發(fā)布時(shí)間：2018-04-03 20:47

  本文選題：sCD40L　切入點(diǎn)：sP-selectin　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過檢測大動(dòng)脈粥樣硬化(LAA)型腦梗死病人血漿可溶性CD40L(s CD40L)及可溶性P-選擇素(s P-selectin)的水平,結(jié)合LAA型腦梗死病人腦動(dòng)脈粥樣硬化病變廣泛程度、微栓子信號以及NIHSS評分,分析血漿s CD40L及s P-selectin與LAA型腦梗死的關(guān)系,進(jìn)一步探討LAA型腦梗死的發(fā)病相關(guān)機(jī)制。方法:選擇我院神經(jīng)內(nèi)科病區(qū)入院病人,嚴(yán)格按照TOAST病因分型標(biāo)準(zhǔn)篩選120例急性LAA型腦梗死入院病人為研究對象,正常對照組60例。為評價(jià)腦梗死病人腦動(dòng)脈粥樣硬化病變的廣泛程度,將120例LAA型腦梗死病人按照腦動(dòng)脈狹窄(動(dòng)脈狹窄程度≥50%)支數(shù)分為單支(n=40)、雙支(n=34)及三支及以上病變(n=46)3個(gè)亞組;為評價(jià)腦梗死病人腦動(dòng)脈粥樣硬化斑塊的穩(wěn)定性,對病例組中責(zé)任病灶涉及頸內(nèi)動(dòng)脈(ICA)系統(tǒng)病變的病人行微栓子信號(MES)監(jiān)測,MES陽性13例,MES陰性68例。所有腦梗死患者住院期間行NIHSS評分以評價(jià)腦梗死急性期神經(jīng)功能缺損程度。我們應(yīng)用酶聯(lián)免疫吸附法(ELISA)測定病例組及正常對照組的血漿s CD40L及s P-selectin水平,并分析s CD40L及s P-selectin與LAA型腦梗死的關(guān)系。此外,我們通過受試者工作曲線(ROC)分析s CD40L及s P-selectin診斷LAA型腦梗死的靈敏度和特異度,并比較曲線下面積,分析兩指標(biāo)對LAA型腦梗死的診斷優(yōu)勢。結(jié)果:LAA型腦梗死病人血漿s CD40L及s P-selectin水平顯著高于對照組(t=-11.960、-13.036,P0.001),且兩者水平分別為LAA型腦梗死的獨(dú)立危險(xiǎn)因素(OR=1.006、1.100,P=0.016、0.033)。血漿s CD40L及s P-selectin水平在病例組的單支病變、雙支病變、多支病變3個(gè)亞組中差異具有顯著性意義(P0.01),通過Bonferroni方法進(jìn)一步分析發(fā)現(xiàn)多支病變亞組血漿s CD40L及s P-selectin水平顯著高于單支病變亞組(P0.01);此外,通過Spearman相關(guān)性分析得出病例組s CD40L及s P-selectin水平與腦動(dòng)脈病變支數(shù)正相關(guān)(r=0.330、0.359,P0.001);MES陽性組病人血漿s CD40L及s P-selectin顯著高于MES陰性組(P0.001)。120例急性LAA型腦梗死病人NIHSS評分與血漿s CD40L及s P-selectin水平分別與成正相關(guān)關(guān)系(r=0.490、0.415,P0.001);此外,我們的數(shù)據(jù)還顯示在LAA型腦梗死病人中,血漿s CD40L與s P-selectin兩者的水平是顯著正相關(guān)的(r=0.712,P0.001)。應(yīng)用ROC曲線分析,s CD40L診斷LAA型腦梗死的ROC曲線下面積0.887,以307.00 pg/m L為截?cái)帱c(diǎn)時(shí),靈敏度81.7%,特異度91.7%;s P-selectin診斷LAA型腦梗死的ROC曲線下面積0.920,以22.62ng/m L為截?cái)帱c(diǎn)時(shí),靈敏度86.7%,特異度90%。兩者對LAA型腦梗死診斷效能比較無統(tǒng)計(jì)學(xué)差異(Z=1.26,P=0.2077)。結(jié)論:血漿可溶性CD40L以及可溶性P-selectin水平升高提示大動(dòng)脈粥樣硬化型腦梗死病人的腦動(dòng)脈粥樣硬化病變累及范圍廣泛、斑塊穩(wěn)定性差,以及急性期神經(jīng)功能缺損程度重。兩者通過血小板活化以及炎癥反應(yīng)等機(jī)制參與動(dòng)脈粥樣硬化的病理過程,可作為LAA型腦梗死腦動(dòng)脈粥樣硬化病變嚴(yán)重程度的臨床檢測標(biāo)志物。
[Abstract]:Objective: to detect the levels of plasma soluble CD40L(s CD40L and soluble P- selectin P-selectin in patients with cerebral infarction of large artery atherosclerosis (LAA) type, combined with the extent of atherosclerosis lesion, microembolus signal and NIHSS score in patients with LAA type cerebral infarction.To analyze the relationship between plasma s CD40L and s P-selectin and LAA type cerebral infarction, and to further explore the pathogenesis of LAA type cerebral infarction.Methods: 120 patients with acute LAA type cerebral infarction were selected according to the criteria of etiological classification of TOAST and 60 cases of normal control group.To evaluate the extent of atherosclerotic lesions in patients with cerebral infarction, 120 patients with LAA type cerebral infarction were divided into three subgroups according to the number of branches of cerebral artery stenosis (arterial stenosis 鈮，

本文編號：1706849