本文選題：急性一氧化碳中毒遲發(fā)性腦病　切入點(diǎn)：實(shí)驗(yàn)室　出處：《延安大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討實(shí)驗(yàn)室檢查指標(biāo)(同型半胱氨酸、髓鞘堿性蛋白、S100B蛋白、神經(jīng)元特異性烯醇化酶)及磁共振成像技術(shù)(1H-MRS、DTI)在急性一氧化碳中毒的早期階段判斷中毒程度和評(píng)價(jià)預(yù)后、治療效果及在早期預(yù)測(cè)可能發(fā)生遲發(fā)性腦病的臨床價(jià)值。方法:1.回顧性分析137例急性一氧化碳中毒患者、43例一氧化碳中毒遲發(fā)性腦病患者及20例健康志愿者血漿Hcy含量,所有研究對(duì)象于肘靜脈采血行t Hcy檢測(cè),統(tǒng)計(jì)所有研究對(duì)象血漿Hcy含量,探討不同程度急性一氧化碳中毒患者t Hcy含量的變化情況、急性中毒患者與遲發(fā)性腦病患者間含量的變化情況以及t Hcy含量與一氧化碳中毒患者年齡間的關(guān)系。2.將60例ACOP患者與20例健康志愿者作為研究對(duì)象。(1).所有研究對(duì)象于肘靜脈采血行MBP、S100B蛋白、NSE檢測(cè),分析遲發(fā)性腦病組、痊愈組及正常對(duì)照組在不同時(shí)期血清MBP、S100B蛋白、NSE含量的變化情況。(2).對(duì)所有受試對(duì)象于感興趣區(qū)(ROI)行1H-MRS及DTI檢查,分析遲發(fā)性腦病組、痊愈組及正常對(duì)照組間相應(yīng)腦區(qū)NAA/Cr比值、Cho/Cr比值、FA值、ADC值的變化情況。結(jié)果:1.不同中毒程度ACOP患者血漿Hcy含量與正常對(duì)照組比較:ACOP患者t Hcy含量較正常對(duì)照組均有升高,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01);隨著中毒程度的加重t Hcy含量呈增高的趨勢(shì),血漿Hcy含量升高的水平為:重度中毒組中度中毒組輕度中毒組正常對(duì)照組。2.遲發(fā)性腦病組與急性中毒組血漿Hcy含量的比較:遲發(fā)性腦病組較急性中毒組血漿Hcy含量明顯升高,其中男性高于女性,男性患者間差異有統(tǒng)計(jì)學(xué)意義(P0.05);女性患者間差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01),總體差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。3.一氧化碳中毒患者年齡與血漿Hcy含量的相關(guān)性分析:一氧化碳中毒患者的年齡與血漿Hcy含量呈正相關(guān),但相關(guān)程度較低。4.ACOP患者血清MBP、S100B蛋白、NSE含量與正常對(duì)照組比較:ACOP患者血清MBP、S100B蛋白、NSE含量均較正常對(duì)照組明顯升高,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01);遲發(fā)性腦病組與痊愈組比較:遲發(fā)性腦病組血清S100B蛋白含量較痊愈組增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);血清MBP、NSE含量明顯高于痊愈組,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。5.遲發(fā)性腦病組患者血清MBP、S100B蛋白、NSE含量在急性中毒時(shí)與發(fā)生遲發(fā)性腦病時(shí)比較:發(fā)生遲發(fā)性腦病時(shí)血清MBP、S100B蛋白、NSE含量較急性中毒時(shí)有所增高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.遲發(fā)性腦病組患者在恢復(fù)期與發(fā)生遲發(fā)性腦時(shí)比較:恢復(fù)期患者血清MBP、S100B蛋白、NSE含量較發(fā)生遲發(fā)性腦病時(shí)均明顯降低,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。7.遲發(fā)性腦病組患者在恢復(fù)期與正常對(duì)照組比較:遲發(fā)性腦病組患者在恢復(fù)期血清S100B蛋白、NSE含量較正常對(duì)照組略有增高,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);而血清MBP含量仍明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。8.行顱腦1H-MRS、DTI檢查結(jié)果顯示:(1).顱腦1H-MRS示:所有急性中毒患者在感興趣區(qū)(基底節(jié)區(qū)、側(cè)腦室旁白質(zhì)、半卵圓中心)均出現(xiàn)不同程度的異常表現(xiàn),主要表現(xiàn)為可檢出不等的乳酸峰,NAA峰減低,NAA/Cr比值降低,Cho峰升高,Cho/Cr比值增高,而遲發(fā)性腦病組患者極少數(shù)可檢出乳酸峰,但NAA/Cr比值、Cho/Cr比值較急性中毒時(shí)變化更明顯。(2).顱腦DTI示:遲發(fā)性腦病患者顱腦諸纖維走行有局限性腫脹,部分走行稀疏或中斷。選取該異常信號(hào)區(qū)作為感興趣區(qū)進(jìn)行測(cè)量結(jié)果顯示:FA值明顯降低,ADC值局部升高或降低。9.ACOP患者不同測(cè)量部位NAA/Cr、Cho/Cr比值與正常對(duì)照組比較:ACOP患者較正常對(duì)照組NAA/Cr比值均降低,Cho/Cr比值均升高,遲發(fā)性腦病組變化更明顯。痊愈組與正常對(duì)照組比較:側(cè)腦室旁白質(zhì)NAA/Cr、Cho/Cr比值差異有統(tǒng)計(jì)學(xué)意義(P0.05);半卵圓中心NAA/Cr比值、Cho/Cr比值差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01),基底節(jié)區(qū)NAA/Cr比值差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01);Cho/Cr比值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。遲發(fā)性腦病組與正常對(duì)照組NAA/Cr、Cho/Cr比值比較:差異均有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。遲發(fā)性腦病組與痊愈組NAA/Cr、Cho/Cr比值比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);基底節(jié)區(qū)和側(cè)腦室旁白質(zhì)差異更顯著(P0.01)。10.遲發(fā)性腦病組在急性中毒時(shí)與發(fā)生遲發(fā)性腦病時(shí)不同測(cè)量部位NAA/Cr比值、Cho/Cr比值比較:發(fā)生遲發(fā)性腦病時(shí)不同測(cè)量部位較急性中毒時(shí)NAA/Cr比值均有降低,Cho/Cr比值均升高,而基底節(jié)區(qū)變化顯著,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.05)。11.遲發(fā)性腦病組不同測(cè)量部位NAA/Cr、Cho/Cr比值比較:不同測(cè)量部位間NAA/Cr、Cho/Cr比值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。12.ACOP患者不同測(cè)量部位FA值與正常對(duì)照組比較:ACOP患者不同測(cè)量部位FA值較正常對(duì)照組均有降低,差異均有明顯統(tǒng)計(jì)學(xué)意義(P0.01);遲發(fā)性腦病組在急性中毒時(shí)與痊愈組比較降低更明顯,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。13.ACOP患者不同測(cè)量部位ADC值與正常對(duì)照組比較:基底節(jié)區(qū)ADC值較正常對(duì)照組升高,側(cè)腦室旁白質(zhì)及半卵圓中心較對(duì)照組均降低,遲發(fā)性腦病組變化更明顯。痊愈組與正常對(duì)照組比較:基底節(jié)區(qū)差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01);側(cè)腦室旁白質(zhì)及半卵圓中心差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。遲發(fā)性腦病組與正常對(duì)照組比較:差異均有明顯統(tǒng)計(jì)學(xué)意義(P0.01)。遲發(fā)性腦病組在急性中毒時(shí)與痊愈組比較:基底節(jié)區(qū)差異有明顯統(tǒng)計(jì)學(xué)意義(P0.01);側(cè)腦室旁白質(zhì)及半卵圓中心差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.ACOP患者血漿Hcy含量在急性中毒時(shí)較對(duì)照組均有增高,且隨中毒程度2.的增加而明顯增高,推測(cè)通過(guò)檢測(cè)血漿Hcy含量可作為臨床判定ACOP患者中毒程度的指標(biāo)之一。血漿Hcy含量與年齡有關(guān)。檢測(cè)血漿Hcy含量是否可以作為早期預(yù)測(cè)DEACMP的指標(biāo)有待進(jìn)一步研究。3.ACOP患者血清MBP、S100B蛋白、NSE含量較正常對(duì)照組均有升高,且發(fā)生遲發(fā)性腦病患者較痊愈組升高更明顯,以MBP、NSE含量升高為矚,DEACMP組恢復(fù)期血清MBP仍高于正常對(duì)照組,推測(cè)監(jiān)測(cè)MBP、NSE含量對(duì)于預(yù)測(cè)遲發(fā)性腦病的發(fā)生更有意義。4.發(fā)生遲發(fā)性腦病時(shí)血清MBP、S100B蛋白、NSE含量較急性中毒時(shí)仍略有增高。5.ACOP患者不同測(cè)量部位NAA/Cr比值較正常對(duì)照組均減低,Cho/Cr比值均增高,各測(cè)量部位間無(wú)明顯差異。6.顱腦DTI技術(shù)可直觀腦白質(zhì)纖維束的走行;ACOP患者不同測(cè)量部位FA值較正常對(duì)照組均降低;基底節(jié)區(qū)ADC值升高,側(cè)腦室旁白質(zhì)及半卵圓中心ADC值均降低。FA、ADC值的變化情況對(duì)于預(yù)測(cè)DEACMP的發(fā)生或評(píng)價(jià)預(yù)后,有待進(jìn)一步探討。
[Abstract]:Objective: To investigate the laboratory indexes (homocysteine, myelin basic protein, S100B protein, neuron specific enolase) and magnetic resonance imaging (1H-MRS, DTI) in the early stage of judgement on the severity and prognosis of acute carbon monoxide poisoning, treatment effect and forecast the possible clinical value of delayed encephalopathy in early stage methods: 1. patients were retrospectively analyzed in 137 patients with acute poisoning of carbon monoxide, 43 cases of delayed encephalopathy after carbon monoxide poisoning patients and 20 healthy volunteers plasma Hcy content, all of the subjects in venous blood T Hcy detection, the Hcy content of all the research objects to investigate the changes of plasma statistics, different degree of t Hcy in patients with acute carbon monoxide poisoning the changes of patients with acute poisoning with delayed encephalopathy patients between the content and the relationship between.2. age T and Hcy content among the 60 patients with carbon monoxide poisoning Patients with ACOP and 20 healthy volunteers as the research object. (1). All subjects from the elbow vein blood MBP, S100B protein, NSE detection and analysis of delayed encephalopathy group, recovery group and normal control group at different times of serum MBP, S100B protein, the changes of the NSE content. (2). Of all subjects in the region of interest (ROI) underwent 1H-MRS and DTI examination, analysis of delayed encephalopathy group, recovery group and normal control group NAA/Cr corresponding brain area ratio, Cho/Cr ratio, FA value, the change of ADC value. Results: compared with the normal control group of 1. different degrees of poisoning in patients with ACOP Hcy content: ACOP t Hcy in patients were higher than normal control group, there was significant difference (P0.01); with the severity of poisoning t Hcy content showed an increasing trend, and increase the content of plasma Hcy level: normal control group.2. severe group, moderate poisoning group mild poisoning group poisoning Comparison of delayed encephalopathy group and acute poisoning group serum Hcy content: delayed encephalopathy group, plasma Hcy content was significantly increased in acute poisoning, the male is higher than female, the difference was statistically significant between male patients (P0.05); there was a significant difference between female patients (P0.01), there was significant difference (P0.01) analysis of the correlation between age and plasma Hcy content of.3. carbon monoxide poisoning: the content of plasma Hcy was positively related with age of patients with carbon monoxide poisoning, but the low level of serum.4.ACOP in patients with MBP, S100B protein, compared with normal control group: the NSE content of serum ACOP in patients with MBP, S100B protein, NSE content were higher than the normal control group was significantly increased, there was significant difference (P0.01); delayed encephalopathy group and cure group: delayed encephalopathy group serum S100B protein content compared with the cured group, there was statistically significant difference Yi (P0.05); serum MBP, NSE were significantly higher than that of the cured group, there was significant difference (P0.01).5. delayed encephalopathy group serum MBP, S100B protein, NSE content in acute poisoning with delayed encephalopathy: delayed encephalopathy of serum MBP, S100B protein, NSE the content is acute poisoning has increased, but the difference was not statistically significant (P0.05).6. delayed encephalopathy group in patients with delayed brain during recovery period and recovery period occurs: serum MBP, S100B protein, the content of NSE is the occurrence of delayed encephalopathy were significantly decreased, there was significant difference (P0.01).7. delayed encephalopathy patients in the recovery period compared with the normal control group: delayed encephalopathy patients in convalescent serum S100B protein, NSE content increased slightly compared with the normal control group, the difference was not statistically significant (P0.05); the serum MBP contents were significantly higher than the control group, 宸紓鏈夌粺璁″鎰忎箟(P0.05).8.琛岄鑴，

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