, and the difference was statistically significant (P 0.01). The incidence of diabetes mellitus and coronary heart disease was higher than that of N-Va D group (P 0.05). There was no significant difference in hyperlipidemia, smoking and drinking history between the two groups. Multivariate regression analysis showed that hypertension was 3.694% (P < 0.025) and diabetes mellitus was 2.922 (P < 0.05). Plasma SS concentration in Va D group was 104.83 鹵18.67 ng / L, which was significantly lower than that in N-Va D group (P < 0.05). 138.36 鹵11.19ng / L) and control group (149.47 鹵7.01ng / L). The differences among the three groups were statistically significant (P 0.01). The plasma ET-1 concentration of Va-D group was 85.76 鹵6.75 PG / ml, significantly higher than that of N-Va-D group (72.95 鹵7.72 PG / ml) and control group (P < 0.05). 62.37 鹵6.34 PG / ml. There were significant differences among the three groups in plasma SS levels in the middle (light, medium and severe) groups with the severity of dementia. The level of ET-1 increased with the aggravation of the severity of dementia, and the difference was statistically significant (P 0.01. 05) by Spearman correlation analysis. There was a positive correlation between plasma SS and MMSE score. There was a negative correlation between plasma ET-1 and MMSE score. Conclusion: hypertension and diabetes mellitus are the main risk factors of VAD. Plasma SS level is lower and plasma ET-1 level is higher in patients with VAD. The levels of SS and ET-1 were related to the degree of dementia. The lower the level of SS and the higher the level of ET-1, the greater the diagnostic value of VAD.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.13

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