【作者】 王慧；

【导师】 陈福琴；

【作者基本信息】 山东大学 ， 内科学， 2011， 硕士

【摘要】 目的：分析老年糖尿病并脑梗死患者C反应蛋白、尿微量白蛋白与载脂蛋白的水平变化,探讨其与老年糖尿病患者发生脑梗死之间的关系。方法：1、研究对象：研究人群来自2009年11月～2010年4月在齐鲁医院老年科的住院患者共90例,分为老年糖尿病并发急性脑梗死组(Ⅰ组)30例、老年非糖尿病性急性脑梗死组(Ⅱ组)30例、老年糖尿病无脑梗死组(Ⅲ组)30例。另选择同期在本院查体的健康人群25例作为对照组(Ⅳ组)。其中所有脑梗死患者均符合1995年第4届全国脑血管病学术会议修订的脑血管病诊断标准；所有糖尿病患者均符合WH01999年制定的糖尿病诊断标准。所有研究对象均无急慢性感染、肝功能异常、肾功能衰竭、恶性肿瘤、自身免疫性疾病、慢性心功能衰竭、急性冠脉事件及既往心肌梗死病史。2、研究方法：所有受检对象均测量身高、体质量、腰围、臀围,计算体质量指数(BMI)=体质量(kg)/身高2(m2)、腰臀比(WHR)=腰围/臀围。询问病程,了解有无吸烟史,测血压。空腹采集肘静脉血测定空腹血糖(FBG),糖化血红蛋白(HbA1C),血清总胆固醇(TC)、甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A-I(ApoA-I)、载脂蛋白B(ApoB),高敏C反应蛋白(hs-CRP)。同日留取中段晨尿,取2ml检测尿微量白蛋白(MAU)。3、统计学处理：使用SPSS10.0软件包进行数据处理。正态分布的计量资料用X±s表示；正态分布两组间均数的比较采用t检验,显著性检验采用双侧检验,P<0.05为差异有统计学意义。两变量相关分析运用非参数Spearman等级相关检验。并对以上指标进行logistic回归分析。结果：1.一般资料比较：各组年龄、性别比、吸烟、BMI等因素经统计学检验,两两之间无明显差异(P>0.05),具有可比性。2. hs-CRP值在年龄、男性比、吸烟、BMI等因素差异上均无统计学意义,具有可比性。Ⅰ、Ⅱ、Ⅲ组hs-CRP水平均高于Ⅳ组(P<0.01,P<0.05),且Ⅰ组hs-CRP水平高于Ⅱ、Ⅲ组(P<0.05)。多元线性回归分析表明,hs-CRP浓度与TC、LDL-C、ApoB均无相关性,但与TG、MAU呈正相关(P<0.05),与HDL-C、ApoA-I呈显著负相关(P<0.01)。3.Ⅰ、Ⅱ、Ⅲ组MAU水平均明显高于Ⅳ组(P<0.01),且Ⅰ组MAU水平高于Ⅱ、Ⅲ组(P<0.01),Ⅱ组MAU水平低于Ⅲ组(P<0.01)。相关分析提示,MAU水平和FBG、HbAIC呈正相关(P<0.05),与血脂(TC、TG、HDL-C、LDL-C)均无相关性。4.Ⅰ、Ⅱ、Ⅲ组TC、TG、LDL-C、ApoB水平均高于Ⅳ组(P<0.01), HDL-C、ApoA-I水平均低于Ⅳ组(P<0.01),且Ⅰ组TC、TG、LDL-C、ApoB水平高于Ⅱ、Ⅲ组(P<0.01,P<0.05), HDL-C、ApoA-I水平低于Ⅱ、Ⅲ组(P<0.01,P<0.05)。Ⅱ组TG、LDL-C水平低于Ⅲ组(P<0.05)。结论：1.hs-CRP的浓度变化与糖尿病发生脑梗死的危险性密切相关。2.MAU水平与糖尿病并发脑血管事件密切相关。3.TC、TG、LDL-C、ApoB水平升高与HDL-C、ApoA-I水平降低是糖尿病合并脑血管病变的危险因素。意义：本课题进一步阐明C反应蛋白、尿微量白蛋白、载脂蛋白与老年糖尿病患者发生脑梗死之间的关系,对有效预防老年糖尿病患者脑梗死的发生、减少脑血管终点事件有重要的临床意义和应用价值。更多还原

【Abstract】 Objective:To investigate the changes of C-Reactive Protein、Microalbuminuria and Apolipoprotein in elderly diabetic patients complicated with cerebral infarction.Methods:1.Objects of study:From November 2009 to April 2010 in Geriatrics of Qilu Hospital,Ninty cases were Collected.All the patients were in-patients and were divided into three groups:30 cases of old DM group with acute cerebral infarction(I group),30 cases of Non-DM elderly acute cerebral infarction(II group),30 cases of old DM group without cerebral infarction(III group).25 normal persons served as healthy controls.All the cerebral infarction patients were consistent with cerebrovascular disease diagnostic criteria;All the DM patients were consistent with diabetes mellitus diagnostic criteria.All of the subjects had no acute or chronic infection,liver dysfunction, kidney failure, cancer,autoimmune disease,chronic heart failure,acute coronary events and history of previous myocardial infarction.2. Methods of study:The levels of height、body weight、waistline、hipline be measured,body mass index、waist-to-hip ratio be calculated.Ask the course and find out the smoking history,test blood pressure.Fasting elbow venous blood were collected to measure fasting blood glouse(FBG),glycated hemoglobin(HbA1C),total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C), apolipoprotein A-I (ApoA-I),apolipoprotein B (ApoB) and high-sensitivity C-reactive protein. Morning urine specimens was leaved to detect Microalbuminuria (MAU). 3. Statistical analysis:All data were statistically dealled by SPSS 10.0 package.Measurement data of normal distribution was showed by x±s;the mean of normal distribution between the two groups was compared using the t test number,test of significance using two-sided test,P<0.05 was considered as statistically significant.Correlation analysis of two variables using non-parametric Spearman rank correlation test. And the above-mentioned indicators were analyzed by logistic regression analysis.Results:1.Comparison of general information:age, sex, smoking, BMI and other factors of each group was tested by statistical test, there was no significant difference between any two (P> 0.O5) and be comparable.2.hs-CRP values in age,gender ratio,smoking,BMI and other factors were no statistically significant difference.The level of hs-CRP in I II III groups was higher than that of IV group(P<0.01,.P<0.05),near regression analysis indicated that hs-CRP was no correlation with TC、LDL-C and ApoB,but was positive correlation with TG、MAU(P<0.05),and was significantly negative correlation with HDL-C、ApoA-I(P<0.01).3.The level of MAU in I II III groups was much higher than that of IV group(P<0.01),the level of MAU in I groups was higher than that ofⅡⅢgroup(P<0.01),and the level of MAU inⅡgroups was lower than that of III group(P<0.01).Simple correlation analysis indicated that MAU was positive correlation with FBG and HbA1C,but was no correlation with TC、TG、HDL-C andLDL-C.4.The levels of TC、TG、LDL-C、ApoB were higher than that of IV group(P<0.01), the levels of HDL-C、ApoA-I were lower than that of IV group(P<0.01),and the level of TC、TG、LDL-C and ApoB in I groups were higher than that ofⅡⅢgroup(P<0.01,P<0.05), the level of HDL-C、ApoA-I in I groups were lower than that ofⅡⅢgroup(P<0.01,P<0.05), the level of TG、LDL-C in II groups were lower than that of III group(P<0.05).Conclusions:1.The concentrations of hs-CRP is closely related to the risk of diabetes cerebral infarction. 2. The levels of MAU is closely related to the occurred of cerebral vascular events in diabetes.3.The increased levels of TC,TG,LDL-C,ApoB and the reduced levels of HDL-C,ApoA-I are the risk factors to diabetes mellitus with cerebral vascular disease.Significance:This issue further clarifies the relationship between C-reactive protein, Microalbuminuria,Apolipoprotein and cerebral infarction in elderly diabetic patients, that has important clinical significance and applications Value to the effective prevention of cerebral infarction and deseasing cerebral vascular end point in patients with diabetes.更多还原