腦梗死患者APC、APS及AT-Ⅲ等生物標(biāo)志物與頸動脈粥樣硬化的相關(guān)性分析
發(fā)布時間：2018-08-06 18:46
【摘要】：目的:腦梗死(cerebral infarction)又稱缺血性腦卒中(Ischemic stroke),是指因腦部血液循環(huán)障礙,缺血、缺氧所致的局限性腦組織的缺血性壞死或軟化。腦梗死是腦血管病中最常見的類型,約占全部腦血管病的70%,《柳葉刀》(Lancet)雜志發(fā)布的《全球疾病負(fù)擔(dān)研究》顯示,在2010和2013年,腦卒中在中國仍然是位列第1位的死因。同時韓國的NEW-TOAST分型及中國缺血性卒中亞型(CISS分型)均提示動脈粥樣硬化性腦梗死占比最高,故研究APC、APS、AT-Ⅲ等生物標(biāo)志物對動脈粥樣硬化形成的影響對腦梗死的預(yù)防及治療有重要價值。方法:連續(xù)收集2015年10月至2016年3月發(fā)病入住承德醫(yī)學(xué)院附屬醫(yī)院神經(jīng)內(nèi)科的患者,經(jīng)頭顱螺旋CT診斷符合中華醫(yī)學(xué)會神經(jīng)病學(xué)分會腦血管病學(xué)組標(biāo)準(zhǔn)的腦梗死患者共計502例,其中男性患者304例,女性患者198例,年齡45-80歲,平均(60.75±9.435)歲。超聲檢查用由專業(yè)超聲醫(yī)師操作,采用美國索諾聲便攜彩超儀M-Turbo完成頸動脈超聲檢查(探頭頻率13-6 MHz1),檢查患者雙側(cè)頸總動脈(commom carotid artery,CCA)、頸內(nèi)動脈(internal carotid artery,ICA)、頸外動脈(external cartied artery,ECA)、椎動脈(vertebral artery,VA)、鎖骨下動脈(subclavian artery,SA)。將502例患者根據(jù)頸部血管動脈粥樣硬化程度分為正常組(c IMT1.0mm)、頸動脈內(nèi)膜增厚組(1.0≤c IMT1.5mm)和頸動脈斑塊形成組。所有患者均于入院后24小時內(nèi)采集清晨空腹靜脈血。由我院檢驗科完成血漿活化蛋白C(actived protein C)、活化蛋白S(actived protein S)與抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ),同型半胱氨酸(Hcy)、高敏感C反應(yīng)蛋白(hs-C reactive protein,hs-CRP)、總膽紅素(Total bilirubin,TBIL)、直接膽紅素(Direct bilirubin,DBIL)、總膽固醇(Total cholesterol,TCH)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL),胱抑素C等相關(guān)指標(biāo)的測定。采用SPSS19.0統(tǒng)計軟件處理,計量資料使用`x±s表示,數(shù)據(jù)經(jīng)正態(tài)性檢驗符合正態(tài)分布,且滿足方差齊性要求,樣本均數(shù)比較采用獨立樣本T檢驗,多組間均數(shù)比較采用單因素方差分析,計數(shù)資料采用卡方檢驗,頸動脈粥樣硬化影響因素采用Logistic回歸,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:患者一般資料比較3組患者性別構(gòu)成、甘油三酯、膽固醇、高密度脂蛋白、低密度脂蛋白差異無統(tǒng)計學(xué)意義。血糖水平比較,頸動脈斑塊組c IMT增厚組c IMT正常組,但c IMT增厚組與c IMT正常組之間差異無統(tǒng)計學(xué)差異(P0.05);年齡水平比較,頸動脈斑塊組c IMT增厚組c IMT正常組,且各組間差異具有統(tǒng)計學(xué)意義(P0.05)。3組患者中,AT-Ⅲ水平比較,頸部血管正常組高于頸動脈內(nèi)膜增厚組高于頸動脈斑塊形成組,且各組間差異具有統(tǒng)計學(xué)意義(P0.05);在APC、APS水平中,c IMT正常組及c IMT增厚組與頸動脈斑塊形成組之間具有統(tǒng)計學(xué)差異(P0.05),而c IMT正常組與c IMT增厚組之間無明顯差異(P0.05);胱抑素C水平方面,頸動脈斑塊形成組(0.946±0.223 mmol/L)高于頸動脈內(nèi)膜增厚組(0.866±0.142mmol/L),也高于頸動脈內(nèi)膜正常組(0.855±0.191mmol/L),其差異具有統(tǒng)計學(xué)意義(P0.05),但是頸動脈內(nèi)膜增厚組與頸動脈內(nèi)膜正常組之間差異無統(tǒng)計學(xué)意義(P0.05)。Logistic回歸分析結(jié)果顯示高h(yuǎn)s-CRP水平以及高Cyst-C水平為頸動脈粥樣硬化斑塊形成的危險因素,而高APC、APS、AT-Ⅲ水平則是其保護(hù)性因素。結(jié)論:APC、APS、AT-Ⅲ、Hcy、Cyst-C、hs-CRP與頸動脈粥樣硬化存在密切相關(guān)性,高APC、APS、AT-Ⅲ為頸動脈粥樣硬化的保護(hù)性因素,高Hcy、Cyst-C、hs-CRP是頸動脈粥樣硬化的危險因素。血漿Hcy、Cyst-C、hs-CRP水平可反映頸動脈粥樣硬化程度。
[Abstract]:Objective: cerebral infarction (cerebral infarction), also known as ischemic stroke (Ischemic stroke), refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorder, ischemia and hypoxia. Cerebral infarction is the most common type of cerebrovascular disease, accounting for about 70% of all cerebral vascular diseases, < < Lancet 'magazine published < global. The disease burden study shows that stroke in China is still the first leading cause of death in 2010 and 2013. Both the NEW-TOAST classification of Korea and the ischemic stroke type (CISS type) in China all suggest the highest proportion of atherosclerotic cerebral infarction. Therefore, the effects of biomarkers such as APC, APS, and AT- III on the formation of atherosclerosis are studied. The prevention and treatment of cerebral infarction have important value. Methods: the patients who had been admitted to Affiliated Hospital of Chengde Medical College from October 2015 to March 2016 were collected, and 502 cases of cerebral infarction were diagnosed by the spiral CT of the head of the Chinese Medical Association, which were in accordance with the standard of cerebrovascular disease group of the Chinese Medical Association. Among them, 304 cases were male patients. 198 patients, aged 45-80 years, mean (60.75 + 9.435) years of age. Ultrasound examination was performed by a professional ultrasonic physician. The carotid ultrasound examination (probe frequency 13-6 MHz1) was performed by the sono portable color Doppler M-Turbo in the United States. The bilateral common carotid artery (commom carotid artery, CCA), the internal carotid artery (internal carotid artery, ICA), and the external carotid artery were examined. External cartied artery (ECA), vertebral artery (vertebral artery, VA), subclavian artery (subclavian artery, SA). 502 patients were divided into normal group (C IMT1.0mm), carotid intima thickening group (1) and carotid plaque formation group according to the degree of vascular atherosclerosis in the neck. All patients were collected within 24 hours after admission. Plasma activated protein C (actived protein C), active protein S (actived protein S) and antithrombin III (antithrombin III, AT- III), homocysteine (Hcy), Gao Min sensing C reaction protein, total bilirubin, direct bilirubin, and direct bilirubin were completed in the Department of Laboratory Department of our hospital. Ilirubin, DBIL), total cholesterol (Total cholesterol, TCH), triglyceride (Triglyceride, TG), high density lipoprotein (High density lipoprotein, HDL), low density lipoprotein (Low), cystatin and other related indicators. According to normal distribution, and meet the requirement of homogeneity of variance, the average number of samples was compared with independent sample T test. Single factor analysis of variance was used to compare the average number of multiple groups. Counting data was checked by chi square test. The factors of carotid atherosclerosis were affected by Logistic regression. The difference of P0.05 was statistically significant. Results: the general data of the patients were compared to 3 groups. Sex composition, triglyceride, cholesterol, high density lipoprotein and low density lipoprotein were not statistically significant. Blood sugar levels were compared, the C IMT thickening group of carotid plaque group was C IMT, but there was no statistical difference between the C IMT thickening group and the normal C IMT group (P0.05); the age level was compared with the C IMT thickening group of the carotid plaque group. The difference between the groups was statistically significant (P0.05) group.3, and the level of AT- III in the normal group of the neck was higher than that of the carotid artery intima group, which was higher than that of the carotid artery plaque formation group, and the difference between the groups was statistically significant (P0.05). In the APC, APS level, the C IMT normal group and the C IMT thickening group and the carotid plaque formation group. There was statistical difference (P0.05), but there was no significant difference between the normal group of C IMT and the thickening group of C IMT (P0.05). The level of cystatin C, the carotid plaque formation group (0.946 + 0.223 mmol/L) was higher than the carotid intima thickening group (0.866 + 0.142mmol/L), and higher than that of the normal carotid artery intima group (0.855 + 0.191mmol/L), and the difference was statistically significant. P0.05) but there was no statistically significant difference between the carotid intima thickening group and the normal carotid artery intima (P0.05).Logistic regression analysis showed that high H s-CRP level and high Cyst-C level were the risk factors for the formation of carotid atherosclerotic plaque, while the high APC, APS, and AT- III levels were its protective factors. Conclusion: APC, APS, AT- III, Hcy, Cyst-C, hs-CRP is closely related to carotid atherosclerosis. High APC, APS and AT- III are protective factors for carotid atherosclerosis. High Hcy, Cyst-C, and hs-CRP are risk factors for carotid atherosclerosis. The level of plasma Hcy, Cyst-C, and hs-CRP can reflect the degree of carotid atherosclerosis.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
本文編號：2168657
[Abstract]:Objective: cerebral infarction (cerebral infarction), also known as ischemic stroke (Ischemic stroke), refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorder, ischemia and hypoxia. Cerebral infarction is the most common type of cerebrovascular disease, accounting for about 70% of all cerebral vascular diseases, < < Lancet 'magazine published < global. The disease burden study shows that stroke in China is still the first leading cause of death in 2010 and 2013. Both the NEW-TOAST classification of Korea and the ischemic stroke type (CISS type) in China all suggest the highest proportion of atherosclerotic cerebral infarction. Therefore, the effects of biomarkers such as APC, APS, and AT- III on the formation of atherosclerosis are studied. The prevention and treatment of cerebral infarction have important value. Methods: the patients who had been admitted to Affiliated Hospital of Chengde Medical College from October 2015 to March 2016 were collected, and 502 cases of cerebral infarction were diagnosed by the spiral CT of the head of the Chinese Medical Association, which were in accordance with the standard of cerebrovascular disease group of the Chinese Medical Association. Among them, 304 cases were male patients. 198 patients, aged 45-80 years, mean (60.75 + 9.435) years of age. Ultrasound examination was performed by a professional ultrasonic physician. The carotid ultrasound examination (probe frequency 13-6 MHz1) was performed by the sono portable color Doppler M-Turbo in the United States. The bilateral common carotid artery (commom carotid artery, CCA), the internal carotid artery (internal carotid artery, ICA), and the external carotid artery were examined. External cartied artery (ECA), vertebral artery (vertebral artery, VA), subclavian artery (subclavian artery, SA). 502 patients were divided into normal group (C IMT1.0mm), carotid intima thickening group (1) and carotid plaque formation group according to the degree of vascular atherosclerosis in the neck. All patients were collected within 24 hours after admission. Plasma activated protein C (actived protein C), active protein S (actived protein S) and antithrombin III (antithrombin III, AT- III), homocysteine (Hcy), Gao Min sensing C reaction protein, total bilirubin, direct bilirubin, and direct bilirubin were completed in the Department of Laboratory Department of our hospital. Ilirubin, DBIL), total cholesterol (Total cholesterol, TCH), triglyceride (Triglyceride, TG), high density lipoprotein (High density lipoprotein, HDL), low density lipoprotein (Low), cystatin and other related indicators. According to normal distribution, and meet the requirement of homogeneity of variance, the average number of samples was compared with independent sample T test. Single factor analysis of variance was used to compare the average number of multiple groups. Counting data was checked by chi square test. The factors of carotid atherosclerosis were affected by Logistic regression. The difference of P0.05 was statistically significant. Results: the general data of the patients were compared to 3 groups. Sex composition, triglyceride, cholesterol, high density lipoprotein and low density lipoprotein were not statistically significant. Blood sugar levels were compared, the C IMT thickening group of carotid plaque group was C IMT, but there was no statistical difference between the C IMT thickening group and the normal C IMT group (P0.05); the age level was compared with the C IMT thickening group of the carotid plaque group. The difference between the groups was statistically significant (P0.05) group.3, and the level of AT- III in the normal group of the neck was higher than that of the carotid artery intima group, which was higher than that of the carotid artery plaque formation group, and the difference between the groups was statistically significant (P0.05). In the APC, APS level, the C IMT normal group and the C IMT thickening group and the carotid plaque formation group. There was statistical difference (P0.05), but there was no significant difference between the normal group of C IMT and the thickening group of C IMT (P0.05). The level of cystatin C, the carotid plaque formation group (0.946 + 0.223 mmol/L) was higher than the carotid intima thickening group (0.866 + 0.142mmol/L), and higher than that of the normal carotid artery intima group (0.855 + 0.191mmol/L), and the difference was statistically significant. P0.05) but there was no statistically significant difference between the carotid intima thickening group and the normal carotid artery intima (P0.05).Logistic regression analysis showed that high H s-CRP level and high Cyst-C level were the risk factors for the formation of carotid atherosclerotic plaque, while the high APC, APS, and AT- III levels were its protective factors. Conclusion: APC, APS, AT- III, Hcy, Cyst-C, hs-CRP is closely related to carotid atherosclerosis. High APC, APS and AT- III are protective factors for carotid atherosclerosis. High Hcy, Cyst-C, and hs-CRP are risk factors for carotid atherosclerosis. The level of plasma Hcy, Cyst-C, and hs-CRP can reflect the degree of carotid atherosclerosis.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
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