本文選題：動(dòng)脈粥樣硬化　切入點(diǎn)：腦梗死　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討大動(dòng)脈粥樣硬化型腦卒中(LAA)患者血漿LP-PLA2水平與顱內(nèi)外血管動(dòng)脈粥樣硬化及狹窄程度的相關(guān)性。方法:選取2015年12月~2016年12月我院神經(jīng)內(nèi)科收治的LAA患者60例作為研究對象,選取同期我院體檢中心健康體檢者40例作為對照組,采用雙抗體夾心酶聯(lián)免疫吸附法(ELISA)測定兩組對象LP-PLA2水平,并同時(shí)檢測血糖、血脂、同型半胱氨酸等生化指標(biāo),兩組對象均行頸部血管超聲觀察頸動(dòng)脈粥樣硬化程度、有無動(dòng)脈粥樣硬化斑塊以及斑塊性質(zhì),并行頭頸部CTA檢查觀察頭頸部血管狹窄程度。應(yīng)用SPSS 22.0統(tǒng)計(jì)軟件處理研究數(shù)據(jù)。結(jié)果:1 LAA組的吸煙比例、飲酒比例、高血壓比例、糖尿病比例均高于對照組,差異無統(tǒng)計(jì)學(xué)意義(P0.05),LAA組平均年齡、男性性別比例均低于對照組,差異亦無統(tǒng)計(jì)學(xué)意義(P0.05);2 LAA組LDL、TC、TG以及Fib水平均高于對照組,其差異有統(tǒng)計(jì)學(xué)意義(P0.05),對照組HDL水平高于LAA組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);3 LAA組LP-PLA2水平和HCY水平均明顯高于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4 LAA組患者中,隨神經(jīng)功能缺損嚴(yán)重程度的增加,LP-PLA2水平呈現(xiàn)顯著升高的趨勢,組間比較差異有統(tǒng)計(jì)學(xué)意義(P=0.001);5 LAA組患者中,頸內(nèi)動(dòng)脈系統(tǒng)供血區(qū)域梗死患者共計(jì)34人,LPPLA2水平為156.26±31.46ng/ml,椎-基底動(dòng)脈系統(tǒng)供血區(qū)域梗死患者共計(jì)21人,其LP-PLA2水平為164.68±21.17ng/ml,差異無統(tǒng)計(jì)學(xué)意義(P=0.247);6 LAA組不同位置血管狹窄各亞組之間,組間比較差異無統(tǒng)計(jì)學(xué)意義(P=0.695);7 LAA組患者共檢出斑塊者56例,其中穩(wěn)定性斑塊者11例,LP-PLA2水平為170.59±38.16ng/ml,易損性斑塊者45例,LP-PLA2水平為192.86±37.29ng/ml,均顯著高于無斑塊組LP-PLA2水平112.38±26.17ng/ml,且差異有統(tǒng)計(jì)學(xué)意義(P=0.000);8 LAA組血管0級患者共5例,LP-PLA2水平為112.25±28.65ng/ml,1級患者共15例,LP-PLA2水平為149.76±31.18ng/ml,2級患者共32例,LP-PLA2水平為175.38±41.24ng/ml,3級患者共8例,LP-PLA2水平為185.59±39.52ng/ml,差異有統(tǒng)計(jì)學(xué)意義(P=0.002)。結(jié)論:本實(shí)驗(yàn)研究結(jié)果顯示,血漿LP-PLA2可能是動(dòng)脈粥樣硬化腦梗死的新型危險(xiǎn)因素,其水平的高低與動(dòng)脈粥樣硬化腦梗死患者的嚴(yán)重程度顯著相關(guān),并對該類患者顱內(nèi)外血管的動(dòng)脈粥樣硬化嚴(yán)重程度有一定預(yù)測作用,能夠輔助預(yù)測動(dòng)脈粥樣硬化斑塊的穩(wěn)定程度。早期檢測LP-PLA2水平能夠?qū)?dòng)脈粥樣硬化腦梗死患者的二級預(yù)防及個(gè)體化治療提供一定的幫助,并對未來LP-PLA2特異性抑制劑的研制提供一定的臨床依據(jù)。
[Abstract]:Objective: to investigate the relationship between plasma LP-PLA2 levels and the degree of atherosclerosis and stenosis in patients with atherosclerotic stroke. Methods: from December 2015 to December 2016, the patients with LAA in neurology department of our hospital were selected. 60 cases were included in the study. 40 healthy subjects in the same period were selected as control group. The levels of LP-PLA2 were measured by double antibody sandwich enzyme linked immunosorbent assay (Elisa), and blood glucose, blood lipids, homocysteine and other biochemical indexes were also detected. The degree of carotid atherosclerosis, whether or not atherosclerotic plaques and the nature of atherosclerotic plaques were observed by cervical vascular ultrasound in both groups. The degree of vascular stenosis in head and neck was observed by CTA. The data were processed by SPSS 22.0 software. Results the smoking, drinking, hypertension and diabetes rates in the LAA group were higher than those in the control group. There was no significant difference in average age, sex ratio of male and control group, and there was no significant difference in the levels of Fib and TG in LAA group. The difference was statistically significant (P 0.05). The level of HDL in control group was higher than that in LAA group. The levels of LP-PLA2 and HCY in P0.05 LAA group were significantly higher than those in the control group, and the LP-PLA2 level was significantly increased with the increase of the severity of neurological impairment in the P0.05 / 4 LAA group. There were significant differences between the two groups. In the 5 LAA group, 34 patients with internal carotid artery system infarction had LPLA2 level of 156.26 鹵31.46 ng / ml, and 21 patients with vertebrobasilar artery supply area infarction. The level of LP-PLA2 was 164.68 鹵21.17ng / ml, there was no significant difference between the two groups. There was no significant difference among the subgroups of vascular stenosis at different locations in the LAA group. There was no significant difference between the two groups in the detection of plaques in 56 cases in the group of 0.695ng / ml, and there was no significant difference between the two groups. The LP-PLA2 level in 11 patients with stable plaque was 170.59 鹵38.16 ng / ml, and that in 45 patients with vulnerable plaque was 192.86 鹵37.29 ng / ml, which was significantly higher than that in the plaque free group (112.38 鹵26.17 ng / ml), and the difference was statistically significant in 5 patients with grade 0 of vascular grade 0 in P0.000 / 8 LAA group. The level of LP-PLA2 was 112.25 鹵28.65 ng / ml 1. The level of LP-PLA2 was 149.76 鹵31.18ng / ml 2 in 15 patients. The level of LP-PLA2 was 175.38 鹵41.24ng / ml in 32 patients. The level of LP-PLA2 was 185.59 鹵39.52ng / ml, the difference was statistically significant (P 0.002). Conclusion: the level of LP-PLA2 in 32 patients with LP-PLA2 is 175.38 鹵41.24ng / ml, and the level of LP-PLA2 is 185.59 鹵39.52ng / ml. Plasma LP-PLA2 may be a new risk factor for atherosclerotic cerebral infarction, and its level is significantly related to the severity of atherosclerotic cerebral infarction. And it can predict the severity of atherosclerosis of intracranial and external vessels in this kind of patients. Early detection of LP-PLA2 level can be helpful for secondary prevention and individualized treatment in patients with atherosclerotic cerebral infarction. It also provides some clinical basis for the development of LP-PLA2 specific inhibitors in the future.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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