本文關(guān)鍵詞： S100β蛋白 GDNF POCD 體外循環(huán) 心臟瓣膜置換　出處：《西南醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:觀察體外循環(huán)下心臟手術(shù)患者血清中膠質(zhì)源性神經(jīng)營養(yǎng)因子(glial cell line-derived neurotrophic,GDNF)、S100β蛋白的表達水平與體外循環(huán)術(shù)后認知功能障礙(postoperative congnitive dysfunction,POCD)的關(guān)系,并探討、評價GDNF、S100β蛋白在體外循環(huán)后POCD診斷中的價值。方法:選擇在本院擬行體外循環(huán)下瓣膜置換術(shù)的風濕性心臟病患者43例,于術(shù)前1天及術(shù)后第7天根據(jù)簡易精神狀態(tài)量表(Mini-mental State Examination Scale,MMSE)將納入患者分為P組(POCD組)、NP組(non-POCD組)。采用酶聯(lián)接免疫吸附劑測定(ELISA)法檢測患者術(shù)前半小時(T1)、術(shù)畢即刻(T2)、術(shù)后1天(T3)、術(shù)后3天(T4)、術(shù)后7天(T5)各時間點靜脈血清中GDNF、S100β蛋白水平。通過Pearson相關(guān)性分析法,分析血清GDNF、S100β蛋白水平與POCD的相關(guān)性,并通過ROC曲線分析法,評價血清中GDNF、S100β蛋白水平對體外循環(huán)后POCD的診斷價值,為體外循環(huán)后POCD的診斷尋找新的、合理的、客觀的生物學指標提供思路。結(jié)果:根據(jù)POCD判定標準,體外循環(huán)下行換瓣手術(shù)患者術(shù)后第7天POCD發(fā)生率為37.5%(15/43,例)。在T1時間點,P組與NP組患者血清GDNF及S100β蛋白表達水平無統(tǒng)計學差異(p0.05),在T2~T5時間點,與NP組患者相比,P組患者血清S100β蛋白表達明顯升高、血清GDNF表達顯著降低(p0.05)。P組中,血清S100β蛋白表達與MMSE評分呈負相關(guān),血清GDNF表達與MMSE評分呈正相關(guān);血清S100β蛋白表達也與血清GDNF表達呈負相關(guān)(p0.05)。P組中,血清S100β蛋白的曲線下面積(AUC)=0.853,敏感性為77.6%,特異性為75.4%;血清GDNF的曲線下面積(AUC)=0.901,敏感性為80.9%,特異性為83.3%;血清S100β蛋白結(jié)合血清GDNF的曲線下面積(AUC)=0.953,敏感性為87.5%,特異性為88.6%(p0.05)。結(jié)論:作為體外循環(huán)下心臟手術(shù)患者術(shù)后POCD診斷的生物學標志物,術(shù)后血清S100β蛋白表達明顯升高或血清GDNF表達顯著降低在體外循環(huán)后POCD的診斷中具有一定價值;兩者結(jié)合用于診斷POCD更有意義。
[Abstract]:Objective: to observe the glial cell line-derived neurotrophic in serum of patients undergoing cardiopulmonary bypass (CPB). Expression of S100 尾 protein and postoperative congnitive dysfunction after cardiopulmonary bypass. The relationship between POCDs and the evaluation of GDNF. The value of S100 尾 protein in the diagnosis of POCD after cardiopulmonary bypass methods: 43 patients with rheumatic heart disease undergoing valve replacement under cardiopulmonary bypass were selected. Minimental State Examination Scale was performed 1 day before operation and 7 days after operation. MMSE was divided into P group (P group) and P group (POCD group). In NP group, non-POCD group, enzyme linked immunosorbent assay (Elisa) was used to detect T1D before operation and T2 + T3 was performed at the end of operation (1 day after operation). The levels of GDNF S100 尾 protein in venous serum at 3 days after operation and 7 days after operation were analyzed by Pearson correlation analysis. The correlation between S100 尾 protein level and POCD was evaluated by ROC curve analysis to evaluate the diagnostic value of serum GDNF S100 尾 protein level after cardiopulmonary bypass (CPB). To find a new, reasonable and objective biological index for the diagnosis of POCD after cardiopulmonary bypass. Results: according to the criteria of POCD. The incidence of POCD in patients undergoing valve replacement under cardiopulmonary bypass was 37.5 / 43 on the 7th day after operation. There was no significant difference in the expression of GDNF and S100 尾 protein between P group and NP group. In P group, the expression of serum S100 尾 protein was significantly increased, and the expression of serum GDNF was significantly decreased in P group. In group P, the expression of serum S100 尾 protein was negatively correlated with MMSE score. The expression of serum GDNF was positively correlated with the MMSE score. There was also a negative correlation between the expression of serum S100 尾 protein and the expression of serum GDNF. In group P, the area under the curve of serum S100 尾 protein was 0.853. The sensitivity was 77.6 and the specificity was 75.4; The area under the curve of serum GDNF was 0.901, the sensitivity was 80.9 and the specificity was 83.3; The area under the curve of serum S100 尾 protein binding to serum GDNF was 0.953 and the sensitivity was 87.5%. Conclusion: it is a biomarker for the diagnosis of postoperative POCD in patients undergoing cardiopulmonary bypass (CPB). The increase of serum S100 尾 protein expression or the decrease of serum GDNF expression were valuable in the diagnosis of POCD after cardiopulmonary bypass (CPB). The combination of the two is more meaningful in the diagnosis of POCD.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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本文編號：1475965