本文選題：腦動脈瘤 + 炎癥反應(yīng)�。� 參考：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：腦動脈瘤破裂所引起的蛛網(wǎng)膜下腔出血是一種致死率、致殘率極高的中風(fēng)類型,腦動脈瘤的發(fā)生、發(fā)展機(jī)制尚不明了。目前的治療針對已形成的動脈瘤,對于動脈瘤沒有有效的防治措施,如何預(yù)防動脈瘤的發(fā)生發(fā)展是一個(gè)極具挑戰(zhàn)性的課題。本研究基于一種新型的血流動力學(xué)性大鼠動脈瘤模型,對于動脈瘤的成瘤因素進(jìn)行初步探討；同時(shí),收集腦動脈瘤患者的中醫(yī)證候資料。初步探討腦動脈瘤患者的中醫(yī)證候類型以及動脈瘤圍手術(shù)期的中醫(yī)證候變化。為動脈瘤防治工作提供參考。方法：課題分為兩個(gè)部分。第一部分為動物實(shí)驗(yàn)：大鼠分為2組(實(shí)驗(yàn)組、對照組),統(tǒng)計(jì)各組大鼠的死亡率,成瘤率(病理組織切片,進(jìn)行HE染色、VG染色),進(jìn)行免疫組化分析,監(jiān)測各組大鼠的平均動脈收縮壓,對比各組標(biāo)本的腦血管管徑、血管壁厚度。第二部分為臨床回顧性研究：回顧廣東省中醫(yī)院神經(jīng)五科在2013年1月-2014年12月期間,所收治的腦動脈瘤患者(經(jīng)DSA診斷),納入其中28例患者,使用證候量表分析其入院時(shí)中醫(yī)癥候分布情況,對比動脈瘤栓塞術(shù)圍手術(shù)期證候變化情況。結(jié)果：第一部分實(shí)驗(yàn)結(jié)果：死亡率：對照組無非正常死亡,實(shí)驗(yàn)組20%(3/15)。成瘤率：對照組0%(0/15),實(shí)驗(yàn)組33%(4/12)。免疫組化可見動脈瘤壁上有巨噬細(xì)胞的染色。血壓監(jiān)測提示對照組收縮壓無明顯波動,實(shí)驗(yàn)組大鼠術(shù)后收縮壓逐漸升高,實(shí)驗(yàn)組大鼠術(shù)后大腦前動脈管徑和厚度逐漸增加。第二部分回顧性研究結(jié)果：共納入28符合標(biāo)準(zhǔn)的腦動脈瘤患者,入院時(shí)中醫(yī)證候積分以風(fēng)證、火熱證、痰證、血瘀證為高,術(shù)后風(fēng)證、火熱證、血瘀證積分下降明顯,痰證積分下降不明顯。結(jié)論：1.新型動脈瘤模型可穩(wěn)定的產(chǎn)生動脈瘤,可用于動脈瘤的病因探究；MCP-1介導(dǎo)的血管壁上的慢性炎癥反應(yīng)可能與腦動脈瘤的發(fā)生發(fā)展關(guān)系密切。2、腦動脈瘤患者的證候規(guī)律為風(fēng)證、火熱證、血瘀證、痰證兼而為患；其中痰證在腦動脈瘤栓塞術(shù)后積分下降不明顯,提示痰證可能為腦動脈瘤病程過程中持續(xù)存在的中醫(yī)病理因素,可能是腦動脈瘤形成的重要因素。
[Abstract]:Objective: subarachnoid hemorrhage caused by rupture of cerebral aneurysm is a type of apoplexy with high mortality and disability rate. The current treatment is aimed at the formed aneurysms, there is no effective prevention and treatment for aneurysms, how to prevent the occurrence and development of aneurysms is a very challenging topic. Based on a new model of hemodynamic aneurysm in rats, the factors of aneurysm formation were preliminarily discussed. At the same time, TCM syndromes of cerebral aneurysm patients were collected. To explore the types of TCM syndromes of cerebral aneurysms and the changes of TCM syndromes in the perioperative period of aneurysms. To provide a reference for the prevention and treatment of aneurysms. Methods: the project was divided into two parts. The first part was animal experiment: rats were divided into two groups (experimental group, control group, the mortality rate and tumorigenesis rate (pathological section, HE staining, VG staining, immunohistochemical analysis). The mean systolic blood pressure of rats was monitored and the diameter of cerebral vessels and the thickness of vascular wall were compared. The second part is a clinical retrospective study: a retrospective study of 28 patients with cerebral aneurysms admitted from January 2013 to December 2014 in the Department of Neurology, Guangdong Provincial Hospital of traditional Chinese Medicine (DSA) was conducted. Syndrome scale was used to analyze the distribution of TCM symptoms at admission and to compare the changes of syndrome in perioperative period of aneurysm embolization. Results: the first part of the experiment: mortality: the control group is no more than normal death, experimental group 20 / 15. Tumour rate: control group 0 / 15, experimental group 33 / 12. Immunohistochemical staining showed macrophage staining on the wall of the aneurysm. Blood pressure monitoring showed that there was no obvious fluctuation of systolic blood pressure in the control group. The systolic blood pressure increased gradually in the experimental group and the diameter and thickness of the anterior cerebral artery increased gradually in the experimental group. The results of the second part of the retrospective study: 28 patients with cerebral aneurysms who met the criteria were included. The scores of TCM syndromes on admission were high in wind syndrome, fire heat syndrome, phlegm syndrome and blood stasis syndrome. The scores of wind syndrome, fire heat syndrome, blood stasis syndrome decreased significantly after operation. Phlegm syndrome integral drop is not obvious. Conclusion 1. A new type of aneurysm model can produce aneurysm stably, which can be used to explore the etiology of aneurysm. The chronic inflammatory reaction on the wall of blood vessel mediated by MCP-1 may be closely related to the occurrence and development of cerebral aneurysm. The syndrome pattern of cerebral aneurysm is wind syndrome. Heat syndrome, blood stasis syndrome, phlegm syndrome and phlegm syndrome were not significantly decreased after embolization of cerebral aneurysm, suggesting that phlegm syndrome may be a persistent pathological factor of TCM during the course of cerebral aneurysm. It may be an important factor in the formation of cerebral aneurysm.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743

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本文編號：2039521