本文選題：急性腦梗死 + 同型半胱氨酸血癥��； 參考：《揚州大學(xué)》2014年碩士論文

【摘要】：目的：觀察HHcy與急性腦梗死的相關(guān)性,分析MTHFR C677T基因?qū)cy水平的影響,探討MTHFR C677T基因多態(tài)性與急性腦梗死的相關(guān)性；同時對急性腦梗死患者進行CISS分型,探討HHcy及MTHFR C677T與不同病因及發(fā)病機制急性腦梗死的相關(guān)性。 方法：1、連續(xù)性收集2013年1月至2014年3月就診于蘇北醫(yī)院神經(jīng)內(nèi)科發(fā)病時間7d急性腦梗死患者,共567例。所有患者翌日清晨空腹抽取靜脈血2m1采用酶聯(lián)免疫分析法測定血漿Hcy水平,按照缺血性卒中CISS分型標準并結(jié)合影像學(xué)特點進行病因分型,比較各亞型的Hcy水平。 2、567例患者中在LA.A型及PAD型中隨機抽取97例(ACI組),留取靜脈血5ml,通過凝膠電泳方法檢測MTHFR C677T基因多態(tài)性。年齡、性別等匹配的57例健康體檢者作為健康對照組。比較ACI組及健康對照組的Hcy水平,比較各組內(nèi)TT、CC、CT基因型的Hcy水平,按照CISS分型標準對ACI組的LAA型根據(jù)發(fā)病機制分為四種亞型,比較四個亞型及PAD型患者的Hey水平及TT基因及T基因檢出率。 結(jié)果：1、與健康對照組比較,ACI組Hcy水平明顯增高(P0.05)；567例ACI患者依照CISS分型的病因分型的五種亞型的Hcy水平比較,LAA型Hcy水平較其他各型明顯增高,其差異具有統(tǒng)計學(xué)意義(P0.05);PAD型Hcy水平較UE、CS型明顯增高(P0.05),PAD型Hcy水平較OE型也明顯增高,但其差異無統(tǒng)計學(xué)意義(P0.05)；其余各組比較均無明顯差異(P0.05)。 2、健康對照組與ACI組的T基因及TT基因檢出率無明顯差異(P0.05)；各組內(nèi)TT、CC、CT基因型的Hcy水平比較,TT基因型Hcy水平高于CC、CT基因型,但其差異無統(tǒng)計學(xué)意義(P0.05)。 3、將依發(fā)病機制分型的四種亞型與PAD型比較,A-A栓塞型、穿支型動脈口閉塞及混合型的Hcy水平較PAD型明顯增高,且其差異具有統(tǒng)計學(xué)意義(P0.05)。LAA型中的四種亞型間Hcy水平無明顯差異(P0.05)。五種亞型的T基因及TT基因檢出率未見明顯差異(P0.05)。 結(jié)論：1、高同半型胱氨酸血癥是缺血性卒中的危險因素,且與卒中亞型中大動脈粥樣硬化型關(guān)系密切,與穿支動脈病型可能也有相關(guān)性。 2、MTHFR C677T基因多態(tài)性的T基因突變對血同型半胱氨酸濃度有影響。 3、MTHFR C677T基因多態(tài)性與缺血性卒中無直接相關(guān)性。
[Abstract]:Objective: to observe the correlation between HHcy and acute cerebral infarction, to analyze the effect of MTHFR C677T gene on Hcy level, to explore the relationship between MTHFR C677T gene polymorphism and acute cerebral infarction, and to classify the patients with acute cerebral infarction by CISS.To investigate the correlation between HHcy and MTHFR C677T and acute cerebral infarction with different etiology and pathogenesis.Methods from January 2013 to March 2014, 567 patients with acute cerebral infarction were admitted to the Department of Neurology, Subei Hospital from January 2013 to March 2014.The plasma Hcy levels were measured by enzyme linked immunosorbent assay (Elisa) in all patients with venous blood 2m1 collected on an empty stomach the next morning. According to the criteria of CISS classification and imaging features of ischemic stroke, the Hcy levels of each subtype were compared.Among 2567 patients, 97 patients with LA.A and PAD were randomly selected, and 5 ml of venous blood was collected. The polymorphism of MTHFR C677T gene was detected by gel electrophoresis.Age, sex, and other matched 57 healthy people as a healthy control group.The levels of Hcy in ACI group and healthy control group were compared, and the Hcy level of TTC CCT genotype in each group was compared. According to CISS classification criteria, LAA type in ACI group was divided into four subtypes according to the pathogenesis.The levels of Hey and the detection rate of TT gene and T gene in four subtypes and PAD patients were compared.Results compared with the healthy control group, the level of Hcy in the control group was significantly higher than that in the control group. The Hcy level of the five subtypes of ACI according to the etiological classification of CISS was significantly higher than that of the other types.The level of P0.05pad type Hcy was significantly higher than that of UECS-type and the level of P0.05pad type Hcy was significantly higher than that of OE type, but the difference was not statistically significant (P0.05), and there was no significant difference in other groups.2. There was no significant difference in the detection rate of T gene and TT gene between healthy control group and ACI group (P 0.05). The Hcy level of TT genotype was higher than that of CCT CT genotype in each group, but the difference was not statistically significant (P 0.05).3Compared the four subtypes according to pathogenesis with PAD type, the Hcy level of perforating artery occlusion and mixed type was significantly higher than that of PAD type, and there was no significant difference in Hcy level among the four subtypes of P0.05. LAA type.There was no significant difference in the detection rate of T gene and TT gene among the five subtypes (P 0.05).Conclusion hyperhomocysteinemia is a risk factor for ischemic stroke, and is closely related to the type of atherosclerosis in the middle and large arteries of the subtype of stroke, and may also be related to the type of perforating artery disease.2the mutation of T gene in MTHFR C677T gene had an effect on serum homocysteine concentration.3There was no direct correlation between MTHFR C677T gene polymorphism and ischemic stroke.
【學(xué)位授予單位】：揚州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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