本文選題：心臟遠隔預(yù)適應(yīng) + 缺血再灌注��； 參考：《天津醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 背景：對骨骼肌進行暫時性的缺血再灌注,能夠產(chǎn)生類似缺血預(yù)適應(yīng)的心臟保護作用,這一現(xiàn)象稱為“心臟遠隔缺血預(yù)適應(yīng)”(cardiac remote ischemic preconditioning)。但間斷重復(fù)阻斷骨骼肌血流會在一定程度上引起骨骼肌的生化微環(huán)境的變化,進而有可能會對循環(huán)血小板的聚集活性產(chǎn)生影響。對于上述問題,尚未見到相關(guān)研究報道。 目的：旨在觀察健康志愿者中,骨骼肌暫時性缺血再灌注處理對循環(huán)血小板體外聚集活性的干預(yù)作用,并探討其有關(guān)影響因素。 方法：在中國人民武裝警察部隊醫(yī)學(xué)院附屬醫(yī)院共招募31名健康志愿者,操作流程經(jīng)醫(yī)院倫理委員會通過,所有受試者簽署知情同意書。采用血壓計袖帶束縛單側(cè)上肢后,將壓力維持在200mmHg,采用3個5min-5min缺血-再灌注循環(huán)的標準操作流程實現(xiàn)骨骼肌的缺血再灌注。采集受試者基線、缺血再灌注后60min,以及缺血再灌注后24小時靜脈血進行血小板聚集活性測試(ADP誘導(dǎo)的比濁法)、有關(guān)血生化檢測；采用ELISA法測定各時點組織因子(tissue factor,TF)、高敏C反應(yīng)蛋白(high sensitive C reactive protein, hsCRP)、肌紅蛋白以及纖溶酶原激活物抑制因子-1(plasminogen activator inhibitor-1,PAI-1)水平變化。 結(jié)果：按照納入排除標準,最后24名完成所有測試的受試者數(shù)據(jù)納入分析。其中女性8人,男性16人,平均年齡30.7±1.4歲,平均腰臀比0.84±0.1,平均體重指數(shù)(body mass index)22.1±0.5 Kg/m2。24名受試者均完成所有采血。所有受試者在進行上肢缺血再灌注處理過程中,未報告明顯肢體局部或全身不適感。在進行肢體缺血再灌注處理前后,血鉀水平未發(fā)現(xiàn)明顯變化(缺血前,缺血后60min以及缺血24h后,分別對應(yīng)4.5±0.1 mmol/L,4.5±0.1 mmol/L和4.4±0.1mmol/L,P=0.568)。此外,PAI-1水平也未出現(xiàn)明顯動態(tài)變化(14.6±0.2ng/mL,14.6±0.3 ng/mL,14.5±0.2 ng/mL,P=0.848)。血漿總組織因子水平呈現(xiàn)明顯的動態(tài)變化趨勢：表現(xiàn)為骨骼肌缺血再灌注后(60min)立即增高,24小時后逐漸回落至基線水平(與基線水平比較無差異),且60min后與基線水平和24小時后比較均有統(tǒng)計學(xué)差異。 在肢體缺血再灌注處理60min后,受試者整體血小板聚集活性離散趨勢明顯增大,提示存在個體血小板反應(yīng)的異質(zhì)性。按照血小板的聚集率的不同,個體血小板的反應(yīng)性定義為在肢體缺血再灌注處理之后60min的聚集活性與基線聚集活性的差值(ΔAggregation,ΔA),如ΔA=10%,則此個體定義為高反應(yīng)者：其余個體定義為無/低反應(yīng)者。高反應(yīng)者共6人,其中女性1人,男性5人；無/低反應(yīng)者共18人,其中女性7人,男性11人。缺血再灌注處理之前,兩組人群的所有研究指標之間均未見統(tǒng)計學(xué)差異。此外,缺血后24小時,各項指標之間亦未見統(tǒng)計學(xué)差異。hsCRP在骨骼肌缺血再灌注60min后,在高反應(yīng)組和無低反應(yīng)組中存在差異(高反應(yīng)組2.0±0.3 mg/L v.s.無/低反應(yīng)組2.9±0.2 mg/L,P=0.026)。尤其值得注意的是,血循環(huán)hsCRP的變化量(ΔhsCRP,即再灌注后60min的hsCRP與基線hsCRP的差值)在兩組之間也存在統(tǒng)計學(xué)差異(高反應(yīng)組0.28±0.11 mg/L v.s.無/低反應(yīng)組-0.38±0.31 mg/L,P=0.016)；而24小時后,上述影響基本回復(fù)至基線水平(高反應(yīng)組2.2±0.4mg/L v.s無/低更應(yīng)組2.8±0.2mg/L,P=0.149)ΔhsCRP與AA呈現(xiàn)負相關(guān)關(guān)系(r=-0.411,P=0.046)。結(jié)論：總體而言,骨骼肌缺血再灌注處理對循環(huán)血小板的聚集活性無明顯影響,但可引起循環(huán)總組織因子水平的一過性增高。健康人群中的血小板的聚集活性對暫時性骨骼肌缺血再灌注存在異質(zhì)性,尤其是血小板聚集活性高反應(yīng)者在骨骼肌缺血后60min循環(huán)CRP水平增高不明顯,明顯低于無/低反應(yīng)者。
[Abstract]:Background: temporary ischemia-reperfusion of skeletal muscles can produce a protective effect similar to ischemic preconditioning. This phenomenon is called cardiac remote ischemic preconditioning. However, intermittent repetitive blocking of skeletal muscle blood flow can cause the biochemical microenvironment of skeletal muscle to a certain extent. It is possible that the aggregation activity of circulating platelets may be affected.
Objective: To observe the effect of temporary ischemia reperfusion on the extracorporeal platelet aggregation activity of circulating platelets in healthy volunteers, and to explore the related factors.
Methods: a total of 31 healthy volunteers were recruited in the Affiliated Hospital of the Chinese people's armed police force. The operation process was passed through the hospital ethics committee. All the subjects signed the informed consent. After using the cuff of the sphygmomanometer, the pressure was maintained at 200mmHg and the standard operation of 3 5min-5min ischemia reperfusion cycles was used. The flow of ischemic reperfusion of skeletal muscle was realized. Baseline of the subjects, 60min after ischemia-reperfusion, and 24 hours after ischemia and reperfusion were tested for platelet aggregation activity (ADP induced turbidimetry), blood biochemical test, and ELISA assay (tissue factor, TF), and high sensitive C reactive protein (high sensit). Ive C reactive protein (hsCRP), myoglobin and plasminogen activator inhibitor -1 (plasminogen activator inhibitor-1, PAI-1) level changes.
Results: according to the exclusion criteria, the final 24 subjects completed all the test data into the analysis. Among them, 8 were women, 16 men were male, the average age was 30.7 + 1.4, the average waist hip ratio was 0.84 + 0.1, the average body mass index (body mass index) 22.1 + 0.5 Kg/m2.24 subjects all completed all blood collection. All the subjects were in the upper limb ischemia and reperfusion. During the perfusion treatment, there was no obvious local or systemic discomfort. There was no obvious change in the level of blood potassium before and after ischemia and reperfusion (ischemia, 60min and 24h, respectively, 4.5 + 0.1 mmol/L, 4.5 + 0.1 mmol/L and 4.4 + 0.1mmol/L, P=0.568). Besides, there was no obvious movement of PAI-1. State changes (14.6 + 0.2ng/mL, 14.6 + 0.3 ng/mL, 14.5 + 0.2 ng/mL, P=0.848). The plasma total tissue factor level showed a significant trend of dynamic change: the expression of skeletal muscle ischemia reperfusion (60min) immediately increased, after 24 hours gradually fall to the baseline level (compared with baseline water level no difference), and 60min after the baseline level and 24 hours after the ratio. There were statistical differences.
After the treatment of 60min, the trend of the platelet aggregation activity in the subjects increased significantly, suggesting the heterogeneity of the individual platelet reaction. According to the platelet aggregation rate, the individual platelet reactivity was defined as the aggregation activity of 60min and the baseline aggregation activity after the limb ischemia reperfusion treatment. The difference (delta Aggregation, Delta A), such as delta A=10%, was defined as a high response person: the rest of the individual was defined as a non / low response person. A total of 6 high responders, of which 1 were female, 5 men, and 18 were no / low response, including 7 women and 11 men. Before the ischemia reperfusion treatment, no statistics were found among all the research indicators of the two groups. In addition, 24 hours after ischemia, there was no statistical difference between the indexes and.HsCRP after skeletal muscle ischemia reperfusion 60min, there was a difference between the high reaction group and the no low reaction group (the high reaction group was 2 + 0.3 mg/L v.s. no / low reaction group, 2.9 + 0.2 mg/L, P=0.026). The difference between the hsCRP of 60min and the baseline hsCRP after reperfusion was also statistically different between the two groups (the 0.28 + 0.11 mg/L v.s. without / -0.38 + 0.31 mg/L, P=0.016) in the high reaction group, and the above effect was basically returned to the baseline level after 24 hours (2.2 + 0.4mg/L v.s without / low in the high response group, 2.8 + 0.2mg/L, P=0.149) A showed a negative correlation (r=-0.411, P=0.046). Conclusion: in general, skeletal muscle ischemia reperfusion treatment has no obvious effect on the aggregation activity of circulating platelets, but it can cause an excessive increase in the level of circulating total tissue factors. The aggregation activity of platelet in healthy people is heterogeneous in transient skeletal muscle ischemia reperfusion. The high level of platelet aggregation activity in the 60min cycle after skeletal muscle ischemia increased CRP level was not obvious, significantly lower than those with no / low response.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R363

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