本文選題：血清C肽　切入點(diǎn)：缺血性腦血管病　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的本研究通過(guò)對(duì)非糖尿病的缺血性腦血管病患者行頸動(dòng)脈超聲檢測(cè)頸動(dòng)脈內(nèi)-中膜厚度(IMT)及血清C肽檢測(cè),探討在缺血性腦血管病中血清C肽水平與非糖尿病患者頸動(dòng)脈內(nèi)中膜厚度(IMT)的相關(guān)性。方法篩選自2013年9月至2014年4月在東阿縣人民醫(yī)院住院的所有非糖尿病的缺血性腦血管病患者115例。包括男性56例,女性59例,患者的年齡介于49歲至71歲之間,平均年齡為64.2±8.9歲。缺血性腦血管病包括短暫性腦缺血發(fā)作(TIA)和腦梗塞(PCI),短暫性腦缺血發(fā)作(TIA)是指顱內(nèi)動(dòng)脈病變引起的一過(guò)性或短暫性、局灶性腦或視網(wǎng)膜功能障礙,臨床癥狀一般持續(xù)10至15分鐘,多在1小時(shí)內(nèi)恢復(fù),不超過(guò)24小時(shí)。不遺留神經(jīng)功能缺損的癥狀和體征,影像學(xué)(CT、MRI)檢查無(wú)責(zé)任病灶。腦梗塞(PCI)指腦部血液循環(huán)障礙,缺血、缺氧導(dǎo)致的局限性腦組織的缺血性壞死或軟化。所有病人均符合短暫性腦缺血發(fā)作(TIA)及腦梗塞(PCI)的標(biāo)準(zhǔn),并排除年齡大于80歲,糖尿病患者、腦出血患者、惡性腫瘤、在過(guò)去的2月內(nèi)有手術(shù)及嚴(yán)重的外傷史、嚴(yán)重的心肺肝腎疾病、感染性疾病、自身免疫性疾病、一氧化碳中毒、安眠藥物中毒、農(nóng)藥中毒的患者,所有入選患者均由有5年以上工作經(jīng)驗(yàn)的超聲醫(yī)師行頸部血管超聲檢查測(cè)頸動(dòng)脈內(nèi)中膜厚度,并根據(jù)內(nèi)中膜厚度進(jìn)行分組,入選患者并行空腹血清C肽、血糖、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、血同型半胱氨酸(Hcy)檢查,統(tǒng)計(jì)所有患者的性別、年齡、吸煙及飲酒情況,房顫病史、高血壓的分級(jí),血清C肽、血同型半胱氨酸(Hcy)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)及頸動(dòng)脈內(nèi)中膜厚度(IMT);2比較各組的臨床資料和C肽水平,利用統(tǒng)計(jì)學(xué)分析在缺血性腦血管病中血清C肽與非糖尿病患者頸動(dòng)脈內(nèi)中膜厚度(IMT)關(guān)系。應(yīng)用SPSS 18.0軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(sx±)表示,通過(guò)兩獨(dú)立樣本t檢驗(yàn)統(tǒng)計(jì)對(duì)兩組間均數(shù)進(jìn)行比較,采用方差分析的方法比較多組間均數(shù)并進(jìn)行均數(shù)的兩兩比較。采用卡方檢驗(yàn)統(tǒng)計(jì)分析組間構(gòu)成比的比較。采用Person相關(guān)分析對(duì)指標(biāo)間相關(guān)性進(jìn)行統(tǒng)計(jì)學(xué)分析,采用多元線(xiàn)性回歸分析探索C肽含量的影響因素。檢驗(yàn)水準(zhǔn)a=0.05,P≤0.05為兩組之間的差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1、三組CIMT分組間與C肽、年齡、LDL、HDL、Hcy指標(biāo)的比較:CIMT0.9mm組、0.9≤CIMT1.1mm組、CIMT≥1.1mm組的平均年齡差異有統(tǒng)計(jì)學(xué)意義(P0.05),隨著年齡的增加,CIMT厚度增加;CIMT0.9mm組、0.9≤CIMT1.1mm組的Hcy均數(shù)較CIMT≥1.1mm的Hcy均數(shù)明顯降低,差異有統(tǒng)計(jì)學(xué)意義((P0.05);CIMT三組間在C肽、LDL、HDL方面的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2、性別與CIMT分組的關(guān)系:在CIMT0.9mm組、CIMT≥1.1mm組女性占得比例較男性高,0.9≤CIMT1.1mm組男性占的比例較高,不同性別的CIMT差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、不同性別間和C肽、LDL、HDL、Hcy指標(biāo)的比較:女性LDL均數(shù)較男性LDL均數(shù)高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但由于兩者均數(shù)均在正常范圍內(nèi),故差異無(wú)臨床意義;不同性別間在Hcy、C肽、HDL差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4、有無(wú)吸煙與C肽、LDL、HDL、Hcy指標(biāo)的比較:吸煙者LDL的均數(shù)較不吸煙者LDL的均數(shù)低,LDL的差異有統(tǒng)計(jì)學(xué)意義(P0.05),但由于兩者的均數(shù)在正常值范圍內(nèi),故差異無(wú)臨床意義;有無(wú)吸煙在C肽、HDL、Hcy方面的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5、有無(wú)飲酒與C肽、LDL、HDL、Hcy指標(biāo)的比較:無(wú)飲酒者Hcy的均數(shù)較飲酒者Hcy的均數(shù)低,Hcy的差異有統(tǒng)計(jì)學(xué)意義(P0.05);有無(wú)飲酒在C肽、HDL、LDL方面的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6、有無(wú)房顫與年齡、C肽、LDL、HDL、Hcy指標(biāo)的比較:患者有無(wú)房顫,在年齡、C肽、LDL、HDL、Hcy方面的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。7、高血壓分級(jí)與年齡、C肽、LDL、HDL、Hcy指標(biāo)的比較:1級(jí)高血壓HDL的均數(shù)較2級(jí)和無(wú)高血壓HDL均數(shù)低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但三者的HDL均數(shù)在正常值范圍內(nèi),差異無(wú)臨床意義;在年齡、C肽、LDL、Hcy方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。8、研究對(duì)象血清中C肽的含量與頸部血管內(nèi)膜厚度呈負(fù)相關(guān)(r值為-0.273,P值為0.003),血清中C肽的含量與LDL、HDL、Hcy之間無(wú)相關(guān)性。9、除年齡外,將C肽、LDL、HDL、Hcy四項(xiàng)指標(biāo)進(jìn)入回歸方程中,Hcy的P值為0.038,與頸動(dòng)脈內(nèi)中膜厚度有線(xiàn)性回歸關(guān)系,C肽、LDL、HDL與頸動(dòng)脈內(nèi)中膜厚度無(wú)線(xiàn)性回歸關(guān)性。結(jié)論在缺血性腦血管病中血清C肽可減少非糖尿病頸動(dòng)脈內(nèi)中膜厚度,說(shuō)明C肽在預(yù)防頸動(dòng)脈粥樣硬化的發(fā)生發(fā)展中可能起到保護(hù)性的作用。
[Abstract]:The purpose of this study is based on the non diabetic patients with ischemic cerebrovascular disease carotid ultrasound detection of carotid artery intima-media thickness (IMT) and detection of serum C peptide, serum C peptide level and non diabetic patients with carotid intima-media thickness in ischemic cerebrovascular disease (IMT). The correlation method of screening from September 2013 to April 2014 in Dong'e County People's Hospital of all 115 patients with ischemic cerebrovascular disease in non diabetic patients. Including male 56 cases, female 59 cases, age of the patients ranged from 49 to 71 years old, the average age was 64.2 + 8.9 years. Ischemic cerebrovascular disease including transient ischemic attack (TIA) and cerebral infarction (PCI), transient ischemic attack (TIA) is caused by intracranial arterial lesions in a transient or transient focal cerebral or retinal dysfunction, clinical symptoms usually lasts for 10 to 15 minutes, the recovery in 1 hours, not more than 24 When not. Left neurological defect symptoms and signs, imaging (CT, MRI). Check without responsible lesions of cerebral infarction (PCI) refers to the brain blood circulation disorder, ischemia, limitation of brain tissue hypoxia leads to necrosis or softening. All of the patients with transient ischemic attack (TIA) and brain infarction (PCI) standard, and the exclusion of older than 80, patients with diabetes, patients with cerebral hemorrhage, malignant tumor, surgery and severe trauma history in the past February, severe cardiopulmonary liver and kidney disease, infectious diseases, autoimmune diseases, carbon monoxide poisoning, hypnotic drug poisoning, poisoning the patients, measuring the intima-media thickness of carotid artery in all patients were selected from more than 5 years working experience in ultrasound doctors for neck vascular ultrasound, and were grouped according to the intima-media thickness of the patients, parallel fasting serum C peptide, blood glucose, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), homocysteine (Hcy) examination, statistics of all patients with gender, age, smoking and drinking, history of atrial fibrillation, hypertension grade, serum C peptide, plasma homocysteine (Hcy), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) and carotid intima-media thickness (IMT); the 2 groups were compared the clinical data and C peptide level, using statistical analysis of serum C peptide and non diabetic carotid intima-media thickness in patients with ischemic cerebrovascular disease (IMT). SPSS 18 software was used for data analysis. The measurement data using the mean and standard deviation (SX +) said on the two groups were compared by two independent samples t test statistics, analysis of variance was used to compare Multi-X group and comparison were the number 22. The constituent ratio of the chi square statistic analysis between groups. The statistical analysis of the correlation between indicators by Person correlation analysis, multiple regression analysis was used to explore the influencing factors of C peptide content. The inspection level a=0.05, P = 0.05, there was statistically significant difference between the two groups. The 1 group, three CIMT group and C peptide, LDL, age, HDL, Hcy index CIMT0.9mm group, 0.9 CIMT1.1mm group, the average age was statistically significant difference of CIMT than 1.1mm group (P0.05), with the increase of age, the increase of the thickness of CIMT; CIMT0.9mm group, 0.9 CIMT1.1mm group of Hcy compared with the number of CIMT was 1.1mm Hcy were significantly decreased, the difference was statistically significant ((P0.05); the CIMT between the three groups in the C peptide, LDL, HDL differences were not statistically significant (P0.05.2), the relation between gender and CIMT group: in group CIMT0.9mm, CIMT = 1.1mm group of female proportion is higher than the male group, 0.9 CIMT1.1mm men accounted for a higher proportion of different gender difference CIMT 寮傛湁緇熻瀛︽剰涔，

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