血清及脑脊液胱抑素C与吉兰-巴雷综合征相关性的临床分析
|
摘要
目的探讨胱抑素C(Cys C)与吉兰-巴雷综合征(GBS)的临床相关性,比较血清和脑脊液中Cys C值在GBS中的变化以及Cys C含量变化与GBS病情轻重的关系。方法收集蚌埠医学院第一附属医院2015年12月—2018年2月收治的GBS患者30例作为GBS组,收集同期骨科、普外科因局麻手术需行椎管麻醉的患者30例作为对照组,收集2组血清及脑脊液Cys C值及其他临床资料。结果 (1)GBS组与对照组脑脊液Cys C比较,差异无统计学意义(P=0.450)。(2)2组血清Cys C比较,GBS组较对照组升高,差异有统计学意义(P=0.005);GBS组轻度与重度血清Cys C比较,重度组较轻度组明显升高,差异有统计学意义(P=0.012)。(3)血清Cys C与GBS患者Hughes评分呈正相关(r=0.759,P<0.001),脑脊液Cys C与GBS患者Hughes评分不相关(P>0.05)。(4)GBS患者Hughes评分与年龄、血清Cys C、脑脊液蛋白呈正相关,与前驱事件呈负相关,与脑脊液Cys C及性别不相关。(5)以Hughes评分为因变量,以前驱事件、血清Cys C、脑脊液蛋白、年龄为自变量,结果发现血清Cys C、脑脊液蛋白是Hughes评分的危险因素。结论血清Cys C或许可以作为GBS患者病情严重程度的评价指标;血清Cys C与脑脊液蛋白是GBS患者肢体瘫痪的危险因素。
Objective To investigate clinical relevance between the level of the serum cystatin C(Cys C) and GuillainBarré syndrome(GBS),and the discrepancy in the levels of Cys C between serum and cerebrospinal fluid(CSF) in patients with GBS.Methods Total 30 cases of GBS in our department from December 2015 to February 2018 were collected as GBS group,while other 30 patients undergoing spinal anesthesia were collected from Orthopedics department and General surgical department as the control group.The levels of Cys C in serum and cerebrospinal fluid and other clinical data were collected in the two groups.Results(1)There was no statistically difference in the levels of Cys C in the cerebrospinal fluid between the two groups,P = 0.450.(2)The level of serum Cys C in the GBS group was higher when compared with the control group(P = 0.005);The level of serum Cys C in patients with severe GBS increased significantly as compared with the patients with mild GBS,the difference was statistically significant(P = 0.012).(3)There was a positive correlation between serum Cys C level and Hughes score in GBS patients(r = 0.759,P < 0.001),however,there was no correlation between CSF Cys C level and Hughes score in GBS patients(P > 0.05).(4)The Hughes score of GBS patients was positively correlated with age,serum Cys C and cerebrospinal fluid protein,and negatively with the precursor events,but not with the level of CSF Cys C and sex.(5)Taking Hughes score as the dependent variable,taking precursor events,serum Cys C,cerebrospinal fluid protein and age as independent variables,we found that the levels of serum Cys C and cerebrospinal fluid protein were risk factors of Hughes score.Conclusion Serum Cys C may be used as an indicator of the severity of GBS patients;the levels of serum Cys C and cerebrospinal fluid protein are the risk factors of limb paralysis in GBS patients.
Objective To investigate clinical relevance between the level of the serum cystatin C(Cys C) and GuillainBarré syndrome(GBS),and the discrepancy in the levels of Cys C between serum and cerebrospinal fluid(CSF) in patients with GBS.Methods Total 30 cases of GBS in our department from December 2015 to February 2018 were collected as GBS group,while other 30 patients undergoing spinal anesthesia were collected from Orthopedics department and General surgical department as the control group.The levels of Cys C in serum and cerebrospinal fluid and other clinical data were collected in the two groups.Results(1)There was no statistically difference in the levels of Cys C in the cerebrospinal fluid between the two groups,P = 0.450.(2)The level of serum Cys C in the GBS group was higher when compared with the control group(P = 0.005);The level of serum Cys C in patients with severe GBS increased significantly as compared with the patients with mild GBS,the difference was statistically significant(P = 0.012).(3)There was a positive correlation between serum Cys C level and Hughes score in GBS patients(r = 0.759,P < 0.001),however,there was no correlation between CSF Cys C level and Hughes score in GBS patients(P > 0.05).(4)The Hughes score of GBS patients was positively correlated with age,serum Cys C and cerebrospinal fluid protein,and negatively with the precursor events,but not with the level of CSF Cys C and sex.(5)Taking Hughes score as the dependent variable,taking precursor events,serum Cys C,cerebrospinal fluid protein and age as independent variables,we found that the levels of serum Cys C and cerebrospinal fluid protein were risk factors of Hughes score.Conclusion Serum Cys C may be used as an indicator of the severity of GBS patients;the levels of serum Cys C and cerebrospinal fluid protein are the risk factors of limb paralysis in GBS patients.
引文
[1]VAN DEN BERG B,WALGAARD C,DRENTHEN J,et al.GuillainBarrésyndrome:pathogenesis,diagnosis,treatment and prognosis[J].Nat Rev Neurol,2014,10(8):469-482.
[2]贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2015:350-353.
[3]UCIBIOR A,GOLEBIOWSKA D,ADAMCZYK A,et al.The renal effects of vanadate exposure:potential biomarkers and oxidative stress as a mechanism of functional renal disorders-preliminary studies[J].Biomed Res Int,2014,2014:740105.
[4]蒋伟明,王敏,芦伟.儿童格林-巴利综合征研究进展[J].现代中西医结合杂志,2015,24(2):219-221.
[5]VERMA R,CHAUDHARI T S,RAUT T P,et al.Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome(GBS)[J].J Neurol Sci,2013,335(1-2):105-111.
[6]王峰.血清胱抑素C与急性脑梗死的相关性分析研究[D].芜湖:皖南医学院,2017.
[7]张娟.血清与脑脊液胱抑素C测定在脑梗死中的临床意义[J].世界最新医学信息文摘,2018,18(47):117,125.
[8]郁迪,刘向祎.脑脊液胱抑素C对视神经炎的诊断价值[J].国际检验医学杂志,2018,39(11):1293-1296.
[9]王家驷,王廷杰,孙良丽,等.吉兰-巴雷综合征脑脊液胱氨酸蛋白酶抑制剂C及常规指标检测的临床价值[J].中华临床医师杂志(电子版),2013,7(20):9050-9055.
[10]NAGAMINE S,FUJIWARA Y,SHIMIZU T,et al.Association of ubiquitin carboxy-terminal hydrolase-L1 in ceRebrospinal fluid with clinical severity in a cohort of patients with Guillain-Barrésyndrome[J].Neurol Sci,2015,36(6):921-926.
[11]王晓科.吉兰-巴雷综合征脑脊液及血清蛋白标志物的研究[D].长春:吉林大学,2012.
[12]GONZALEZ-QUEVEDO A,CARRIERA R F,O’FARRILL Z L,et al.An appraisal of blood-cerebrospinal fluid barrier dysfunction during the course of Guillain Barrésyndrome[J].Neurol India,2009,57(3):288-294.
[13]陈兰英.血清胱抑素C与2型糖尿病周围神经病变的相关性[D].杭州:浙江大学,2014.
[14]周书怡,耿道颖.扩散成像技术在臂丛神经病变的应用研究进展[J].国际医学放射学杂志,2015,38(2):115-117.
[15]韩彤立,杨欣英.专家评述:吉兰-巴雷综合征谱系疾病的诊断[J].中华实用儿科临床,2016,31(12):884-886.
[16]岳红梅.中青年动脉粥样硬化性脑梗塞与血清胱抑素C的相关性研究[D].济南:山东大学,2014.
[17]SAHIN S,CINAR N,KARSIDAG S.Are cerebrospinal fluid protein levels and plasma neutrophil/lymphocyte ratio associated with prognosis of Guillain Barre syndrome[J].Neurol Int,2017,9(2):7032.
[18]王敏,周招华,邓仕标,等.吉兰-巴雷综合征患者脑脊液蛋白水平与周围神经髓鞘损伤的相关性分析[J].上海交通大学学报(医学版),2017,37(10):1372-1375.
[19]杨红,汤可娜,仲星星,等.吉兰-巴雷综合征脑脊液蛋白与面神经瘫痪的相关性[J].中国神经精神疾病杂志,2016,42(3):141-144.
[2]贾建平,陈生弟.神经病学[M].北京:人民卫生出版社,2015:350-353.
[3]UCIBIOR A,GOLEBIOWSKA D,ADAMCZYK A,et al.The renal effects of vanadate exposure:potential biomarkers and oxidative stress as a mechanism of functional renal disorders-preliminary studies[J].Biomed Res Int,2014,2014:740105.
[4]蒋伟明,王敏,芦伟.儿童格林-巴利综合征研究进展[J].现代中西医结合杂志,2015,24(2):219-221.
[5]VERMA R,CHAUDHARI T S,RAUT T P,et al.Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome(GBS)[J].J Neurol Sci,2013,335(1-2):105-111.
[6]王峰.血清胱抑素C与急性脑梗死的相关性分析研究[D].芜湖:皖南医学院,2017.
[7]张娟.血清与脑脊液胱抑素C测定在脑梗死中的临床意义[J].世界最新医学信息文摘,2018,18(47):117,125.
[8]郁迪,刘向祎.脑脊液胱抑素C对视神经炎的诊断价值[J].国际检验医学杂志,2018,39(11):1293-1296.
[9]王家驷,王廷杰,孙良丽,等.吉兰-巴雷综合征脑脊液胱氨酸蛋白酶抑制剂C及常规指标检测的临床价值[J].中华临床医师杂志(电子版),2013,7(20):9050-9055.
[10]NAGAMINE S,FUJIWARA Y,SHIMIZU T,et al.Association of ubiquitin carboxy-terminal hydrolase-L1 in ceRebrospinal fluid with clinical severity in a cohort of patients with Guillain-Barrésyndrome[J].Neurol Sci,2015,36(6):921-926.
[11]王晓科.吉兰-巴雷综合征脑脊液及血清蛋白标志物的研究[D].长春:吉林大学,2012.
[12]GONZALEZ-QUEVEDO A,CARRIERA R F,O’FARRILL Z L,et al.An appraisal of blood-cerebrospinal fluid barrier dysfunction during the course of Guillain Barrésyndrome[J].Neurol India,2009,57(3):288-294.
[13]陈兰英.血清胱抑素C与2型糖尿病周围神经病变的相关性[D].杭州:浙江大学,2014.
[14]周书怡,耿道颖.扩散成像技术在臂丛神经病变的应用研究进展[J].国际医学放射学杂志,2015,38(2):115-117.
[15]韩彤立,杨欣英.专家评述:吉兰-巴雷综合征谱系疾病的诊断[J].中华实用儿科临床,2016,31(12):884-886.
[16]岳红梅.中青年动脉粥样硬化性脑梗塞与血清胱抑素C的相关性研究[D].济南:山东大学,2014.
[17]SAHIN S,CINAR N,KARSIDAG S.Are cerebrospinal fluid protein levels and plasma neutrophil/lymphocyte ratio associated with prognosis of Guillain Barre syndrome[J].Neurol Int,2017,9(2):7032.
[18]王敏,周招华,邓仕标,等.吉兰-巴雷综合征患者脑脊液蛋白水平与周围神经髓鞘损伤的相关性分析[J].上海交通大学学报(医学版),2017,37(10):1372-1375.
[19]杨红,汤可娜,仲星星,等.吉兰-巴雷综合征脑脊液蛋白与面神经瘫痪的相关性[J].中国神经精神疾病杂志,2016,42(3):141-144.