【作者】 王华；

【导师】 田爱兰；

【作者基本信息】 河南大学 ， 神经病学， 2011， 硕士

【摘要】 背景与目的:进展性脑梗塞(Progressive cerebral infarction,PCI)是指急性脑梗塞发生后24-72小时神经功能缺损程度仍然在不断发展,在3-5天达到高峰。临床的常规医疗处理难以逆转其病理过程,其发生率、病死率及致残率均非常高,严重威胁了人类的生命及健康,是一种难治性脑血管病,其早期诊断也比较困难,而且很容易产生医疗纠纷,近年来受到广泛关注。进展性脑梗塞的病因和危险因素有很多,其发病是由多种危险因素共同作用于不同环节所引起的,与血管狭窄程度、急性期血压下降、血糖升高、感染后血管炎症反应、高胆固醇血症、以及肥胖、吸烟、酗酒等有着密切关系,然而,进展性脑梗塞还存在其他未明确的因素参与其发病的过程。目前有研究表明超敏C反应蛋白( High sensitive C-reactive protein,hs-CRP)、溶血磷脂酸(Lysophospholipid acid,LPA)、纤维蛋白原(Fibrinogen,FIB)、D-二聚体(D Dimer,D-D)与进展性脑梗塞的发生发展关系密切,因此,发现新的危险因素并对其尽早加以控制,对进展性脑梗塞目前防治现状的改善意义重大。本实验研究就本院收治的进展性脑梗塞患者临床资料结合其hs-CRP、LPA、FIB、D-D的检测结果,对进展性脑梗塞的相关危险因素进行分析探讨,从而为进展性脑梗塞的防治提供新的理论依据。方法:选择符合纳入标准的2010年3月- 2010年12月河南大学第一附属医院神经内科续贯住院的急性脑梗塞患者,所有患者均在入院时及住院48小时应用美国国立卫生研究院卒中量表(NIHSS)进行神经功能评分,如果急性脑梗塞患者48小时的(NIHSS)评分较住院时增加3分或以上作为神经系统症状恶化的量化指标,定为进展性脑梗塞组。随机抽取稳定性脑梗塞组40例作为对照组,进展性脑梗塞组20例作为观察组,分别在住院时及发病24小时和48小时抽取静脉血,测定hs-CRP、LPA、FIB、D-D。通过对两组患者hs-CRP、LPA、FIB及D-D的测定值进行对照及相关统计分析,以研究hs-CRP、LPA、FIB及D-D与进展性脑梗塞的关系。结果:1、进展性脑梗塞组患者入院时、24小时及48小时的hs-CRP、LPA、FIB、D-D水平均高于稳定性脑梗塞组(p<0.05)。2、经Spearman相关分析发现,进展性脑梗塞组第48小时的血清hs-CRP、LPA、FIB、D-D水平与美国国立卫生研究院卒中量表(NIHSS)评定的进展性脑梗塞患者第48小时的神经功能缺损评分均呈正相关,相关系数分别为(hs-CRP△r=0.956p=0.000、LPA※r=0.884 p=0.000、FIB☆r=0.685 p=0.000、D-D▽r=0.622 p=0.003),其中hs-CRP、LPA的相关系数较FIB和D-D大。3、进展性脑梗塞和稳定性脑梗塞患者血清hs-CRP浓度均有所持续增高,但进展性脑梗塞患者hs-CRP比稳定性脑梗塞患者升高明显,幅度大。结论:1、hs-CRP、LPA、FIB、D-D水平升高可能是进展性脑梗塞的危险因素,在脑梗塞患者及其高危人群中应广泛开展hs-CRP、LPA、FIB、D-D的检测,必要时给予有针对性的有效性的治疗。2、进展性脑梗塞患者发病第48小时血清hs-CRP、LPA、FIB、D-D与第48小时的美国国立卫生研究院卒中量表(NIHSS)均呈正相关,提示hs-CRP、LPA、FIB、D-D水平越高,神经功能缺损程度越重。其中hs-CRP、LPA的相关系数较FIB和D-D大,hs-CRP最大,提示急性脑梗塞患者的hs-CRP、LPA值越高,神经功能损害程度越重,预后越差,对进展性脑梗塞的预后判定价值hs-CRP优于LPA、FIB及D-D。3、进展性脑梗塞和稳定性脑梗塞患者hs-CRP浓度均高于正常值,说明急性脑梗塞后持续炎症反应,可能是其发生机制之一。在进展性脑梗塞组早期hs-CRP就比稳定性脑梗塞组明显升高,提示hs-CRP水平越高,病情进一步加重的可能性越大。更多还原

【Abstract】 Background and purpose:Progressive cerebral infarction (PCI) refers to neurologic function defects still in continuous development 24 to 72 hours after acute cerebral infarction occurres, and reaches a peak in 3 - 5 days. It is difficult to reverse this pathological process with conventional clinical treatment. With high incidence, mortality and morbidity, it is a threat to human life and health. PCI is an intractable cerebrovascular disease, and early diagnosis is difficult, and it very easy to induce medical disputes.It has gained wide attention in recent years. There are multiple causes and risk factors of progressive cerebral infarction. It is closely associated with blood vessel narrowing, acute blood pressure drop, high blood sugar, and vascular inflammation after infection, high cholesterol, obesity, smoking and alcohol use, as well as other risk factors. Current research shows that serum high sensitive C-reactive protein(hs-CRP), lysophospholipid acid (LPA), fibrinogen (FIB), D Dimer (D-D)are related to the occurrence and development of progressive cerebral infarction, so it is important to improve prevention of progressive cerebral infarction and discover new risk factors to control PCI early. We discuss the relationship of hs-CRP, LPA, FIB, D-D to progressive cerebral infarction and analyse the associated risk factors of progressive cerebral infarction by detecting the levels of hs-CRP, LPA, FIB, D-D in blood, and provide a new paradigm for the prevention and cure of progressive cerebral infarction.methods:Choose acute cerebral infarction according to inclusion criteria in neurology ward of the First Affiliate Hospital of Henan University from March 2010 to December 2010. All of the patients were neurobehaviorally scored according to the U.S. national institutes of health stroke scale (NIHSS) on admission and hospitalization for 48 hours. If acute cerebral infarction patients,scores of 48 hours (NIHSS) were three points or more than the scores of admission or the quantitative index of nervous system symptoms worsen then acute cerebral infarction is defined as progressive cerebral infarction. A random sample of 40 cases of stable cerebral infarction was used as control group. 20 cases from progressive cerebral infarction were used as the observer group. Venous blood was extracted on admission and hospitalization at 24 and 48 hours to examine the levels of hs-CRP, LPA, FIB, and D-D in blood. Investigate the relationship of hs-CRP, LPA, FIB, D-D to progressive cerebral infarction by comparing relevant statistical analyses of the two groups of patient levels of hs-CRP, LPA, FIB, and D-D.Results:1. In the progressive cerebral infarction group, the patient levels of hs-CRP, LPA, FIB, and D-D are all higher than the stable cerebral infarction group on admission and hospitalization at 24 and 48 hours.2. Spearman correlation analysis found that the levels of hs-CRP, LPA, FIB, and D-D all positively correlated with progressive cerebral infarction neurologic deficits score at 48 hours (NIHSS). Correlation coefficients were (hs-CRP△r=0.956p=0.000 LPA※r=0.884 p=0.000 FIB☆r=0.685 p=0.000 D-D▽r=0.622 p=0.003), The correlation coefficient of hs-CRP and LPA is higher than FIB and D -D.3. In progressive cerebral infarction and stable cerebral infarction, serum high sensitive C-reactive protein (hs-CRP) levels are all sustained; however, the hs-CRP level of progressive cerebral infarction has a more significant increase.Conclusion:1. The rising levels of hs-CRP, LPA, FIB, and D-D may be a risk factor of progressive cerebral infarction. In high-risk patients with cerebral infarction, levels of hs-CRP, LPA, FIB, and D–D should be closely monitored to provide effective treatment.2. The correlations of hs-CRP, LPA, FIB, D-D in progressive cerebral infarction patients,neurologic deficits score at 48 hours (NIHSS) were all positive. This shows that if the level of hs-CRP, LPA, FIB, and D-D are higher, then the neural function defect degree is greater. Among them the correlation coefficient of hs-CRP and LPA is larger than FIB and D-D. The correlation coefficient of hs-CRP is the largest and it shows that if the acute cerebral infarction levels of hs-CRP and LPA are higher, then the neural function defect degree is greater, and prognosis is worse. The prognostic value towards progressive cerebral infarction of hs-CRP is better than LPA, FIB, and D-D.3. In progressive cerebral infarction and stable cerebral infarction patients, serum high sensitive C-reactive protein (hs-CRP) levels are all higher than normal. This shows that continued inflammation after acute cerebral infarction is likely one of its causes. Early, the hs-CRP of progressive cerebral infarction group has markedly increased compared to the stable cerebral infarction group. This shows that if the level of hs-CRP is higher, then the likelihood of a further aggravating illness is greater.更多还原