本文選題：vWF　切入點：s-CD40L　出處：《河北大學(xué)》2017年碩士論文

【摘要】：研究背景及目的腦微出血(cerebral microbleeds,CMBs)是顱內(nèi)微小血管損傷后血細(xì)胞通過損傷嚴(yán)重的血管內(nèi)皮滲漏到周圍組織,從而導(dǎo)致含鐵血黃素沉積的一種亞臨床表現(xiàn)。CMBs的出現(xiàn)標(biāo)志著患者顱內(nèi)血管出現(xiàn)受損情況,且患者具有出血傾向的狀態(tài)。作為一種亞臨床疾病,CMBs缺乏相應(yīng)的神經(jīng)功能障礙表現(xiàn),目前,CMBs的診斷有賴于高強(qiáng)度核磁共振檢查的磁敏感加權(quán)成像(susceptibility weighted imaging,SWI)及T2加權(quán)成像(T2*)序列,CMBs具體表現(xiàn)為圓形或者卵圓形,直徑在2-5mm之間的低信號病灶。CMBs的發(fā)病率在不同人群中有所差別,研究表明,急性腦梗死患者CMBs的發(fā)病率約在40%左右,并且急性腦梗死合并CMBs與梗死后出血轉(zhuǎn)化有一定的關(guān)聯(lián)性。但是,迄今為止,腦微出血形成的具體機(jī)制尚不明確,目前研究結(jié)果考慮其形成原因可能與血管內(nèi)皮功能障礙及炎癥反應(yīng)等因素關(guān)系密切。血管性血友病因子(Von Willebrand factor,v WF)作為一種蛋白多聚體,是一種大分子量物質(zhì),在人體凝血過程中發(fā)揮著十分重要的作用,目前已有研究表明,血管性血友病因子可以良好的反應(yīng)內(nèi)皮細(xì)胞活動度,是預(yù)測血管內(nèi)皮功能狀態(tài)的可靠標(biāo)準(zhǔn)。血管內(nèi)可溶性CD40配體(soluble CD40ligand,s-CD40L)是目前研究發(fā)現(xiàn)較為可靠的血管炎性反應(yīng)指標(biāo)。綜上,本研究選擇收集急性期腦梗死患者血液中v WF及s-CD40L含量的檢測結(jié)果,對血液中兩項因子的含量檢測結(jié)果進(jìn)行分析,重點探尋兩種因子與腦微出血(CMBs)的相關(guān)性。期望為臨床腦微出血的診療有所幫助。方法收集2016年2月至2016年10月河北大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科病房內(nèi)住院的急性期腦梗死患者(發(fā)病6-72h之間)共150例,通過核磁共振特殊序列SWI檢查將所有患者進(jìn)行分組,其中包括急性期腦梗死合并微出血患者62例,急性期腦梗死不合并腦微出血患者88例,收集150例急性期腦梗死患者一般基礎(chǔ)信息并進(jìn)行OCSP分型,于發(fā)病2周內(nèi)復(fù)查頭部CT明確是否存在梗死后出血轉(zhuǎn)化。收集門診就診的健康成人30例作為正常對照組。健康成人于體檢當(dāng)天靜脈采血,腦梗死患者于入院當(dāng)天行靜脈采血,所有血液標(biāo)本離心后-70℃凍存,待標(biāo)本收集完成后,同一批次使用ELISA試劑盒完成v WF及s-CD40L含量測定。針對收集數(shù)據(jù)運(yùn)用統(tǒng)計學(xué)方法處理,尋找微出血與患者一般基本信息、OCSP分型、v WF及s-CD40L含量之間蘊(yùn)藏的相關(guān)關(guān)系,其中P0.05標(biāo)志差異有統(tǒng)計學(xué)意義。結(jié)果1.急性期腦梗死合并CMBs患者及急性期腦梗死不合并CMBs患者靜脈血v WF及s-CD40L含量較正常成人明顯升高,其中急性期腦梗死合并CMBs患者靜脈血中v WF及s-CD40L含量較急性期腦梗死不合并CMBs者升高(P0.001)。2.OCSP分型中不同急性期腦梗死分型患者v WF及s-CD40L含量不同,且各型患者間兩種因子血清中含量差異明顯(P0.001)。3.急性期腦梗死合并CMBs患者靜脈血中v WF及s-CD40L含量與CMBs數(shù)量線性相關(guān),隨著CMBs的數(shù)量增加,v WF及s-CD40L含量也呈增加趨勢(R=0.873,P0.001;R=0.762,P0.001)。4.經(jīng)過多因素logistic回歸分析表明年齡、高血壓病、同型半胱氨酸及v WF可作為急性期腦梗死合并CMBs的獨立危險因素。5.急性期腦梗死合并CMBs較急性期腦梗死不合并CMBs患者發(fā)生梗死后出血轉(zhuǎn)化的可能性明顯增高,且發(fā)生出血轉(zhuǎn)化與CMBs個數(shù)之間正相關(guān)(R=0.704,P0.001)。結(jié)論1.腦微出血的發(fā)生與年齡、高血壓病、同型半胱氨酸、v WF及s-CD40L含量關(guān)系密切。2.急性期腦梗死伴有腦微出血患者較單純急性期腦梗死患者靜脈血中v WF及sCD40L含量高。3.v WF及s-CD40L,特別是v WF可作為檢測指標(biāo)對急性期腦梗死患者出血傾向進(jìn)行初步評估。4.急性期腦梗死發(fā)生出血轉(zhuǎn)化與腦微出血之間存在相關(guān)性,發(fā)生出血轉(zhuǎn)化與腦微出血個數(shù)正相關(guān)。
[Abstract]:Background and objective: cerebral microbleeds (cerebral microbleeds CMBs) is a very small intracranial vascular injury after severe injury of blood cells by vascular endothelial leakage into the surrounding tissue, resulting in a sub clinical manifestation of.CMBs hemosiderin deposition marks the intracranial vascular damage, and patients with bleeding tendency. As a kind of subclinical disease, CMBs lack of corresponding nerve dysfunction, at present, susceptibility weighted imaging in the diagnosis of CMBs depends on the high strength MRI (susceptibility weighted imaging, SWI) and T2 weighted imaging (T2*) sequence specific CMBs showed round or oval, the incidence of 2-5mm in diameter between the low signal.CMBs lesions rate was different in different population studies show that the incidence of CMBs in patients with acute cerebral infarction rate is about 40%, and acute cerebral infarction with CMB S and post infarction hemorrhage transformation have certain relevance. However, so far, the mechanism of the formation of the cerebral microbleeds is not clear, the results of the present study considered the relationship between reason and vascular endothelial dysfunction and inflammation factors closely. Von Willebrand factor (Von Willebrand factor, V WF) as a protein polymer, is a kind of high molecular weight substances play a very important role in the blood coagulation process, the present study has shown that von Willebrand factor can be a good response of endothelial cell activity, is a reliable standard predictive state of vascular endothelial function. Intravascular soluble CD40 ligand (soluble, CD40ligand, s-CD40L) is the present study found that inflammatory reaction index is more reliable. The detection results were collected in patients with cerebral infarction in acute stage of V WF and s-CD40L in this study, the blood The content of test results in two factor analysis, explores two factors with cerebral microbleeds (CMBs). The correlation between expectations for the clinical diagnosis and treatment of cerebral microbleeds in patients with acute cerebral infarction help. Methods from February 2016 to October 2016 in Hebei University Affiliated Hospital neurology ward in the hospital (onset 6-72h) a total of 150 cases. Through MRI sequence specific SWI examination of all patients were divided into two groups, including acute cerebral infarction with micro hemorrhage in 62 patients with acute cerebral infarction with cerebral microbleeds in patients with 88 cases, a total of 150 patients with acute cerebral infarction and the general basic information of the OCSP type, in the first 2 weeks after the head of CT is clear there are post infarction hemorrhage transformation. Healthy adults collected 30 outpatients as normal control group. Healthy adults to physical examination in the venous blood in patients with cerebral infarction in the hospital when As the venous blood of all blood samples after centrifugation at -70 deg.c freezing, after all the sample were collected, using the same batch ELISA kit for determination of V WF and s-CD40L content. The use of statistical methods for the collection of data processing, find the micro bleeding with the basic information, the OCSP type, is the relationship between V and WF the content of s-CD40L, which has statistical significance P0.05 symbol difference. Results of 1. patients with acute cerebral infarction with CMBs and acute cerebral infarction with CMBs venous blood of patients with V WF and the s-CD40L content was significantly higher in normal adults, including acute cerebral infarction with CMBs venous blood in patients with V WF and the s-CD40L content was not acute cerebral infarction with CMBs. (P0.001) in acute cerebral infarction of different.2.OCSP subtypes in patients with type V WF and different s-CD40L content, and various types of patients in two kinds of factors in serum had obvious difference (P0.001).3. Acute cerebral infarction with CMBs venous blood in patients with V WF and s-CD40L CMBs and the content of the number of linear correlation with the increase in the number of CMBs, V, WF and s-CD40L was also increased (R=0.873, P0.001; R=0.762, P0.001).4. after multivariate logistic regression analysis showed that age, hypertension, homocysteine and v WF as the acute cerebral infarction with CMBs independent risk factors of acute cerebral infarction with.5. CMBs in acute cerebral infarction patients without CMBs infarction hemorrhagic transformation after the possibility of increased significantly, and the occurrence of a positive correlation between the number of hemorrhagic transformation with CMBs (R=0.704, P0.001). With age, the conclusion of the 1. cerebral microbleeds in hypertensive. Homocysteine, V WF and s-CD40L content in patients with acute cerebral infarction with close.2. venous blood of patients with cerebral microbleeds in patients with acute cerebral infarction than in V WF and.3.v WF s and high sCD40L content -CD40L, especially V WF can be used as the detection index of patients with acute cerebral infarction hemorrhage tendency preliminary assessment of.4. in patients with acute cerebral infarction hemorrhage transformation and cerebral microbleeds there is a correlation between the occurrence of hemorrhagic transformation, and the number of cerebral microbleeds are related.

【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 徐大飛;楚蘭;李婭;楊勇;;腦微出血及其與抗栓治療相關(guān)性研究進(jìn)展[J];中國神經(jīng)免疫學(xué)和神經(jīng)病學(xué)雜志;2016年05期

2 牛杰,毛節(jié)明,陳明哲,張U，

本文編號：1711846