血清PCT與糖尿病不同病情程度相關(guān)性分析研究
發(fā)布時間：2019-05-28 02:54
【摘要】：背景:糖尿病(Diabetes mellitus,DM)的發(fā)病和治療已經(jīng)成為人類人口安全的重大問題,目前DM治療難點是診療時的證據(jù)不足,導(dǎo)致治療不足或過量。炎癥和其功能的雙向性在機體中扮演著防衛(wèi)和破壞的作用,而DM在病程發(fā)生和發(fā)展的進程中持續(xù)性高基礎(chǔ)水平的炎癥已備受關(guān)注,雖然DM發(fā)生機制上的研究眾多且深入,但仍然未能在臨床應(yīng)用中得到有效和廣泛的應(yīng)用,具體原因可能與炎癥的參與種類數(shù)量眾多且相互影響有關(guān)。血清降鈣素原(procalcitonin,PCT)經(jīng)研究發(fā)現(xiàn)是無激素活性的前肽物質(zhì),在體內(nèi)外穩(wěn)定性非常好。近年來PCT在臨床上的應(yīng)用價值主要是細(xì)菌感染、全身性炎癥反應(yīng)的早期預(yù)測和評估,臨床資料證實PCT對于細(xì)菌性炎癥的嚴(yán)重程度和抗菌預(yù)后效果的評估有重要的作用。由于其產(chǎn)生具有一定的組織特異性和表達廣泛性,提示這一指標(biāo)可能具有排除細(xì)菌感染診療以外的應(yīng)用診斷價值,在近年的基礎(chǔ)研究和臨床觀察發(fā)現(xiàn),PCT還具有無菌炎癥病情程度的判斷以及組織損傷程度的評估價值,同時PCT與炎癥因子的相關(guān)性研究發(fā)現(xiàn),PCT還具有對炎癥因子綜合反映的能力。這些前人的研究發(fā)現(xiàn)提示PCT對炎癥損傷的反映能力與糖尿病診療需求不謀而合。目的:通過分析不同病情程度的糖尿病(Diabetes Mellitus,DM)患者血清降鈣素原(procalcitonin,PCT)的表達差異,比較PCT同糖尿病發(fā)病進程的相關(guān)性炎癥、糖尿病病情程度的相關(guān)性,提示PCT對糖尿病病情判斷有一定的價值。方法:選取878名糖尿病患者為研究對象,分析不同感染程度患者的PCTTNF-αIL-6INF-γ水平;聯(lián)合感染診斷,空腹血糖(FBG)和糖化血紅蛋白(Hb A1c)、尿微量白蛋白(UmAlb)、急性病生理學(xué)和長期健康評價II(APACHEII:Acute Physiology and Chronic Health Evaluation II)對DM早期無并發(fā)癥、慢性并發(fā)癥和急性并發(fā)癥進行病情嚴(yán)重程度分組分級,評估病情與PCTTNF-αIL-6INF-γ的表達水平的相關(guān)性。結(jié)果:1.DM患者中PCT表達隨著病程嚴(yán)重程度升高而升高DM患者的PCT基礎(chǔ)表達水平高于正常健康人,且急性并發(fā)癥型的患者PCT表達水平最高,而早期DM組PCT表達水平最低。PCT表達差異隨著病情的加重明顯上調(diào),而其它的炎癥指標(biāo)TNF-αIL-6、INF-γ在DM的早期和慢性并發(fā)癥嚴(yán)重程度較低的無感染和局部感染表現(xiàn)出上調(diào),在慢性并發(fā)癥嚴(yán)重程度較高和全身性感染的DM患者均未發(fā)現(xiàn)有較明顯的變化趨勢。2.DM患者中PCT表達水平與病情的嚴(yán)重程度存相關(guān)性DM患者PCT的表達水平均高于正常健康人水平(0.1±0.05ng/ml),聯(lián)合不同分期的病情分級指標(biāo)和PCT等相關(guān)炎癥指標(biāo)的相關(guān)性發(fā)現(xiàn),在早期無并發(fā)癥、慢性并發(fā)癥和急性并發(fā)的DM患者中,PCTTNF-αIL-6均在各組中表現(xiàn)出表達差異;INF-γ僅在DM早期無并發(fā)癥和慢性并發(fā)癥的患者中(HbA1c%/FPG分級評分較低)表現(xiàn)出表達差異,而在全身性感染DM患者中表達水平均低于正常健康人水平(8.31±2.87pg/ml)。相關(guān)性分析發(fā)現(xiàn),炎癥因子PCTTNF-αIL-6INF-γ在不同病情程度表現(xiàn)出不同程度的相關(guān)性;PCT在不同病情分級DM患者中與TNF-αIL-6INF-γ存在相關(guān)性,其中與TNF-αIL-6存在正相關(guān),而與INF-γ表現(xiàn)出負(fù)相關(guān),但在炎癥程度較高的慢性并發(fā)癥和急性并發(fā)癥DM患者的相關(guān)性統(tǒng)計分析較差。Hb A1c%/FPG分級嚴(yán)重程度較低的患者中,PCTTNF-αIL-6INF-γ與病情分級均存在相關(guān)性,其中與PCTTNF-αIL-6表現(xiàn)出正相關(guān),與INF-γ表現(xiàn)出負(fù)相關(guān)。按照APACHEII評分的DM急性并發(fā)癥患者中,評分小于15的患者PCTTNF-αIL-6INF-γ均表現(xiàn)出相關(guān)性,而在評分15的患者中相關(guān)性較差,PCT與評分表現(xiàn)出低相關(guān)性。結(jié)論:DM患者PCT的表達水平差異是對病情嚴(yán)重程度特別是炎癥程度的反應(yīng),PCT可能對DM病情嚴(yán)重程度的診療具有重要的參考價值。
[Abstract]:BACKGROUND: The onset and treatment of diabetes (Diabetes Mellitus, DM) has become a major problem in the safety of human population, and the difficulty in the treatment of DM is insufficient evidence in diagnosis and treatment, resulting in insufficient or excessive treatment. The bidirectionality of inflammation and its function acts as a defensive and destructive role in the body, and the persistent high basal level of inflammation in the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the However, it is still not possible to have an effective and extensive application in clinical application, and the specific reason may be related to the number of involved types of inflammation and the interaction. Procalcitonin (PCT) has been found to be a pre-peptide substance without hormone activity, and the external stability of procalcitonin (PCT) is very good. In recent years, the clinical application value of PCT is mainly the early prediction and evaluation of bacterial infection and systemic inflammatory response, and the clinical data confirm that PCT has an important role in the assessment of the severity of bacterial inflammation and the evaluation of the effect of antibacterial and prognosis. due to the fact that it has certain tissue specificity and wide expression, it is suggested that this index may have the diagnostic value of the application other than the diagnosis and treatment of bacterial infection, and in recent years basic research and clinical observation have found, The PCT also has the value of the judgment of the degree of the condition of the aseptic inflammation and the evaluation value of the degree of tissue injury, and the correlation between the PCT and the inflammatory factors has found that the PCT also has the ability to comprehensively reflect the inflammatory factors. These previous studies have found that the ability of PCT to reflect the inflammatory injury and the need for diagnosis and treatment of diabetes do not match. Objective: To compare the expression of procalcitonin (PCT) in the patients with diabetes (Diabetes Mellitus, DM), and to compare the correlation between the correlation of PCT and the pathogenesis of diabetes and the degree of diabetes. It is suggested that PCT has a certain value for the diagnosis of diabetes. Methods:878 diabetic patients were selected to study the PCT? TNF-1 in patients with different degree of infection. IL-6? INF-1 level; combined infection diagnosis, fasting blood glucose (FBG) and glycosylated hemoglobin (Hb), urinary microalbumin (UmAlb), acute venereal disease physiology and long-term health evaluation II (AACHEII: Aute Physiology and Chronic Health Evaluation II) did not have complications in the early stage of DM, The severity of the chronic complications and the acute complications was graded, and the condition of the disease was assessed with PCT? TNF-1? The expression level of IL-6? INF-1. Results:1. PCT expression in DM patients increased with the severity of the course of the disease, and the level of PCT basal expression in DM patients was higher than that of normal controls, and the level of PCT expression in patients with acute complication was the highest, while the level of PCT expression in early DM group was the lowest. The difference of PCT expression is up-regulated with the severity of the disease, and other inflammatory markers TNF-1? IL-6, INF-1 showed up-regulation of non-infection and local infections with a lower severity of early and chronic complications of DM, There were no significant changes in the level of PCT expression in DM patients and the severity of the disease, and the level of PCT in DM patients was higher than that of normal controls (0.1 to 0.05 ng/ ml). The correlation of the disease grade index and the PCT and other relevant inflammation indexes of different stages was found, in the early period of no complications, chronic complications and acute concurrent DM patients, PCT? TNF-1? IL-6 showed a difference in expression in each group; INF-6 showed a difference in expression only in patients with no complications and chronic complications in the early stage of DM (lower HbA1c%/ FPG grade score), while the level of expression in patients with systemic infection was lower than that of normal controls (8.31% 2.87 pg/ ml). The correlation analysis found that the inflammatory factor PCT? TNF-1? IL-6? INF-1 showed a different degree of correlation in different degree of disease. There is a correlation between IL-6? INF-1, which is associated with TNF-1? There was a positive correlation between IL-6 and negative correlation with INF-6, but the statistical analysis of the correlation between chronic and acute complications with high degree of inflammation was poor. In patients with lower levels of Hb%%/ FPG, PCT? TNF-1? There was a correlation between IL-6? INF-1 and the grade of the disease, which was related to PCT? TNF-1? IL-6 showed positive correlation and negative correlation with INF-6. In patients with DM acute complications according to the APACHEII score, patients with a score of less than 15 PCT? TNF-1? IL-6? INF-1 showed a correlation, whereas in patients with a score of 15, the correlation was poor and there was a low correlation between the PCT and the table. Conclusion: The level of PCT expression in DM patients is a response to the severity of the disease, especially the degree of inflammation, and PCT may be of great reference value to the diagnosis and treatment of the severity of the disease.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1
本文編號：2486676
[Abstract]:BACKGROUND: The onset and treatment of diabetes (Diabetes Mellitus, DM) has become a major problem in the safety of human population, and the difficulty in the treatment of DM is insufficient evidence in diagnosis and treatment, resulting in insufficient or excessive treatment. The bidirectionality of inflammation and its function acts as a defensive and destructive role in the body, and the persistent high basal level of inflammation in the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the course of the However, it is still not possible to have an effective and extensive application in clinical application, and the specific reason may be related to the number of involved types of inflammation and the interaction. Procalcitonin (PCT) has been found to be a pre-peptide substance without hormone activity, and the external stability of procalcitonin (PCT) is very good. In recent years, the clinical application value of PCT is mainly the early prediction and evaluation of bacterial infection and systemic inflammatory response, and the clinical data confirm that PCT has an important role in the assessment of the severity of bacterial inflammation and the evaluation of the effect of antibacterial and prognosis. due to the fact that it has certain tissue specificity and wide expression, it is suggested that this index may have the diagnostic value of the application other than the diagnosis and treatment of bacterial infection, and in recent years basic research and clinical observation have found, The PCT also has the value of the judgment of the degree of the condition of the aseptic inflammation and the evaluation value of the degree of tissue injury, and the correlation between the PCT and the inflammatory factors has found that the PCT also has the ability to comprehensively reflect the inflammatory factors. These previous studies have found that the ability of PCT to reflect the inflammatory injury and the need for diagnosis and treatment of diabetes do not match. Objective: To compare the expression of procalcitonin (PCT) in the patients with diabetes (Diabetes Mellitus, DM), and to compare the correlation between the correlation of PCT and the pathogenesis of diabetes and the degree of diabetes. It is suggested that PCT has a certain value for the diagnosis of diabetes. Methods:878 diabetic patients were selected to study the PCT? TNF-1 in patients with different degree of infection. IL-6? INF-1 level; combined infection diagnosis, fasting blood glucose (FBG) and glycosylated hemoglobin (Hb), urinary microalbumin (UmAlb), acute venereal disease physiology and long-term health evaluation II (AACHEII: Aute Physiology and Chronic Health Evaluation II) did not have complications in the early stage of DM, The severity of the chronic complications and the acute complications was graded, and the condition of the disease was assessed with PCT? TNF-1? The expression level of IL-6? INF-1. Results:1. PCT expression in DM patients increased with the severity of the course of the disease, and the level of PCT basal expression in DM patients was higher than that of normal controls, and the level of PCT expression in patients with acute complication was the highest, while the level of PCT expression in early DM group was the lowest. The difference of PCT expression is up-regulated with the severity of the disease, and other inflammatory markers TNF-1? IL-6, INF-1 showed up-regulation of non-infection and local infections with a lower severity of early and chronic complications of DM, There were no significant changes in the level of PCT expression in DM patients and the severity of the disease, and the level of PCT in DM patients was higher than that of normal controls (0.1 to 0.05 ng/ ml). The correlation of the disease grade index and the PCT and other relevant inflammation indexes of different stages was found, in the early period of no complications, chronic complications and acute concurrent DM patients, PCT? TNF-1? IL-6 showed a difference in expression in each group; INF-6 showed a difference in expression only in patients with no complications and chronic complications in the early stage of DM (lower HbA1c%/ FPG grade score), while the level of expression in patients with systemic infection was lower than that of normal controls (8.31% 2.87 pg/ ml). The correlation analysis found that the inflammatory factor PCT? TNF-1? IL-6? INF-1 showed a different degree of correlation in different degree of disease. There is a correlation between IL-6? INF-1, which is associated with TNF-1? There was a positive correlation between IL-6 and negative correlation with INF-6, but the statistical analysis of the correlation between chronic and acute complications with high degree of inflammation was poor. In patients with lower levels of Hb%%/ FPG, PCT? TNF-1? There was a correlation between IL-6? INF-1 and the grade of the disease, which was related to PCT? TNF-1? IL-6 showed positive correlation and negative correlation with INF-6. In patients with DM acute complications according to the APACHEII score, patients with a score of less than 15 PCT? TNF-1? IL-6? INF-1 showed a correlation, whereas in patients with a score of 15, the correlation was poor and there was a low correlation between the PCT and the table. Conclusion: The level of PCT expression in DM patients is a response to the severity of the disease, especially the degree of inflammation, and PCT may be of great reference value to the diagnosis and treatment of the severity of the disease.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1
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