發(fā)布時(shí)間：2018-09-09 09:20

【摘要】：目的：應(yīng)用流式細(xì)胞法結(jié)合細(xì)胞表面標(biāo)志測(cè)定急性腦梗塞和慢性腦缺血患者循環(huán)內(nèi)皮祖細(xì)胞(Endothelial progenitor cell,EPC)水平，比較急性腦梗塞患者、慢性腦缺血患者和正常對(duì)照組循環(huán)EPC水平，分析急性腦梗塞患者循環(huán)EPC水平與腦血管病危險(xiǎn)因素之間的相關(guān)性，分析慢性腦缺血患者循環(huán)EPC水平與頸動(dòng)脈狹窄之間的關(guān)系，揭示EPC在缺血性腦血管病研究中的意義。 方法：1.采用CD34+、CD133+和KDR+細(xì)胞表面標(biāo)志鑒定循環(huán)內(nèi)皮祖細(xì)胞。分別從25例急性腦梗塞患者發(fā)病24小時(shí)內(nèi)和30例慢性腦缺血患者和15例無(wú)腦缺血正常人的外周靜脈采集靜脈血4ml。采用流式細(xì)胞計(jì)數(shù)法測(cè)定循環(huán)內(nèi)皮祖細(xì)胞數(shù)。2.測(cè)定25例急性腦梗塞患者循環(huán)EPC水平，并收集一般臨床資料和檢查指標(biāo)，包括：年齡、收縮壓(SBP)、糖化血紅蛋白(HbA1c)、總膽固醇(TC)，甘油三酯(TG)、低密度脂蛋白膽固醇（LDL-C）、高密度脂蛋白膽固醇（HDL-C)，運(yùn)用Pearson相關(guān)性分析其與循環(huán)EPC水平的相關(guān)性。3.測(cè)定30例慢性腦缺血患者循環(huán)EPC水平，采用數(shù)字減影血管造影方法測(cè)定其頸動(dòng)脈狹窄程度，，比較不同頸動(dòng)脈狹窄程度與循環(huán)EPC水平的關(guān)系，采用頸血管超聲檢查測(cè)定其頸動(dòng)脈內(nèi)中膜厚度(CIMT),運(yùn)用Pearson相關(guān)性分析IMT與循環(huán)EPC水平的相關(guān)性。 結(jié)果：1.急性腦梗塞患者和慢性性腦缺血患者相比正常對(duì)照組，循環(huán)EPC數(shù)量明顯下降（P＜0.01）；急性腦梗塞患者較慢性腦缺血患者循環(huán)EPC數(shù)量下降更明顯（P＜0.01）。2.急性腦梗塞患者循環(huán)EPC水平與收縮壓、總膽固醇、低密度脂蛋白呈中度負(fù)相關(guān),與糖化血紅蛋白、甘油三酯呈低度負(fù)相關(guān)（P＜0.05）。3.頸動(dòng)脈輕度狹窄和中重度狹窄患者較正常對(duì)照組循環(huán)EPC數(shù)量下降（P＜0.05），且中重度狹窄患者較輕度狹窄組患者下降更明顯（P＜0.05）；慢性腦缺血患者頸動(dòng)脈內(nèi)中膜厚度與循環(huán)EPC水平呈中度負(fù)相關(guān)（P＜0.05）。 結(jié)論：急性腦梗塞患者和慢性腦缺血患者循環(huán)內(nèi)皮祖細(xì)胞數(shù)明顯降低，循環(huán)內(nèi)皮祖細(xì)胞數(shù)的降低可能是腦缺血發(fā)生的危險(xiǎn)因素之一；腦血管危險(xiǎn)因素高血壓、總膽固醇、低密度脂蛋白、頸動(dòng)脈狹窄與循環(huán)EPC水平之間有密切相關(guān)性；EPC對(duì)于臨床預(yù)測(cè)、預(yù)防和治療缺血性腦血管性具有重要臨床價(jià)值和潛力。
[Abstract]:Objective: to determine the level of circulating endothelial progenitor cell (Endothelial progenitor cell,EPC) in patients with acute cerebral infarction and chronic cerebral ischemia by flow cytometry combined with cell surface markers, and to compare the level of circulating EPC in patients with acute cerebral infarction, patients with chronic cerebral ischemia and control group. The relationship between circulating EPC level and risk factors of cerebrovascular disease in patients with acute cerebral infarction was analyzed. The relationship between circulating EPC level and carotid artery stenosis in patients with chronic cerebral ischemia was analyzed. The significance of EPC in the study of ischemic cerebrovascular disease was revealed. Method 1: 1. Circulating endothelial progenitor cells were identified by CD34 CD 133 and KDR cell surface markers. Venous blood was collected from peripheral veins of 25 patients with acute cerebral infarction within 24 hours of onset, 30 patients with chronic cerebral ischemia and 15 normal subjects without cerebral ischemia. Flow cytometry was used to measure the number of circulating endothelial progenitor cells. The level of circulating EPC was measured in 25 patients with acute cerebral infarction, and general clinical data and examination indexes, including age, were collected. Systolic blood pressure (SBP), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were analyzed by Pearson correlation analysis. The level of circulating EPC was measured in 30 patients with chronic cerebral ischemia. The degree of carotid artery stenosis was measured by digital subtraction angiography, and the relationship between different degree of carotid stenosis and circulating EPC level was compared. Carotid intima-media thickness (CIMT),) was measured by carotid ultrasound. Pearson correlation was used to analyze the correlation between IMT and circulating EPC. The result is 1: 1. The number of circulating EPC in patients with acute cerebral infarction and chronic cerebral ischemia was significantly lower than that in normal controls (P < 0. 01), and the number of circulating EPC in patients with acute cerebral infarction was significantly lower than that in patients with chronic cerebral ischemia (P < 0. 01). The level of circulating EPC was negatively correlated with systolic blood pressure, total cholesterol, low density lipoprotein, glycosylated hemoglobin and triglyceride in patients with acute cerebral infarction (P < 0. 05). The number of circulating EPC in patients with mild and moderate stenosis of carotid artery was lower than that in control group (P < 0. 05), and the number of circulating EPC in patients with moderate and severe stenosis was significantly lower than that in patients with mild stenosis (P < 0. 05). There was a moderate negative correlation between carotid intima media thickness and circulating EPC level in patients with chronic cerebral ischemia (P < 0. 05). Conclusion: the number of circulating endothelial progenitor cells in patients with acute cerebral infarction and chronic cerebral ischemia is significantly decreased, and the decrease of circulating endothelial progenitor cells may be one of the risk factors of cerebral ischemia. There is a close correlation between low density lipoprotein (LDL), carotid stenosis and circulating EPC levels. EPCs have important clinical value and potential for clinical prediction, prevention and treatment of ischemic cerebrovascular disease.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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