【摘要】： 目的:自從Fabricant等以Marek病毒(一種禽類病毒)感染雞而引起動(dòng)脈粥樣硬化以來(lái),動(dòng)脈粥樣硬化的病毒病因?qū)W說(shuō)受到越來(lái)越多學(xué)者的關(guān)注,人巨細(xì)胞病毒(Humancytomegalovirus,HCMV)被認(rèn)為是與動(dòng)脈粥樣硬化關(guān)系最密切的一種病毒。本課題組的研究結(jié)果已證明臨床HCMV的激活感染是動(dòng)脈粥樣硬化的獨(dú)立危險(xiǎn)因素之一,關(guān)于這一課題,國(guó)內(nèi)外的許多學(xué)者從不同的角度進(jìn)行了相關(guān)研究,有關(guān)HCMV感染與動(dòng)脈粥樣硬化間關(guān)系的實(shí)驗(yàn)室研究已有大量文獻(xiàn)報(bào)道,但研究結(jié)果仍存在爭(zhēng)議,而且實(shí)驗(yàn)室環(huán)境不能準(zhǔn)確反映暴露于外部世界的真實(shí)條件,而流行病學(xué)則通過(guò)直接研究自然環(huán)境下的人群而避免了這類問(wèn)題,實(shí)驗(yàn)室研究同流行病學(xué)調(diào)查的結(jié)合將對(duì)這一課題從不同的角度進(jìn)行探討�，F(xiàn)有的流行病學(xué)資料多集中于孕婦、新生兒、獻(xiàn)血員、器官移植者及免疫缺陷者(如多發(fā)性硬化、AIDS患者等),調(diào)查人群層面單一,不能反映整體人群HCMV的感染狀況。HCMV-pp65是一種重要的晚期抗原,HCMV活動(dòng)性感染時(shí)HCMV-pp65表達(dá)于外周血單核細(xì)胞、中性多形核白細(xì)胞和血管內(nèi)皮細(xì)胞中,而潛伏感染時(shí)表達(dá)極低,現(xiàn)已成為國(guó)際公認(rèn)的診斷HCMV活動(dòng)性感染的標(biāo)準(zhǔn)方法之一。我們將在河北省11個(gè)行政區(qū)域內(nèi)進(jìn)行相關(guān)的流行病學(xué)調(diào)查,檢測(cè)HCMV-pp65,并隨訪調(diào)查人群,進(jìn)行前瞻性研究,觀察其動(dòng)脈粥樣硬化性疾病尤其是腦梗死的發(fā)生情況,從流行病學(xué)角度探討動(dòng)脈粥樣硬化與HCMV的關(guān)系,進(jìn)一步探討動(dòng)脈粥樣硬化的病因及相關(guān)危險(xiǎn)因素,進(jìn)而尋找防治缺血性腦血管病的新模式,這也是我們進(jìn)行此次流行病學(xué)調(diào)查的主要目的。 方法:本研究采用免疫組織化學(xué)方法檢測(cè)靜脈血白細(xì)胞中的巨細(xì)胞病毒晚期抗原pp65,對(duì)河北省部分地區(qū)(包括石家莊市、藁城市、柳辛莊、趙縣、高陽(yáng)、蠡縣、阜平、獻(xiàn)縣、贊皇、南皮、涉縣、武邑、崇禮)人群巨細(xì)胞病毒的激活感染HCMV-pp65陽(yáng)性率進(jìn)行了流行病學(xué)調(diào)查,共1954例,其中男性781例,女性1173例,平均年齡(55.16±10.30)歲。各縣、市按行政地域分成六個(gè)地區(qū):石家莊地區(qū)、保定地區(qū)、滄州地區(qū)、邯鄲地區(qū)、張家口地區(qū)和衡水地區(qū)。 利用microsoft excel建立數(shù)據(jù)庫(kù),將數(shù)據(jù)庫(kù)資料導(dǎo)入為SAS數(shù)據(jù)集,利用SAS 6.12統(tǒng)計(jì)軟件對(duì)所調(diào)查人群HCMV-pp65陽(yáng)性率及其與地域、年齡、性別等相關(guān)因素進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)數(shù)資料采用x~2檢驗(yàn)或校正的x~2檢驗(yàn),α=0.05。 結(jié)果:1對(duì)河北省13個(gè)縣區(qū)的1954例調(diào)查對(duì)象抽取靜脈血檢測(cè)人巨細(xì)胞病毒晚期抗原pp65,免疫組化染色后,陰性細(xì)胞為均勻一致的藍(lán)紫色,陽(yáng)性細(xì)胞胞漿和(或)胞核為棕黃色,陽(yáng)性細(xì)胞數(shù)大于1/50000判為pp65抗原陽(yáng)性。 2河北省部分地區(qū)人群抽血檢測(cè)人巨細(xì)胞病毒晚期抗原pp65,共1954例,其中農(nóng)村1807例,城鎮(zhèn)147例,平均年齡(55.16±10.30)歲,計(jì)算得出pp65陽(yáng)性率17.14%�？傮w人群pp65陽(yáng)性率在性別間差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=0.283,P＞0.05;年齡分組pp65陽(yáng)性率差異有統(tǒng)計(jì)學(xué)意義,x~2=8.688,P＜0.05,以60-年齡組最高(20.74%),40-年齡組最低(14.11%);地區(qū)間pp65陽(yáng)性率差異有統(tǒng)計(jì)學(xué)意義,x~2=55.246,P＜0.05,以保定地區(qū)最高(26.65%),依次為滄州(23.32%)、邯鄲(22.22%)、張家口(19.57%)、衡水(11.95%)、石家莊(11.49%)。 3農(nóng)村人群組1807例,平均年齡(55.87±10.19)歲,計(jì)算得出外周血pp65陽(yáng)性率18.04%。農(nóng)村人群pp65陽(yáng)性率在性別間差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=1.948,P＞0.05;年齡分組pp65陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=6.824,P＞0.05;地區(qū)間pp65陽(yáng)性率差異有統(tǒng)計(jì)學(xué)意義,x~2=44.386,P＜0.05,以保定地區(qū)最高(26.65%),依次為滄州(23.32%)、邯鄲(22.22%)、張家口(19.57%)、石家莊(12.52%)、衡水(11.95%)。 4城鎮(zhèn)人群組147例,平均年齡(46.87±7.54)歲,計(jì)算得出外周血pp65陽(yáng)性率6.12%。城鎮(zhèn)人群pp65陽(yáng)性率在性別間差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=0.035,P＞0.05;年齡分組pp65陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=1.624,P＞0.05。 5農(nóng)村與城鎮(zhèn)人群外周血pp65陽(yáng)性率比較差異有統(tǒng)計(jì)學(xué)意義,x~2=13.594,P＜0.05。 6平原地區(qū)與山區(qū)人群外周血pp65陽(yáng)性率比較差異無(wú)統(tǒng)計(jì)學(xué)意義,x~2=2.396,P＞0.05。 結(jié)論:1河北省部分地區(qū)調(diào)查人群中HCMV-pp65陽(yáng)性率為17.14%,說(shuō)明普通人群中存在HCMV的激活感染; 2河北省各地區(qū)間存在HCMV-pp65陽(yáng)性率的顯著性差異; 3 HCMV-pp65陽(yáng)性率性別間差異無(wú)統(tǒng)計(jì)學(xué)意義,但男性略高于女性; 4總體人群年齡分組HCMV-pp65陽(yáng)性率區(qū)組間差異有統(tǒng)計(jì)學(xué)意義,而農(nóng)村組和城鎮(zhèn)組年齡分組差異均無(wú)統(tǒng)計(jì)學(xué)意義,但隨年齡增加HCMV-pp65陽(yáng)性率有上升趨勢(shì); 5農(nóng)村與城鎮(zhèn)人群HCMV-pp65陽(yáng)性率比較差異有統(tǒng)計(jì)學(xué)意義,農(nóng)村明顯高于城鎮(zhèn); 6平原地區(qū)和山區(qū)HCMV-pp65陽(yáng)性率無(wú)顯著性差異; 7由研究結(jié)果推測(cè)所調(diào)查地區(qū)總體健康人群中HCMV的激活感染率應(yīng)低于17.14%。
[Abstract]:AIM: Since Fabricant et al. has caused atherosclerosis since the infection of Marek's virus (an avian virus), the etiology of atherosclerosis has attracted more and more attention from scholars, human cytomegalovirus (human cytomegalovirus), HCMV) is believed to be the most closely related to atherosclerosis. The results of our research team have shown that the activation infection of HCMV is one of the independent risk factors of atherosclerosis. Laboratory studies on the relationship between HCMV infection and atherosclerosis have been reported in a large number of literature, but the results of the study are still in dispute, and the laboratory environment cannot accurately reflect the real conditions exposed to the outside world, Epidemiological studies have avoided this problem by directly studying the population in the natural environment, and the combination of laboratory research and epidemiological investigation will discuss this subject from different angles. The current epidemiological data is concentrated in pregnant women, newborns, blood donors, organ transplant recipients and immunodeficient persons (such as multiple sclerosis, AIDS patients, etc.). HCMV pp65 is an important late antigen, HCMV-pp65 is expressed in peripheral blood monocytes, polymorphonuclear leukocytes and vascular endothelial cells when HCMV activity is infected. We will conduct relevant epidemiological investigation in 11 administrative regions of Hebei Province, detect HCMV pp65, follow up the investigation population, conduct prospective study, observe the occurrence of atherosclerotic disease, especially cerebral infarction. The relationship between atherosclerosis and HCMV was discussed from the angle of epidemiology, the cause of atherosclerosis and related risk factors were further studied, and the new model of prevention and treatment of ischemic cerebrovascular disease was found, which was also the main purpose of this epidemiological investigation. Methods: In this study, we used immunohistochemical method to detect the late antigen pp65 of giant cell virus in venous blood cells. The positive rate of HCMV pp65 in human cytomegalovirus (HCMV-pp65) in the population of Wuyi and Chongli was investigated in 1954. Among them, 781 cases were male, 1173 were female, and the average age (55. 16) was 10. 3. 0). The city is divided into six areas according to the administrative region: Shijiazhuang, Inner Mongolia, Cangzhou, Wenzhou, Zhangjiakou and Heng The database was established by microsoft excel, the database data were imported into SAS data set, and the positive rate of HCMV pp65 in the investigated population and its related factors, such as geography, age, sex, etc. were analyzed by SAS 6.12 statistical software. Statistical analysis. The count data is x ~ 2 test or corrected x ~ 2 test Results: 1 of the 1954 survey subjects in 13 counties in Hebei Province were recruited to detect the late antigen pp65 of human cytomegalovirus in venous blood, and the negative cells were uniformly consistent blue-purple and positive cells after immunohistochemical staining. The cytoplasm and/ or nucleus are brown, and the number of positive cells is greater than 1/ 5000. 0 was positive for pp65 antigen. A total of 1954 cases were detected by blood draw in some areas of Hebei Province. Among them, there were 1807 rural areas, 147 towns, and an average age (55. 16, 10. 30). The positive rate of pp65 was 17. 14%. The positive rate of pp65 in general population was not statistically significant, x ~ 2 = 0.283, P> 0.05; the positive rate of pp65 in age group was statistically significant, x ~ 2 = 8.688, P <0.05, the highest (20.74%) in 60-age group and 40-age group (14. 11%). The accounting significance, x ~ 2 = 55. 246, P <0.05, was the highest (26.65%), the highest (23.32%) in Cangzhou (23.32%), Zhangjiakou (19. 57%), Hengshui (11. 9). 5%), Shijiazhuang (11.49%). In the rural population group, 1807, mean age (55. 87, 10.19) years old, count The positive rate of pp65 in rural population was 18. 04%. The positive rate of pp65 in rural population was not statistically significant, x ~ 2 = 1. 948, P> 0.05; the positive rate of pp65 in age group was not statistically significant, x ~ 2 = 6.824, P> 0.05; the positive rate of pp65 positive rate was statistically significant, x ~ 2 = 44. 386, P <0 05, the highest (26. 65%) in the area of Shijiazhuang, Cangzhou (23. 32%), Shijiazhuang city (22. 22%), Zhangjiakou (19. 57%), Shijiazhuang (12.52%), Hengshui (11.95%). 147 cases of urban population group, average age (46. 87) 7.5 The positive rate of pp65 in urban population was 6. 12%. The positive rate of pp65 in urban population was not statistically significant. The positive rate of p65 in the peripheral blood of rural and urban population was higher than that in urban population without statistical significance, x2 = 1.624, P> 0.05. 5. The difference was statistically significant, x ~ 2 = 13. 594, P <0.05. 6 Plain area and peripheral blood pp6 in mountainous area. 5. There was no statistical significance in the positive rate of positive rate, x2 = 2.396, P> 0.05. Conclusion: The HCM in the survey population in some areas of Hebei Province The positive rate of V-pp65 was 17. 14%, indicating the presence of HCM in the general population. V activation infection; HCMV pp65 positive rate in different regions of Hebei province There was no significant difference between the positive rate of HCMV pp65 and the positive rate of HCMV pp65, but there was a statistically significant difference between the positive rate of HCMV pp65 and the positive rate of HCMV pp65. The differences of age groups in rural and urban groups were not statistically significant, but increased with age. CMV-pp65 yang a rising trend in sexual rates; HCMV-pp in rural and urban populations. 65 Positive rates were statistically significant, and rural areas were significantly higher than towns; in plain areas and mountain areas HCM
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R181.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 胡兆平,宋海波,冉玲,童志才,陶良軍,王紅梅;安徽省合肥地區(qū)獻(xiàn)血員的血清流行病學(xué)調(diào)查[J];疾病控制雜志;1997年02期

2 朱見(jiàn)文;何俊瑛;高玉林;張美英;;短暫性腦缺血發(fā)作患者中人巨細(xì)胞病毒-PP65抗原檢測(cè)[J];臨床薈萃;2006年05期

3 葉冬青,黃芬,胡兆平,鄭慧玲,王玉琴;合肥地區(qū)職業(yè)獻(xiàn)血員巨細(xì)胞病毒感染狀況調(diào)查[J];臨床輸血與檢驗(yàn);1999年03期

4 何俊瑛,高玉林,王永祥,李明林,鞏忠;進(jìn)展性卒中與穩(wěn)定性卒中巨細(xì)胞病毒抗原血癥檢測(cè)的臨床意義[J];腦與神經(jīng)疾病雜志;2004年04期

5 馬道新,于修平,薛付忠,趙蔚明,賈繼輝,周亞濱,李國(guó)榮;山東省人巨細(xì)胞病毒感染的流行病學(xué)調(diào)查及其相關(guān)因素研究[J];山東大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2005年07期

6 黃晨,張榮懷,王曉明,郭海濤;人巨細(xì)胞病毒感染對(duì)人臍靜脈內(nèi)皮細(xì)胞周期和凋亡的影響 動(dòng)脈粥樣硬化發(fā)生的可能病因[J];中國(guó)臨床康復(fù);2005年27期

7 肖丹，劉穎祺，李麗云，，路向紅;對(duì)92例健康獻(xiàn)血員巨細(xì)胞病毒感染的監(jiān)測(cè)報(bào)告[J];中國(guó)公共衛(wèi)生;1997年12期

本文編號(hào)：2270781