【摘要】：目的及意義:探究40～65歲腦動(dòng)脈粥樣硬化(Cerebral Atherosclerosis,CAD)患者中痰濕質(zhì)、瘀血質(zhì)與循環(huán)內(nèi)皮祖細(xì)胞(Endothelial Progenitor Cells,EPCs)數(shù)量的關(guān)系,為從中西醫(yī)結(jié)合方面探究血管自我更新修復(fù)以防治腦動(dòng)脈粥樣硬化提供新思路。研究方法:本研究入選2016年2月至2017年2月福建省立醫(yī)院神經(jīng)內(nèi)科門診及病房40～65歲經(jīng)中醫(yī)體質(zhì)問(wèn)卷篩選出的痰濕質(zhì)、瘀血質(zhì)、平和質(zhì)患者,根據(jù)腦動(dòng)脈粥樣硬化篩查與診斷規(guī)范(2014版)判別CAD病變及其程度,將無(wú)CAD的平和質(zhì)患者設(shè)為對(duì)照組,CAD的痰濕質(zhì)、瘀血質(zhì)患者設(shè)為實(shí)驗(yàn)組,并利用流式細(xì)胞儀檢測(cè)其外周血EPCs的數(shù)量,分析比較人口統(tǒng)計(jì)學(xué)資料和血管危險(xiǎn)因素,以探究EPCs數(shù)量與40～65歲CAD患者痰濕質(zhì)、血瘀質(zhì)的關(guān)系。.結(jié)果:1、本課題共收錄患者120例,痰濕質(zhì)46例,瘀血質(zhì)49例,對(duì)照組(無(wú)CAD平和質(zhì))25例;CAD組95例,其中輕度CAD 62例,中重度CAD 33例;女性44例(36.67%),平均年齡53.5±6.7歲:CAD相關(guān)危險(xiǎn)因素中高血壓占70.00%,高脂血癥占44.20%。2、多項(xiàng)Logiistic回歸模型分析CAD痰濕質(zhì)、瘀血質(zhì)的影響因素,結(jié)果:高血壓為CAD痰濕質(zhì)、瘀血質(zhì)的獨(dú)立預(yù)測(cè)因素;EPCs數(shù)量與CAD瘀血質(zhì)呈負(fù)相關(guān);CAD瘀血質(zhì)常見于既往有卒中/TIA病史者。3、多變量二元Logistic回歸模型分析CAD的影響因素,結(jié)果:EPCs為CAD的保護(hù)因素,年齡、高血壓為CAD的危險(xiǎn)因素,大多數(shù)卒中/TIA病史的患者有CAD。4、多變量二元Logistic回歸模型分析CAD程度(輕度、中重度)影響因素,結(jié)果:EPCs數(shù)量與CAD程度呈負(fù)相關(guān),瘀血質(zhì)是中重度腦動(dòng)脈粥樣硬化的獨(dú)立預(yù)測(cè)因素因素。5、ROC曲線分析結(jié)果:可認(rèn)為EPCs用于判別對(duì)CAD有意義,EPCs數(shù)量越小為CAD的可能性越大,EPCs所對(duì)應(yīng)的最佳診斷界值為0.115%。結(jié)論:1、EPCs可能是動(dòng)脈粥樣硬化的一個(gè)保護(hù)性因素,其作用可能與促進(jìn)血管更新、延緩衰老有關(guān),但抗血管衰老的機(jī)制有待進(jìn)一步研究。2、EPCs數(shù)量與CAD瘀血質(zhì)呈負(fù)相關(guān),瘀血質(zhì)為腦動(dòng)脈粥樣硬化的獨(dú)立危險(xiǎn)因素,其作用機(jī)制可能與血流動(dòng)力學(xué)及凝血功能異常有關(guān)。尚未發(fā)現(xiàn)EPCs與CAD痰濕質(zhì)的關(guān)系。
[Abstract]:Objective and significance: to investigate the relationship between the quantity of circulating endothelial progenitor cell (Endothelial Progenitor Cells,EPCs) and phlegm wet matter, blood stasis and circulating endothelial progenitor cell (Endothelial Progenitor Cells,EPCs) in 40-65-year-old patients with cerebral atherosclerosis (Cerebral Atherosclerosis,CAD). To explore the combination of traditional Chinese and western medicine to explore vascular self-renewal repair in the prevention and treatment of cerebral atherosclerosis to provide a new way of thinking. Methods: from February 2016 to February 2017, the patients were selected from the outpatient department and ward of Fujian Provincial Hospital from February 2016 to February 2017 at the age of 40 and 65 years old, who were screened out by traditional Chinese Medicine Constitution questionnaire (TCM Constitution questionnaire), and the patients with phlegm dampness, blood stasis and mild quality were selected. According to the criteria for screening and diagnosis of cerebral atherosclerosis (2014 edition), the patients without CAD were divided into the control group, the phlegm damp group and the blood stasis group, and the patients without CAD were divided into the experimental group and the control group, according to the criteria for screening and diagnosis of cerebral atherosclerosis (2014 edition). The quantity of EPCs in peripheral blood was measured by flow cytometry, and the demographic data and vascular risk factors were analyzed and compared to explore the relationship between the quantity of EPCs and phlegm, damp and blood stasis in CAD patients aged 65 years old. Results: (1) there were 46 cases of phlegm-dampness, 49 cases of blood stasis, 25 cases of control group (no CAD level), 95 cases of CAD group, including 62 cases of mild CAD, 33 cases of moderate and severe CAD, and 42 cases of mild CAD and 33 cases of moderate and severe CAD. There were 44 women (36.67%) with an average age of 53.5 鹵6.7 years: hypertension accounted for 70.00% in CAD-related risk factors and hyperlipidemia accounted for 44.20%. Multiple Logiistic regression models were used to analyze the influencing factors of phlegm-dampness and blood stasis in CAD. Results: hypertension was an independent predictor of phlegm-dampness and blood stasis in CAD. There was a negative correlation between the quantity of EPCs and the blood stasis quality of CAD. CAD blood stasis was commonly seen in patients with previous stroke / TIA history. 3. Multivariate binary Logistic regression model was used to analyze the influential factors of CAD. Results: EPCs was the protective factor of CAD, age and hypertension were risk factors of CAD. Most of the patients with stroke / TIA history had CAD.4, multivariate binary Logistic regression model to analyze the influencing factors of CAD degree (mild, moderate and severe). Results: there was a negative correlation between the number of EPCs and the degree of CAD. Blood stasis is an independent predictor of moderate or severe cerebral atherosclerosis. 5. Roc curve analysis: it can be concluded that EPCs can be used to distinguish CAD, and the smaller the number of EPCs is, the more likely it is that the number of EPCs is CAD. The optimal diagnostic threshold for EPCs is 0.115%. Conclusion: 1. EPCs may be a protective factor of atherosclerosis, and its effect may be related to promoting blood vessel renewal and delaying aging, but the mechanism of anti-aging needs to be further studied. 2. There is a negative correlation between the number of CAD and blood stasis. Blood stasis is an independent risk factor of cerebral atherosclerosis, and its mechanism may be related to hemodynamic and coagulation dysfunction. The relationship between EPCs and CAD was not found.
【學(xué)位授予單位】：福建中醫(yī)藥大學(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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