本文選題：ADAMTS4 + 頸動(dòng)脈狹窄��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本試驗(yàn)旨在探討粥樣硬化性頸動(dòng)脈狹窄患者血含I型血小板結(jié)合蛋白基序的解聚蛋白樣金屬蛋白酶4(ADAMTS4)的水平與頸動(dòng)脈斑塊穩(wěn)定性的相關(guān)性,探討其在頸動(dòng)脈斑塊穩(wěn)定性評(píng)估及對(duì)缺血性腦卒中風(fēng)險(xiǎn)預(yù)測(cè)的臨床價(jià)值。方法:采用前瞻性研究方法,入選就診于山西醫(yī)科大學(xué)第二醫(yī)院血管外科60名頸動(dòng)脈狹窄、欲行頸動(dòng)脈內(nèi)膜剝脫術(shù)的患者,留取患者入院24小時(shí)肘靜脈血、頸動(dòng)脈內(nèi)膜剝脫術(shù)(CEA)后的頸動(dòng)脈粥樣硬化斑塊標(biāo)本,據(jù)病理組織分型將其分為穩(wěn)定斑塊組和易損斑塊組。對(duì)照組選自我院體檢中心存在動(dòng)脈粥樣硬化但多普勒超聲檢查提示未見明顯頸動(dòng)脈斑塊的患者,年齡60-80歲,共30名;患者血ADAMTS4水平將采用酶聯(lián)免疫吸附法測(cè)定。按需采用單因素方差分析、Pearson卡方檢驗(yàn)、多因素logistic回歸分析、ROC(receiver operating characteristic curve,感受性曲線)等方法進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:易損斑塊組血ADAMTS4升高程度顯著高于穩(wěn)定斑塊組和對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.001),穩(wěn)定斑塊組血ADAMTS4水平較對(duì)照組增高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);logistic回歸分析顯示:癥狀型頸動(dòng)脈狹窄組與非癥狀型頸動(dòng)脈狹窄組相比,斑塊為易損斑塊的概率更高(p0.05,OR=12.429,95%CI=3.601-42.902),血ADAMTS4水平高組與血ADAMTS4水平低組相比,斑塊為易損斑塊的概率更高(p0.05,OR=8.240,95%CI=1.512-22.915);ROC曲線分析顯示:曲線下面積為0.943,95%CI=0.887-0.999。當(dāng)血ADAMTS4=100.935ng/ml時(shí),達(dá)到最大檢測(cè)效能,靈敏度=83.3%,特異度=1-7.6%=92.4%。結(jié)論:ADAMTS4可作為判斷頸動(dòng)脈粥樣硬化斑塊,尤其是易損斑塊穩(wěn)定性的潛在生化指標(biāo),對(duì)缺血性腦卒中的預(yù)防、早期診斷和尋找新的治療靶點(diǎn)等方面有積極的臨床意義。
[Abstract]:Objective: to investigate the relationship between the level of depolymerized proteinase-like metalloproteinase-4 (ADAMTS4) and carotid plaque stability in patients with atherosclerotic carotid stenosis. To evaluate the stability of carotid plaque and its clinical value in predicting the risk of ischemic stroke. Methods: a prospective study was carried out in 60 patients with carotid artery stenosis and carotid endarterectomy in the second Hospital of Shanxi Medical University. Carotid atherosclerotic plaque specimens after carotid endarterectomy were divided into stable plaque group and vulnerable plaque group according to pathological classification. The control group was selected from 30 patients aged 60-80 years with atherosclerosis but no obvious carotid plaques were detected by Doppler ultrasound. The serum ADAMTS4 level of the patients was determined by enzyme-linked immunosorbent assay (Elisa). Single factor variance analysis and Pearson chi-square test and multivariate logistic regression analysis were used to analyze the receptivity curve of receiver operating characteristic curve,. Results: the level of ADAMTS4 in the vulnerable plaque group was significantly higher than that in the stable plaque group and the control group, the difference was statistically significant (p 0.001). The serum ADAMTS4 level in the stable plaque group was higher than that in the control group. But there was no significant difference in logistic regression analysis between symptomatic carotid artery stenosis group and non-symptomatic carotid artery stenosis group. Compared with non-symptomatic carotid artery stenosis group, the probability of plaque being vulnerable plaque was higher than that of non-symptomatic carotid artery stenosis group, and the probability of plaque was higher than that of non-symptomatic carotid artery stenosis group, and the risk of plaque was higher than that of non-symptomatic carotid artery stenosis group. The incidence of plaque was higher in symptomatic carotid artery stenosis group than in non-symptomatic carotid artery stenosis group. The probability that the patch is a vulnerable patch is higher than that of a vulnerable patch. The analysis of ROC curve shows that the area under the curve is 0.94395 / 0.887-0.999. When the blood was ADAMTS4=100.935ng/ml, the maximum detection efficiency was achieved, the sensitivity was 83.3%, and the specificity was 1-7. 6 and 92. 4%. ConclusionADAMTS4 can be used as a potential biochemical index for judging the stability of carotid atherosclerotic plaques, especially vulnerable plaques, and has a positive clinical significance in the prevention of ischemic stroke, early diagnosis and finding new therapeutic targets.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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本文編號(hào)：1987355