發(fā)布時間：2018-05-14 12:25

  本文選題：視神經(jīng)脊髓炎 + 抵抗素��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的視神經(jīng)脊髓炎(Neuromyelitis optica,NMO)是一種罕見的中樞神經(jīng)系統(tǒng)(central nervous system,CNS)自身免疫性星形膠質細胞病,其發(fā)病是抗體及多種炎癥細胞、因子等共同作用的結果。抵抗素是近年發(fā)現(xiàn)的在多種炎性疾病中發(fā)揮重要作用的脂肪細胞因子。本文旨在研究抵抗素在NMO中的作用。方法納入急性期NMO患者及年齡性別相匹配的健康對照組(Healthy controls,HCs)各56例,同時納入非炎癥性神經(jīng)系統(tǒng)疾病(non-inflammatory neurological disorders,ONNDs)患者12例作為疾病對照組。采集受試對象標本并記錄人口學信息及臨床資料,如體重指數(shù)(Body mass index,BMI)、血糖(Glucose,Glu)、總膽固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、超敏C反應蛋白(high sensitive C reactive protein,hs-CRP)、疾病首發(fā)年齡、病程、年復發(fā)率(annualized relapse rate,ARR)、脊髓受累節(jié)段數(shù)及擴展殘疾狀態(tài)量表(Expanded Disability Status Scale,EDSS)評分等。應用細胞熒光免疫染色法(Cell-based immunofluorescence assay,CBA)檢測NMO患者血清中水通道蛋白4抗體(Aquaporin-4 antibody,AQP4-Ab)水平,同時應用酶聯(lián)免疫吸附測定法(Enzyme linked immunosorbent assay,ELISA)檢測所有研究對象血清和CSF中抵抗素含量以及NMO患者予以大劑量激素沖擊后血清抵抗素水平。分類資料采用χ2檢驗進行分析。正態(tài)分布計量資料采用學生t檢驗分析組間(NMO組、健康對照組、疾病對照組)差異;非正態(tài)分布計量資料采用Mann Whitney U檢驗進行分析;BMI、Glu、TC、TG、HDL、LDL等的作用通過作為協(xié)變量加入到分析模型中進行分析。配對t檢驗用于NMO組治療前后亞組間差異的比較,Spearman相關檢驗用于統(tǒng)計標本resistin水平與患者臨床特點間的相關性。P0.05視為差異具有統(tǒng)計學意義。結果1、NMO組中有44例患者AQP4-Ab為陽性,陽性率為78.6%;2、急性期NMO患者血清抵抗素水平較HCs明顯升高(7.6±3.0 vs 4.1±1.4 ng/ml,p0.001),另外,血清hs-CRP水平在急性期NMO患者中同樣高于HCs(2.0±1.9vs 0.8±0.9mg/l,p=0.017);3、急性期NMO患者CSF中抵抗素水平較ONNDs組明顯升高(0.25±0.23 vs 0.04±0.01 ng/ml,p=0.001);4、NMO患者血清及CSF中抵抗素水平與hs-CRP呈正相關性,且差異具有統(tǒng)計學意義(r=0.303,p=0.023;r=0.622,p=0.003);5、NMO患者BMI及血清TG水平與HCs無明顯差異(p0.05),而Glu、TC、LDL和HDL與HCs間差異具有統(tǒng)計學意義(5.3±0.8 vs 4.5±0.5mmol/l,p0.001;5.0±1.1 vs 4.2±0.5 mmol/l,p0.001;3.1±0.9 vs 2.3±0.6 mmol/l,p0.001;1.3±0.4 vs 1.5±0.4 mmol/l,p=0.025),但協(xié)方差分析結果無顯著性差異(p0.05);6、急性期NMO患者血清抵抗素水平與ARR存在正相關性(r=0.354,p=0.007),但與疾病首發(fā)年齡、病程、脊髓受累節(jié)段數(shù)、EDSS評分以及AQP4-Ab水平無明顯相關性;7、16例應用大劑量激素沖擊的NMO患者在治療后血清抵抗素水平較治療前顯著減低(8.6±3.3 vs 4.7±1.5 ng/ml,p0.001)。結論1.抵抗素可能參與了NMO的發(fā)生和發(fā)展過程,并且在疾病中起到促進炎癥反應的作用;2.NMO患者CSF中抵抗素明顯升高,提示其可通過破壞的血腦屏障進入CNS發(fā)揮炎性作用;3.抵抗素炎性作用的發(fā)揮可能與hs-CRP存在一定相關性;4.血清抵抗素水平高低對于疾病的復發(fā)可能具有一定的預測作用,但與疾病的嚴重程度尚未發(fā)現(xiàn)存在明顯相關性;5.抵抗素在疾病恢復期降低,提示其可能成為評價疾病進程的指標之一,并可能成為NMO治療的潛在靶點。
[Abstract]:Objective Neuromyelitis optica (NMO) is a rare autoimmune astrocytic disease of the central nervous system (central nervous system, CNS), which is the result of the joint action of antibodies and a variety of inflammatory cells and factors. Resistin is found in recent years to play an important role in a variety of inflammatory diseases. The purpose of this study was to study the role of resistin in NMO. Methods 56 cases of acute NMO patients and 56 cases of matched age and sex healthy control group (Healthy controls, HCs) were included, and 12 cases of non inflammatory nervous system disease (non-inflammatory neurological disorders, ONNDs) were included as the disease control group. Sample and record demographic information and clinical data, such as body mass index (Body mass index, BMI), blood glucose (Glucose, Glu), total cholesterol (Total cholesterol, TC), triglycerides (Triglyceride, TG), high-density lipoprotein, low density lipoprotein (LDL), hypersensitive reactive protein Sitive C reactive protein, hs-CRP), the onset age of the disease, the course of disease, the annual recurrence rate (annualized relapse rate, ARR), the number of segmental spinal cord involvement and the scale of the extended disability state (Expanded Disability Status). The level of Aquaporin-4 antibody (AQP4-Ab) antibody (antibody, AQP4-Ab) and the serum and CSF levels of resistin in all the subjects and the level of resistin in all the subjects were detected by the enzyme linked immunosorbent assay (Enzyme linked immunosorbent assay, ELISA). The classification data were analyzed by chi square test. Normal distribution measurement data were used by students t test and Analysis Group (group NMO, health control group and disease control group); non normal distribution measurement data were analyzed by Mann Whitney U test; BMI, Glu, TC, TG, HDL, LDL, etc. were added to the analysis model as co variables. Comparison of the differences between subgroups, Spearman correlation test used the statistical significance of the correlation between the resistin level of statistical specimens and the clinical characteristics of the patients. Results 1, 44 cases in group NMO were AQP4-Ab positive, the positive rate was 78.6%; 2, the level of serum resistin in patients with acute phase NMO was significantly higher than that of HCs (7.6 + 3 vs 4.1 + 1.4. Ng/ml, p0.001), in addition, the level of serum hs-CRP in acute NMO patients was also higher than HCs (2 + 1.9vs 0.8 + 0.9mg/l, p=0.017); 3, the level of resistin in CSF in acute stage NMO was significantly higher than that in ONNDs group (0.25 + 0.23 vs 0.04 + 0.01), and 4. Statistical significance (r=0.303, p=0.023; r=0.622, p=0.003); 5, there was no significant difference between BMI and serum TG in NMO patients and HCs (P0.05), while Glu, TC, LDL and p=0.003 were statistically significant (5.3 + 0.8, 5 + 1.1, 4.2 + 0.5); 3.1 + 0.9 2.3 + 0.6 0.025) but there was no significant difference in covariance analysis (P0.05); 6, there was a positive correlation between serum resistin level and ARR in acute NMO patients (r=0.354, p=0.007), but there was no significant correlation with the onset age, the course of the disease, the number of spinal cord involvement, the EDSS score, and the level of AQP4-Ab; 7,16 cases were treated with large dose of hormone in the treatment of the patients. The level of serum resistin was significantly lower than that before the treatment (8.6 + 3.3 vs 4.7 + 1.5 ng/ml, p0.001). Conclusion 1. resistin may be involved in the development and development of NMO, and play a role in promoting the inflammatory reaction in the disease. The 2.NMO patients' resistin in CSF is obviously elevated, suggesting that it can enter CNS through the damaged blood brain barrier to play the inflammatory action. Use; 3. the inflammatory effect of 3. resistin may have a certain correlation with the presence of hs-CRP; 4. the level of serum resistin may have a certain predictive effect on the recurrence of the disease, but there is no obvious correlation with the severity of the disease; 5. resistin is reduced in the recovery period of the disease, suggesting that it may be the index of the evaluation of the disease process. One of the targets, and may be a potential target for NMO treatment.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R744.52

【參考文獻】

相關期刊論文 前1條

1 ;Role of Resistin in Inflammation and Inflammation-Related Diseases[J];Cellular & Molecular Immunology;2006年01期

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本文編號：1887839