【摘要】：目的：腦出血(intracerebral hemorrhage，ICH)是常見的急性腦血管病之一，在我國其發(fā)病率占全部腦卒中的20%~30%，有研究顯示不低于30%患者終身遺留神經(jīng)功能障礙。其根本原因為：一方面是血腫壓迫其周圍腦組織導(dǎo)致神經(jīng)功能缺損，更重要的是腦出血后遲發(fā)性水腫作用以及其它毒性物質(zhì)對腦組織產(chǎn)生的損傷。因此，研究腦出血繼發(fā)性神經(jīng)損傷機制，進行有目的性的治療，對有效治療腦出血及改善預(yù)后有著重要意義。研究表明鐵離子在腦出血后遲發(fā)性水腫形成和神經(jīng)損傷中起到重要作用。血清鐵蛋白(serum ferritin, SF)是人體內(nèi)鐵的主要儲存形式，它能否作為衡量腦水腫的一個指標，是否與腦出血的預(yù)后相關(guān)，這方面研究較少。最近研究顯示，急性腦血管病患者，其尿酸水平與其預(yù)后相關(guān)，但是沒有達成一致結(jié)論。本文旨在探討腦出血患者血清鐵蛋白、尿酸水平變化及其與預(yù)后相關(guān)性，為臨床腦出血患者早期評估預(yù)后、有效提高治療率、降低致殘率提供可靠依據(jù)。 方法：本研究通過觀察2012年10月到2013年10月神經(jīng)內(nèi)科住院治療的32例自發(fā)性腦出血患者，均符合我國2010年頒布的《成人自發(fā)性腦出血診斷標準》，并經(jīng)頭顱CT證實。其中男性20例，女性12例，平均年齡65.09±11.95歲。病人入院后即刻采集臨床資料（包括危險因素和NIHSS評分）、計算血腫體積、采集血液標本，檢測血清鐵蛋白、尿酸、生化全項、血糖、白細胞等指標；應(yīng)用美國BECKMANCOULTER公司生產(chǎn)的Unicle800生化分析儀，，采用尿酸酶法分別于入院、7d、14d測定尿酸水平變化；應(yīng)用德國羅氏公司生產(chǎn)的E601電化學(xué)發(fā)光儀，采用ECLIA免疫發(fā)光法分別于入院后、3d、7d、14d檢測血清鐵蛋白水平變化，并與30例健康人作對照；如患者病情允許，于第3d復(fù)查頭顱CT，采用多田公式計算血腫及水腫體積；于患病90d隨訪患者，評定NIHSS評分及改良Rankin評分（MRS）以評估神經(jīng)功能恢復(fù)情況及生活能力，根據(jù)MRS評分將患者分為預(yù)后良好組（≤2分者）及不良組（2分者）。應(yīng)用SPSS13.0統(tǒng)計軟件進行數(shù)據(jù)分析，符合正態(tài)分布的計量資料采用t檢驗，不符合者采用非參數(shù)檢驗，相關(guān)性采用Spearman相關(guān)分析，多因素分析采用多元線性回歸。 結(jié)果： 1影響腦出血預(yù)后的危險因素：本研究在排除出血部位對腦出血預(yù)后的影響后，年齡、入院時血壓、血糖、白細胞數(shù)、出血量、血清鐵蛋白水平是影響腦出血預(yù)后的危險因素。 2臨床預(yù)后：32例患者預(yù)后良好組（MRS評分≤2分）18例，預(yù)后不良組（MRS評分2分）14例，其中死亡2例，死亡原因1例為中樞性呼吸循環(huán)衰竭，1例為多臟器功能衰竭。 3血清鐵蛋白水平變化：32例患者血清鐵蛋白在第3d開始升高（232.34±106.62ng/ml），在第7d達高峰水平（245.11±109.52ng/ml），14d時有所下降（224.40±106.34ng/ml），與對照組（163.54±59.41ng/ml）相比，有顯著性差異（P值分別為0.003，0.001，0.007）。 4血清鐵蛋白水平與預(yù)后關(guān)系：預(yù)后良好組與預(yù)后不良組的血清鐵蛋白平比較在各個觀察點均有顯著統(tǒng)計學(xué)差異，血清鐵蛋白越高，預(yù)后越差。預(yù)后良好組入院、3d、7d、14d血清鐵蛋白分別為：141.47±82.09ng/ml，181.77±97.29ng/ml，198.17±96.63ng/ml，159.59±72.43ng/ml；預(yù)后不良組：211.79±100.26ng/ml，297.36±81.48ng/ml，305.45±97.05ng/ml，307.74±82.54ng/ml，經(jīng)統(tǒng)計學(xué)處理有顯著性差異（P值均0.05）。將影響腦出血預(yù)后的危險因素納入多元線性回歸分析發(fā)現(xiàn)血清鐵蛋白是影響腦出血預(yù)后的獨立危險因素（P=0.040）。 5血清鐵蛋白水平與血腫、周圍水腫體積關(guān)系：入院血清鐵蛋白與水腫體積無明顯相關(guān)（r=0.276，P=0.127），與血腫體積亦無相關(guān)關(guān)系（r=0.28，P=0.121）；3d后血清鐵蛋白水平上升，與水腫體積呈正相關(guān)(r=0.402，P=0.022)，與血腫體積呈正相關(guān)（r=0.520，P=0.002）。 6尿酸水平變化及與腦出血預(yù)后關(guān)系：32例患者入院、7d、14d的尿酸水平分別為239.38±69.74umol/L、245.26±76.52umol/L、220.18±58.26umol/L，預(yù)后良好組與預(yù)后不良組的尿酸水平無明顯統(tǒng)計學(xué)差異（P值分別為0.627、0.453、0.498）。尿酸各時間點的水平變化，與對照組比較，無統(tǒng)計學(xué)差異（P0.05）。結(jié)論： 1腦出血患者預(yù)后與年齡、入院時血壓、血糖、白細胞數(shù)、出血量、血清鐵蛋白水平等多因素相關(guān)。 2血清鐵蛋白水平是影響腦出血患者預(yù)后的獨立危險因素，可早期評估預(yù)后，血清鐵蛋白越高，預(yù)后越差，其機制可能與氧化應(yīng)激損害作用有關(guān)。 3腦出血后血清鐵蛋白變化規(guī)律為：3d時開始快速上升，在第7d達高峰水平，14d時仍較對照組高，為進一步研究臨床干預(yù)措施提供了客觀依據(jù)。 4血清尿酸水平與腦出血預(yù)后無相關(guān)性。
[Abstract]:Objective: The cerebral hemorrhage (ICH) is one of the most common acute cerebrovascular diseases. In our country, the incidence of cerebral hemorrhage is 20% ~ 30% of the total stroke, and the study shows that it is not less than 30% of the patients with long-life residual neurological function. The root cause is that, on the one hand, the hematoma presses the surrounding brain tissue to cause a neurological deficit, and more importantly, the delayed edema after the cerebral hemorrhage and the damage of other toxic substances to the brain tissue. Therefore, it is of great significance to study the mechanism of the secondary nerve injury of the cerebral hemorrhage and to have the purpose of treatment, which is of great significance to the effective treatment of the cerebral hemorrhage and the improvement of the prognosis. The study indicated that iron ions play an important role in the formation of delayed edema and nerve injury after cerebral hemorrhage. Serum ferritin (SF) is the main storage form of iron in human body. It can be used as an index to measure brain edema. It is related to the prognosis of cerebral hemorrhage. Recent studies have shown that the levels of uric acid in patients with acute cerebrovascular disease are associated with their prognosis, but do not reach a consistent conclusion. The purpose of this study is to study the changes of serum ferritin and uric acid levels in patients with cerebral hemorrhage and their relationship with the prognosis. Methods: The study of 32 patients with spontaneous intracerebral hemorrhage from October 2012 to October 2013 was in accordance with the criteria for diagnosis of spontaneous cerebral hemorrhage in adults, which was promulgated in China in 2010. Real. There were 20 males and 12 females, with an average age of 65.09 and 11.95. The clinical data (including risk factors and NIHSS score) were collected immediately after the patient was admitted, the volume of the hematoma was calculated, blood samples were collected, serum ferritin, uric acid, biochemical whole-item, blood sugar and white blood cell were collected, and the Biole800 biochemical analysis produced by BECKMANTER was applied. The changes of serum ferritin levels were measured by using the uricase method in hospital, 7d and 14d, respectively. The changes of serum ferritin levels were detected by ECLIA immunoluminescent method after admission,3 days,7 days, and 14 days after admission. According to the condition of the patient, the skull CT was reviewed on the third day, and the volume of the hematoma and edema was calculated using the multi-field formula; the NIHSS score and the modified Rankin score (MRS) were evaluated for the 90-day follow-up of the patient to assess the neurological function recovery and the life energy The patient was divided into a good group of prognosis (2 score) and an adverse group (2) according to the MRS score. ). The data analysis is carried out by using the SPSS 13.0 statistical software. The measurement data in accordance with the normal distribution is t-checked. The non-compliance test is adopted. The correlation is the Spearman correlation analysis. The multi-factor analysis adopts the multi-element linear regression. Return to. Results:1. The risk factors that affect the prognosis of the cerebral hemorrhage: this study, after excluding the effect of the bleeding part on the prognosis of the cerebral hemorrhage, the age, the blood pressure, the blood sugar, the white blood cell number, the blood loss, the serum ferritin level, the prognosis of the cerebral hemorrhage, are the factors that affect the prognosis of the cerebral hemorrhage. The risk factors of clinical prognosis:32 patients with good prognosis (2 scores of MRS),14 patients with poor prognosis (2 scores of MRS),2 with death,1 case of central respiratory cycle failure and 1 case The level of serum ferritin in 32 patients increased (232.34 to 106.62 ng/ ml) at the third day, and decreased at the peak level of day 7 (245.11, 109.52 ng/ ml) and 14 days (224.40 to 106.34 ng/ ml), and there was a significant difference (P-value of 0.003, 0.0, respectively) compared with the control group (163.54, 59.41 ng/ ml). 01, 0.007).4. The serum ferritin level and the prognosis were related to the level of serum ferritin in the group with good prognosis and poor prognosis. There was a significant difference in the serum ferritin level between the good prognosis group and the poor prognosis group, and the blood serum ferritin level was significantly different from each observation point. The higher the serum ferritin, the worse the prognosis. The serum ferritin in the group was 141.47, 82.09 ng/ ml, 181.77, 97.29 ng/ ml, 198.17, 96.63 ng/ ml, 159.59 and 72.43 ng/ ml, respectively. The prognosis of the group was: 211.79, 100.26 ng/ ml, 297.36, 81.48 ng/ ml, 305.45, 97.05 ng/ ml, 307.74 and 82.54 ng/ ml. The difference (P <0.05). The risk factors that affect the prognosis of the cerebral hemorrhage were included in the multivariate linear regression analysis to find that the serum ferritin is an independent risk that affects the prognosis of the cerebral hemorrhage Factor (P = 0.040). The level of serum ferritin and the volume of the hematoma and the surrounding edema: There was no significant correlation between the serum ferritin and the volume of edema (r = 0.276, P = 0.127), and there was no correlation with the volume of the hematoma (r = 0.28, P = 0.121), and the level of serum ferritin in the post-3 day was positively correlated with the volume of edema (r = 0. .402, P = 0.022), positive correlation to hematoma volume (r = 0 The levels of uric acid in 32 patients were 239.38 and 69.74 umol/ L, 245.26, 76.52 umol/ L, 220.18 and 58.26 umol/ L, respectively. There was no significant difference in the levels of uric acid in the group with good prognosis and poor prognosis (P = 0.6, respectively). 27, 0.453, 0.498). The level of uric acid in each time point was changed in comparison with the control group. No, no Conclusion: The prognosis and age of the patients with cerebral hemorrhage, blood pressure, blood sugar and white blood cell count at the time of admission, the serum ferritin level is an independent risk factor that affects the prognosis of the patients with cerebral hemorrhage, and the prognosis can be assessed at an early stage. The higher the serum ferritin, the prognosis The difference was that the mechanism could be related to the effect of oxidative stress. The change of serum ferritin in 3 days of cerebral hemorrhage began to increase rapidly, and at the peak level of the 7th day, the control group was still in the control group at 14 days. High, to further study the clinical intervention measures to provide the custome
【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】：2014
【分類號】：R743.34

【引證文獻】

相關(guān)期刊論文 前2條

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