本文選題：C反應(yīng)蛋白　切入點：腦出血　出處：《河南科技大學(xué)》2017年碩士論文

【摘要】：目的:腦出血(Intracerebral Hemorrhage,ICH),是指原發(fā)性非外傷性腦實質(zhì)內(nèi)出血,又稱自發(fā)性腦出血,在我國占卒中的17.1%-55.4%,年發(fā)病率為60-80/10萬人,急性期病死率為30%-40%,病死率居于急性腦血管病首位。關(guān)于腦出血的治療和預(yù)后評估的研究一直滯后于缺血性腦卒中,而且一直缺乏循證醫(yī)學(xué)證實的有效治療手段。既往公認入院時格拉斯哥昏迷評分、腦出血量、出血部位、年齡等因素與患者的預(yù)后密切相關(guān),所以只是采用手術(shù)或藥物針對顱內(nèi)高壓和腦水腫對癥治療,現(xiàn)在越來越多的研究表明,腦出血后引起的腦組織周圍炎癥反應(yīng),是加重腦損傷的重要途徑。C反應(yīng)蛋白(C-reactive protein,CRP)是炎癥、感染、損傷等刺激下主要由肝臟產(chǎn)生的一種急性反應(yīng)蛋白,腦出血時一系列復(fù)雜的損傷機制中均伴發(fā)著炎癥反應(yīng),許多研究都證實腦出血患者體內(nèi)C反應(yīng)蛋白水平會有不同程度的改變,且患者預(yù)后相關(guān)。本研究旨在統(tǒng)評價C反應(yīng)蛋白對腦出血患者預(yù)后的影響,通過循證醫(yī)學(xué)的角度,更加科學(xué)的評估C反應(yīng)蛋白與腦出血患者預(yù)后的相關(guān)性,為進一步臨床研究及應(yīng)用提供可靠證據(jù)。方法:采用Cochrane系統(tǒng)評價方法,計算機檢索Pub Med、The Cochrane Library、EMbase、相關(guān)期刊論文(CNKI)、萬方數(shù)據(jù)庫(Wan Fang Data)、中文科技期刊全文數(shù)據(jù)庫(VIP),同時手工檢索相關(guān)資料及各研究參考文獻目錄,查找所有關(guān)于C反應(yīng)蛋白與腦出血預(yù)后影響的研究,檢索時限均為從建庫至2016年9月。經(jīng)全面搜索資料庫后,由2位評價員按照納入與排除標準獨立進行篩選文獻,如遇分歧,則討論解決或交由第三方協(xié)助裁定。最后按預(yù)先設(shè)計的資料提取表格提取資料、評價納入研究的方法學(xué)質(zhì)量。應(yīng)用紐卡斯爾一渥太華量表評價隊列研究,評分5~9顆星為高質(zhì)量研究。提取全部研究所需資料和評價納入研究的方法學(xué)質(zhì)量后,采用RevMan 5.3軟件進行Meta分析。結(jié)果:共納入13個觀察性研究(英文文獻6篇、中文文獻7篇),共2298例患者。Meta分析結(jié)果顯示:(1)與正常人群相比,腦出血患者入院時血清CRP水平較正常人群明顯升高,其差異有統(tǒng)計學(xué)意義[MD=6.26,95%CI(5.91,6.62),P0.00001]。(2)腦出血患者中1周內(nèi)死亡的患者入院時血清CRP水平明顯高于存活組,其差異有統(tǒng)計學(xué)意義[MD=3.00,95%CI(1.04,4.96),P=0.003];腦出血患者中1月內(nèi)死亡的患者入院時血清CRP水平明顯高于存活組,其差異有統(tǒng)計學(xué)意義[MD=2.27,95%CI(1.67,2.87),P0.00001];腦出血患者中半年內(nèi)死亡的患者入院時血清CRP水平明顯高于存活組,其差異有統(tǒng)計學(xué)意義[MD=2.62,95%CI(0.97,4.28),P=0.002];腦出血患者中1年內(nèi)死亡的患者入院時血清CRP水平明顯高于存活組,其差異有統(tǒng)計學(xué)意義[MD=2.09,95%CI(0.92,3.26),P=0.0005]。將所有亞組匯總分析后,結(jié)果亦顯示死亡組患者入院時血清CRP水平明顯高于存活組[MD=2.31,95%CI(1.82,2.80),P0.00001],說明入院時血清CRP水平越高,患者的短期死亡風(fēng)險越高,所有對比均有統(tǒng)計學(xué)意義。(3)預(yù)后較差的腦出血患者入院時血清CRP水平明顯高于預(yù)后良好的患者,其差異有統(tǒng)計學(xué)意義[MD=2.86,95%CI(1.38,4.34),P=0.0001]。入院時CRP水平升高的腦出血患者發(fā)生預(yù)后不良的風(fēng)險比CRP水平正常的腦出血患者高8.12倍,兩組比較有統(tǒng)計學(xué)意義[OR=8.12,95%CI(4.72,13.96),P0.00001]。結(jié)論:現(xiàn)有證據(jù)顯示,腦出血患者急性期血清CRP水平較正常人群明顯升高,且與腦出血患者預(yù)后有關(guān)。但受納入研究的數(shù)量與質(zhì)量的限制,上述結(jié)論有待更多大樣本、多中心、高質(zhì)量的研究加以驗證。
[Abstract]:Objective: cerebral hemorrhage (Intracerebral, Hemorrhage, ICH), refers to the primary non traumatic intracerebral hemorrhage, also known as spontaneous cerebral hemorrhage, stroke in China accounted for 17.1%-55.4%, the annual incidence rate of 60-80/10 million people, the death rate in acute stage of 30%-40%, the mortality rate in acute cerebrovascular disease research and treatment first. Assessment of cerebral hemorrhage and prognosis of ischemic stroke has been lagging behind, and has been the lack of effective treatment on medicine confirmed. Previously recognized admission Glasgow coma score, cerebral hemorrhage, bleeding site, prognostic factors such as age and patients are closely related, so only by surgery or drugs for intracranial hypertension and cerebral edema symptomatic treatment, now more and more studies show that peripheral inflammation induced by cerebral hemorrhage in brain tissue, is an important way to aggravate brain injury.C reactive protein (C-reactive protein, CRP) is inflammation, An acute infection, C-reactive protein damage and other stimuli produced mainly by the liver, cerebral hemorrhage is a complex series of damage mechanisms were associated with inflammatory reaction, many studies have confirmed that the level of serum C reactive protein in patients have different degrees of change of cerebral hemorrhage and the prognosis of patients. The purpose of this study is to influence the system evaluation of C reactive protein on the prognosis of patients with cerebral hemorrhage, through the perspective of evidence-based medicine, the prognosis of patients with more scientific assessment of the correlation between C reactive protein and cerebral hemorrhage, for further clinical research and application provide reliable evidence. Methods: the Cochrane, Med The Cochrane searched Pub, Library, EMbase, China journal full text database (CNKI), Wanfang database (Wan Fang Data), Chinese PSTP (VIP), and hand searching related information and the research reference list, find the relevant Study on C reactive protein and prognosis of cerebral hemorrhage, were searched from inception to September 2016. After a comprehensive search database, by 2 reviewers independently according to the inclusion and exclusion criteria were screened in case of disagreement, then discuss solutions or by the third parties to assist decision. Finally, according to the pre designed data extraction table data extraction, quality evaluation methods included in the study. The application of Newcastle Ottawa scale evaluation cohort study, scores of 5~9 stars for high quality research. The quality of all the required information extraction and evaluation methods included in the study, Meta analysis was performed using RevMan 5.3 software. Results: 13 observational studies were included (English 6 articles, Chinese 7 articles), a total of 2298 cases of patients with.Meta analysis results showed that: (1) compared with the normal population, patients with cerebral hemorrhage serum level of CRP was significantly higher than the normal population, the 宸紓鏈夌粺璁″鎰忎箟[MD=6.26,95%CI(5.91,6.62),P0.00001].(2)鑴戝嚭琛，

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