本文選題：鹽酸法舒地爾　切入點(diǎn)：急性腦梗死　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究鹽酸法舒地爾注射液對急性腦梗死患者的臨床療效及其對血清中超敏-C反應(yīng)蛋白(Hs-CRP)、血管內(nèi)皮生長因子(VEGF)、白細(xì)胞介素-6(IL-6)水平的影響,以及探討該藥在急性腦梗死炎癥反應(yīng)過程中可能的作用機(jī)制;探討IL-6、VEGF與梗死體積之間的關(guān)系;探討血清炎癥因子如Hs-CRP、IL-6水平與神經(jīng)缺損的程度和預(yù)后之間是否有關(guān)系。方法:選擇于2016年3月至2016年10月在河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科收入院的符合入選標(biāo)準(zhǔn)的急性腦梗死患者共有84例,其中女性28例,男性56例,年齡范圍在30歲到80歲。將符合要求的所有患者按隨機(jī)數(shù)字進(jìn)行完全隨機(jī)分組,分為鹽酸法舒地爾治療組(n=45)與對照組(n=39),收集期間將不符合要求的患者剔除,兩組均以10d為一個療程。兩組患者在年齡、性別、基礎(chǔ)疾病等方面無顯著差異。所有的患者在入院時和第10天分別用美國國立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)評分和ADL量表評估患者病情。所有的患者均行頭顱CT或MRI檢查,然后根據(jù)Pullicino公式計(jì)算梗死體積。分別于入院第2天和第10天采集肘靜脈血,離心后分離血清,用ELISA試劑盒測定血清VEGF、IL-6水平,Hs-CRP由河北醫(yī)科大學(xué)第二醫(yī)院檢驗(yàn)科完成。應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS進(jìn)行統(tǒng)計(jì)分析:計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示,如果數(shù)據(jù)分布滿足正態(tài)性和方差齊性條件者,可選擇兩獨(dú)立樣本t檢驗(yàn);如果數(shù)據(jù)分布不滿足正態(tài)性和(或)方差齊性條件者,可選擇兩獨(dú)立樣本非參數(shù)Wilcoxon秩和檢驗(yàn)。計(jì)數(shù)資料可選擇R×C卡方檢驗(yàn)。定義顯著性水平α=0.05,并且認(rèn)為P0.05時差別是有統(tǒng)計(jì)學(xué)意義的。相關(guān)性分析選用非參數(shù)檢驗(yàn)Spearman秩相關(guān),定義顯著性水平α=0.01,且認(rèn)為P0.01時兩者之間是有相關(guān)關(guān)系的存在。結(jié)果:1治療組(n=45)和對照組(n=39)兩組患者在性別和年齡方面;血脂化驗(yàn)如甘油三酯、膽固醇、低密度脂蛋白等方面;主要基礎(chǔ)疾病如高血壓病史、冠心病史、糖尿病病史、陳舊性腦梗死病史方面;不良嗜好方面如吸煙史、飲酒史等各方面之間無統(tǒng)計(jì)學(xué)差異(p0.05)。血清同型半胱氨酸之間比較有統(tǒng)計(jì)學(xué)差異(p0.05)。2兩組治療前血清hs-crp水平無統(tǒng)計(jì)學(xué)差異(p=0.927,p0.05);治療后hs-crp水平呈下降趨勢,但兩組之間無統(tǒng)計(jì)學(xué)差異(p=0.920,p0.05);3兩組治療前血清vegf有統(tǒng)計(jì)學(xué)差異(p=0.007,p0.05);治療后血清vegf較治療前增高,且兩組之間有統(tǒng)計(jì)學(xué)差異(p=0.003,p0.05)。4兩組治療前血清il-6無統(tǒng)計(jì)學(xué)差異(p=0.114,p0.05),治療后血清il-6較治療前下降,且兩組之間有統(tǒng)計(jì)學(xué)差異(p=0.043,p0.05)。5nihss評分之間的比較:兩組試驗(yàn)對象治療的顯效率有統(tǒng)計(jì)學(xué)差異(p=0.000,p0.05);有效率無統(tǒng)計(jì)學(xué)差異(p=0.235,p0.05)。6血清hs-crp、il-6與神經(jīng)功能相關(guān)性分析:治療前后血清hs-crp均與同期nihss評分之間無相關(guān)關(guān)系(p0.01);治療前后血清hs-crp均與同期adl評分之間無相關(guān)關(guān)系(p0.01);治療前后血清il-6均與同期nihss評分之間無相關(guān)關(guān)系(p0.01);治療前后血清il-6均與同期adl評分之間有相關(guān)關(guān)系(p0.01)。7不同梗死體積入院時血清il-6、vegf比較:隨著梗死體積增大,血清il-6濃度增高,且大、中、小體積三者之間有差異統(tǒng)計(jì)學(xué)(p=0.025,p0.05);隨著梗死體積的增大,大體積梗死血清vegf的水平高于小體積梗死水平,但不高于中體積梗死水平,三者之間無統(tǒng)計(jì)學(xué)差異(p=0.378,p0.05)。結(jié)論:1試驗(yàn)組和對照組相比,試驗(yàn)組有更強(qiáng)的抗炎能力和更高的臨床治療顯效率。2白細(xì)胞介素-6作為可炎性血清的標(biāo)記物,與梗死體積相關(guān),并能評估預(yù)后,鹽酸法舒地爾可顯著降低其含量,說明鹽酸法舒地爾有更強(qiáng)的抗炎能力和神經(jīng)保護(hù)作用。3hs-crp可能并不適合作為急性腦梗死的血清學(xué)標(biāo)記物,在評估病情和預(yù)后方面均無明顯顯著相關(guān)性。
[Abstract]:Objective: To study the clinical effect of Fasudil Hydrochloride Injection protein in patients with acute cerebral infarction and its response to serum high-sensitivity -C (Hs-CRP), vascular endothelial growth factor (VEGF), interleukin -6 (IL-6) levels, and to investigate the drug in acute cerebral infarction inflammatory reaction in the process of the possible mechanism of IL-6 relationship; between the VEGF and the infarction volume; to investigate the serum levels of inflammatory factors such as Hs-CRP, whether there is a relationship between IL-6 levels and the degree and prognosis of nerve defect. Methods: from March 2016 to October 2016 in the second hospital of Hebei Medical University admitted to hospital with acute cerebral infarction were included a total of 84 cases, there were 28 female and 56 male patients and in the age range of 30 to 80 years old. All patients will meet the requirements of the completely randomized randomly, divided into fasudil group (n=45) and the Control group (n=39), the collection period will not meet the requirements of patients were excluded, two groups were in 10d for a course of treatment. Two patients in age, gender, no significant differences in the underlying disease. All patients at admission and tenth days respectively by the National Institutes of Health Stroke Scale (National Institutes of Health Stroke Scale, NIHSS) score and ADL scale assessment of patients. All patients underwent head CT or MRI examination, and then calculate the infarct volume according to Pullicino formula respectively. On the second day after admission and tenth days to collect venous blood after centrifugal separation of serum, serum VEGF, ELISA IL-6 kit Hs-CRP, completed by the inspection department of the second hospital of Hebei Medical University. SPSS software was used for statistical analysis: measurement data with the mean standard deviation of that if the data distribution satisfies the normality and homogeneity of variances, can choose only two Independent samples t test; if the data does not meet the normal distribution and homogeneity of variance (or) conditions, can choose two independent samples of non parametric test and Wilcoxon test. Enumeration data can choose R * C chi square test. The definition of the confidence level =0.05, and that the P0.05 difference was statistically significant. Correlation analysis using Spearman rank correlation test, the definition of the confidence level =0.01, and that between P0.01 there is a correlation exists. Results: 1 treatment group (n=45) and control group (n=39 group) and two patients in the aspects of gender and age; blood lipid test such as triglycerides, cholesterol, low density lipoprotein protein; basic diseases such as hypertension, coronary heart disease history, diabetes history, aspects of old history of cerebral infarction; bad habits such as smoking, no significant difference between the various aspects of drinking history (P0.05). The serum homocysteine. Were statistically significant difference (P0.05) serum level of hs-CRP had no statistically significant difference in.2 before treatment in the two groups (p=0.927, P0.05); decreased the level of hs-CRP after treatment, but no significant difference between the two groups (p=0.920, P0.05); 3 of the two groups before treatment, there were significant differences in serum VEGF (p=0.007, P0.05) after treatment; the serum VEGF increased compared with that before treatment, and there were significant differences between the two groups (p=0.003, P0.05) of serum IL-6 had no significant difference between the two groups before treatment.4 (p=0.114, P0.05), serum levels of IL-6 after treatment than before treatment decreased, and there were significant differences between the two groups (p=0.043, P0.05).5nihss score between the two groups the test object treatment effective rate had significant difference (p=0.000, P0.05); there is no significant difference between the efficiency (p=0.235, P0.05).6 serum hs-CRP, correlation analysis between IL-6 and nerve function before and after the treatment of serum hs-CRP had no correlation with NIHSS score (P0.01) during the same period; The serum hs-CRP before and after treatment were not correlated with ADL scores over the same period (P0.01); serum IL-6 before and after treatment were not correlated with NIHSS scores over the same period (P0.01); serum IL-6 before and after treatment were correlated with ADL score (P0.01.7) from different infarct volume on admission serum IL-6, VEGF compared with infarction the volume increased, the concentration of serum IL-6 increased, and large, have significant differences between small volume three (p=0.025, P0.05); with the increase of infarct volume, the large volume of infarction serum VEGF levels higher than the small volume of stem flat but not higher than in stagnant water, the volume of infarction level, no significant differences between the three groups (p=0.378. P0.05). Conclusion: the 1 experimental group compared with the control group, the experimental group has stronger anti-inflammatory ability and higher clinical effect rate of treatment.2 interleukin -6 as a marker of inflammatory serum, correlated with infarct volume, and prognosis , fasudil hydrochloride can significantly reduce the content of that fasudil hydrochloride has stronger anti-inflammatory and neuroprotective effects of.3hs-crp may not be suitable as a serological marker of acute cerebral infarction, there were no obvious correlation in the evaluation of disease and prognosis.

【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

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 路雅寧;喬麗云;;NIHSS評分在急性腦梗死臨床評估中的價值[J];生物醫(yī)學(xué)工程與臨床;2015年03期

2 吳建華;方云祥;;法舒地爾對大鼠腦缺血再灌注損傷炎癥反應(yīng)的影響[J];中國臨床藥理學(xué)與治療學(xué);2008年04期

3 陳明生,朱瑞芬,詹慶盈;腦梗死患者血清TNF-α、IL-1β含量的變化及其臨床意義的研究[J];中國神經(jīng)免疫學(xué)和神經(jīng)病學(xué)雜志;2001年01期

，

本文編號：1594219