【作者】 刘军；

【导师】 王宏；

【作者基本信息】 石河子大学 ， 神经病学（专业学位）， 2018， 硕士

【摘要】 目的探讨非致残性缺血性脑血管病患者血清内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(Vaspin)的水平变化及其意义。方法选取2016年12月1日至2017年7月31日在我院神经内科诊治的非致残性缺血性脑血管事件患者(NICE)95例作为NICE组,并依照ADA糖尿病管理指南标准将NICE组分为:NICE不合并糖代谢异常(AGM)组(A组)48例,NICE合并AGM组(B组)47例。选取同期在我院内分泌代谢科就诊的AGM患者45例为单纯AGM组(C组);同期在我院体检的50例血糖代谢正常且无脑梗死的体检人群作为体检对照组(D组)。所有研究对象于入院后记录性别、年龄、身高、体重及高血压病史、吸烟史等一般资料,次日清晨采集空腹静脉血送检血糖、血脂、糖化血红蛋白等生化指标,并抽取受试者空腹静脉血5 m L,采用武汉伊莱瑞特生物科技有限公司的人VASPIN酶联免疫吸附测定试剂盒,测定各组血清Vaspin浓度。结果(1)四组之间年龄、性别、高血压病患病率差异无统计学意义;NICE组较AGM组和体检对照组人群吸烟率升高,且差异有统计学意义(P<0.05)。(2)NICE组在缺血事件构成上,不合并AGM组中TIA和症状迅速缓解未遗留明显残疾的比例较高,而合并AGM组中轻型卒中比例较高。(3)NICE组中根据颈动脉超声检查结果分层,不合并AGM组颈动脉内膜粗糙患者比例较高,而合并AGM组颈动脉斑块形成患者比例较高,差异有统计学意义(P<0.05)。(4)四组间血糖代谢相关的指标FBG、FINS、Hb A1c、BMI、HOMA-IR在存在AGM组较无AGM组升高,且差异有统计学意义(P<0.05)。TG浓度在NICE不合并AGM组、NICE合并AGM组和单纯AGM组均比体检对照组升高,且差异有统计学意义(P<0.05),但三组之间差异无统计学意义。TC、LDL浓度在NICE不合并AGM组和NICE合并AGM组均比单纯AGM组和体检对照组升高,且差异有统计学意义(P<0.05),但两组之间差异无统计学意义。HDL浓度在NICE不合并AGM组和NICE合并AGM组均比体检对照组降低,且差异有统计学意义(P=0.01),其余各组间差异无统计学意义。NICE急性期血清Vaspin水平降低,在四组之间关系为单纯AGM组>体检对照组>NICE合并AGM组>NICE不合并AGM组,且差异均有统计学意义(P<0.05)。(5)Vaspin与血糖代谢相关指标FBG、FINS、BMI、HOMA-IR、Hb A1c等均呈正相关(P<0.05),与HOMA-IR相关性最强(r=0.321)。(6)在NICE合并AGM组,血清Vaspin浓度及胰岛素抵抗指数(HOMA-IR)在糖尿病前期和糖尿病期差异无统计学意义(P>0.05)。(7)NICE不合并AGM组中颈动脉多发斑块组和颈动脉狭窄或闭塞组血清Vaspin浓度比颈动脉粗糙组明显降低,差异有统计学意义(P<0.05)。(8)校正了年龄、性别等混杂因素后,分析显示TC、LDL-C、吸烟等是NICE发生的危险因素,OR值分别为5.126(95%CI:2.814-9.337)、2.557(95%CI:1.471-4.444)及3.150(95%CI:1.354-7.331);血清Vaspin可能是NICE的保护因素,OR值为0.880(95%CI:0.840-0.964),即血清Vaspin每增加1个单位其发生NICE的风险降低0.880倍。结论(1)NICE患者急性期血清Vaspin水平降低,Vaspin可能作为一种保护因素参与NICE的发生、发展过程,其可能会成为预测NICE发生的新的生物学标志物。(2)血清Vaspin水平与颈动脉硬化程度呈负相关,Vaspin水平的降低促进动脉粥样硬化进程。(3)血糖代谢异常患者血清Vaspin水平代偿性升高,且糖尿病前期就已存在胰岛素抵抗现象。更多还原

【Abstract】 Objective To investigate the level of Vaspin with Non-Disabling Ischemic Cerebrovascular Events and its clinical significance.Methods 95 patients with non-disabling ischemic cerebrovascular events(NICE)diagnosed and treated in our department of neurology from December 1,2016 to July 31,2017 were selected as the NICE group.According to ADA guidelines for diabetes management,the NICE components were: 48 cases with NICE non-glycometabolism abnormal(AGM)group(group A)and 47 cases with NICE combined AGM group(group B).45 cases of AGM patients who were diagnosed in the Department of Endocrinology and Metabolism of our hospital during the same period were simple AGM group(group C);50 patients undergoing physical examination in our hospital had neither abnormal glucose metabolism nor cerebral infarction as the control group(group D).All subjects were recorded general information on gender,age,height,weight,history of hypertension,and smoking history after admission.The following morning,fasting blood was collected for biochemical indicators such as blood glucose,blood lipids,and Hb A1 c,and the subject’s fasting was taken.Venous blood 5 m L,using human VASPIN enzyme-linked immunosorbent assay kit from Wuhan Elabscience to determine the serum Vaspin concentration in each group.Results(1)There was no significant difference in the age,sex,and prevalence rate of hypertension among the four groups;the smoking rate in the NICE group was higher than that in the AGM group and the physical examination control group,and the difference was statistically significant(P<0.05).(2)In the composition of ischemic events of the NICE group,in the non-AGM group,the proportion of TIA and rapid symptom relief without significant disability was higher,while in the combined AGM group,the proportion of mild stroke was higher.(3)According to stratification of carotid ultrasound,in the non-AGM of the NICE group,the ratio of carotid intima roughness was higher,while the proportion of carotid plaque formation was higher in the conbined AGM,And the difference is statistically significant(P<0.05).(4)Among the four groups,The blood glucose-related indexes,such as FBG,FINS,Hb A1 c,BMI,and HOMA-IR,were higher in the presence of AGM groups than those without AGM groups(P<0.05).The concentrations of TG in NICE without AGM group,NICE with AGM group and AGM alone group were significantly higher than those in physical examination control group(P<0.05),but there were no significant difference among the three groups.The concentrations of TC and LDL in NICE without AGM group and NICE combined AGM group were higher than those in simple AGM group and physical examination control group,and the difference was statistically significant(P<0.05),but there were no significant difference between the two groups.The concentration of HDL in NICE without AGM group and NICE combined with AGM group was lower than that in physical examination control group,and the difference was statistically significant(P=0.01).There was no significant difference between the other groups.In the acute phase of NICE,serum Vaspin levels decreased,and the relationship between the four groups was simple AGM group> physical examination control group> NICE combined AGM group> NICE non-AGM group,and the difference was statistically significant(P<0.05).(5)Vaspin was positively correlated with the ralated indicators of blood glucose metabolism such as FBG,FINS,BMI,HOMA-IR,Hb A1c(P<0.05),and had the strongest correlation with the indicator of HOMA-IR(r=0.321).(6)In the NICE combined AGM group,there was no significant difference between serum Vaspin concentration and insulin resistance index(HOMA-IR)in both pre-diabetes and diabetic stages(P>0.05).(7)In the NICE without AGM group,the serum Vaspin concentration in carotid artery multiple plaque group,carotid artery stenosis and occlusion group were significantly lower than those in carotid artery rough group,and the difference was statistically significant(P<0.05).(8)After adjusting for age,sex,and other confounding factors,the analysis showed that TC,LDL-C and smoking were risk factors for NICE occurrence.The OR values were 5.126(95% CI: 2.814-9.337),2.557(95% CI:1.471-4.444)and 3.150(95% CI: 1.354-7.331);Serum Vaspin may be a protective factor for NICE,the OR value was 0.880(95% CI: 0.840-0.964),which means that the risk of NICE was reduced by 0.880 times for each increment of serum Vaspin.Conclusion(1)The decrease of serum Vaspin level in the acute phase of NICE patients,Vaspin may be a protective factor in the occurrence and development of NICE,which may be a new biological marker for the prediction of NICE.(2)Serum Vaspin level was negatively correlated with the degree of carotid atherosclerosis.The decrease of Vaspin level promoted the progression of atherosclerosis.(3)The level of serum Vaspin is compensatoryly increased in patients with abnormal blood glucose metabolism,and insulin resistance already exists in prediabetes..更多还原