本文關(guān)鍵詞： 蛛網(wǎng)膜下腔出血 腦血管痙攣 血小板源性生長(zhǎng)因子 腦脊液　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景:蛛網(wǎng)膜下腔出血(subarachnoid hemorrhage,SAH)是高致殘率和致死率的疾病,腦血管痙攣(cerebral vasospasm,CVS)是其主要的并發(fā)癥。有關(guān)CVS發(fā)生的確切機(jī)制目前尚不清楚。因此有必要對(duì)CVS進(jìn)行進(jìn)一步研究。血小板源性生長(zhǎng)因子(PDGF)是生長(zhǎng)因子超家族中的一員,與之結(jié)合的受體有PDGFR-a和-β兩個(gè)亞型。通常情況下,單體狀態(tài)下的PDGF和PDGFR并無(wú)生物學(xué)活性。PDGFR各亞型之間結(jié)構(gòu)和功能相似,均有一個(gè)胞外域、跨膜域和一個(gè)胞內(nèi)的酪氨酸激酶結(jié)構(gòu)域,對(duì)跨膜信號(hào)進(jìn)行轉(zhuǎn)導(dǎo),對(duì)小血管的形成和傷口的修復(fù)具有著重要的調(diào)節(jié)作用。根據(jù)既往臨床及基礎(chǔ)研究提示sPDGFR可能會(huì)參與SAH后血管痙攣的發(fā)生。方法:本次研究包括2015年11月至2016年4月因動(dòng)脈瘤性蛛網(wǎng)膜下腔出血入住我院神經(jīng)外科的患者。所有患者于SAH后1-3d、4-6d、7-9d行腰椎穿刺術(shù)留取腦脊液3ml,或者從留有腦室外引流管或者腰椎穿刺引流管處留取3ml腦脊液。對(duì)照組于接受椎管內(nèi)麻醉前留取腦脊液1ml。所有腦脊液sPDGFR的濃度均有酶聯(lián)免疫吸附試驗(yàn)(ELISA)測(cè)得。記錄患者年齡、性別、發(fā)病時(shí)間等一般資料,患者的臨床資料(Hunt-Hess分級(jí)、Fisher分級(jí)、世界神經(jīng)外科(WFNS)評(píng)分)以及患者影像學(xué)資料。結(jié)果:本研究共納入32例SAH患者,其中女性20例,男性12例。5例正常人腦脊液作為對(duì)照�；颊叩钠骄挲g55.7± 12.3歲。SAH后1-3d,患者腦脊液中sPDGFRβ的平均濃度886.93 pg/ml。正常對(duì)照組的腦脊液中sPDGFRβ平均濃度484.04 pg/ml。SAH患者腦脊液中平均sPDGFRβ濃度高于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p=0.0012)。SAH后患者腦脊液樣本(1-3天,4-6天,and 7-9天)中,sPDGFR β的濃度隨時(shí)間的變化,直到7-9天達(dá)到高(886.93±242.86 pg/ml vs 1229.07±513.69 pg/ml vs 1338.13±468.30 pg/ml,p0.001)。ROC曲線(xiàn)分析后發(fā)現(xiàn)1-3dsPDGFR β濃度對(duì)腦血管痙攣有一定的預(yù)測(cè)能力。曲線(xiàn)下面積(AUC)是0.680(p=0.082)。sPGFR β濃度的診斷閾值是975.38 pg/ml。將患者分為兩組-血管痙攣組和非血管痙攣組,發(fā)現(xiàn)發(fā)生腦血管痙攣患者腦脊液中sPDGFRβ濃度明顯高于非血管痙攣組,差異有統(tǒng)計(jì)學(xué)意義(973.46±239.23pg/ml vs 788.85±213.99pg/ml,p=0.029),sPDGFRβ濃度與血管痙攣有明顯的相關(guān)性(Chi-square=5.542,p=0.019,r=0.416,p=0.018)。SAH 后1-3d腦脊液中高sPDGFRβ濃度是血管痙攣發(fā)生的獨(dú)立危險(xiǎn)因素(p=0.001,OR=19.22,95%CI:3.27-113.03),除此之外,年齡(p0.001,OR=0.024,95%CI:0.004-0.157)和 WFNS分級(jí)IV-V(p=0.061,OR=5.196,95%CI:1-29.16)也是CVS發(fā)生的獨(dú)立危險(xiǎn)因素。腦脊液中高sPDGFRβ濃度不是SAH患者6個(gè)月預(yù)后不良的獨(dú)立危險(xiǎn)因素。結(jié)論:SAH后腦脊液中sPDGFR β濃度明顯升高,1-3d腦脊液中高sPDGFR β濃度與SAH后腦血管痙攣的發(fā)生明顯相關(guān),且是腦血管痙攣發(fā)生的獨(dú)立危險(xiǎn)因素。因此,早期檢測(cè)腦脊液中sPDGFRβ濃度對(duì)腦血管痙攣的診斷具有潛在臨床參考價(jià)值。
[Abstract]:Background: subarachnoid hemorrhage (SAH) is a disease with high disability rate and mortality. Cerebral vasospasmCVS is a major complication of cerebral vasospasm. The exact mechanism of CVS is not clear. Therefore, it is necessary to further study CVS. PDGF is a member of the superfamily of growth factors. The binding receptors are PDGFR-a and 尾 subtypes. In general, PDGF and PDGFR in monomer state have no biological activity. The structure and function of each subtype of PDGFR are similar, and each of them has an extracellular domain. Transmembrane domain and an intracellular tyrosine kinase domain transduction of transmembrane signal. SPDGFR may be involved in the development of vasospasm after SAH according to previous clinical and basic studies. Methods: this study includes November 2015 to 2016. Patients admitted to neurosurgery department for aneurysm subarachnoid hemorrhage. All patients received lumbar puncture at 1-3 d 4-6 d after SAH for 3 ml of cerebrospinal fluid, or 3 ml of brain from left ventricular drainage tube or lumbar puncture drainage tube. Spinal fluid. Cerebrospinal fluid (CSF) 1 ml was retained in the control group before being anesthetized into the spinal canal. The concentration of sPDGFR in all cerebrospinal fluid was measured by enzyme linked immunosorbent assay (Elisa). Sex, onset time and other general data, clinical data of patients with Hunt-Hess grade and Fisher grade, World Neurosurgery WFS score) and imaging data of patients. Results: 32 patients with SAH were included in this study, 20 of whom were women. The average age of patients was 55.7 鹵12.3 years. The average concentration of sPDGFR 尾 in CSF was 886.93 PG / ml. The average concentration of sPDGFR 尾 in CSF of normal controls was 484.04 pg/ml.SAH. The concentration was higher than that in the control group. There was a significant difference in the concentration of sPDGFR 尾 with time in cerebrospinal fluid (CSF) samples of patients with SAH (1-3 days, 4-6 days and 7-9 days). By 7 to 9 days after reaching a high level of 886.93 鹵242.86 pg/ml vs 1229.07 鹵513.69 pg/ml vs 1338.13 鹵468.30 PG / ml P 0.001U, ROC curve analysis showed that the concentration of 1-3dsPDGFR 尾 could predict cerebral vasospasm to some extent, and the area under the curve was 0.680p0.082n.sPGFR 尾 concentration, the diagnostic threshold was 975.38 PG / ml. Spastic group and non-vasospasm group, It was found that the concentration of sPDGFR 尾 in cerebrospinal fluid of patients with cerebral vasospasm was significantly higher than that of non-vasospasm group. The difference was statistically significant (973.46 鹵239.23 PG / ml vs 788.85 鹵213.99pg / ml / ml / ml / ml respectively) and there was a significant correlation between the concentration of sPDGFR 尾 and vasospasm. In addition, the high concentration of sPDGFR 尾 in cerebrospinal fluid was an independent risk factor for the development of vasospasm. In addition, high sPDGFR 尾 concentration in cerebrospinal fluid was found to be an independent risk factor for the development of vasospasm. Age (p 0.001) and WFNS grade IV-V: 0.061) are also independent risk factors for the occurrence of CVS. High sPDGFR 尾 concentration in cerebrospinal fluid is not an independent risk factor for poor prognosis in patients with SAH at 6 months. Conclusion the concentration of sPDGFR 尾 in cerebrospinal fluid is significantly higher than that in cerebrospinal fluid for 1 to 3 days after CVS. The moderate and high concentration of sPDGFR 尾 was significantly correlated with the occurrence of cerebral vasospasm after SAH. Therefore, early detection of sPDGFR 尾 concentration in cerebrospinal fluid has potential clinical reference value in the diagnosis of cerebral vasospasm.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.35

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