發(fā)布時(shí)間：2018-03-17 08:43

  本文選題：主動(dòng)脈夾層　切入點(diǎn)：基質(zhì)金屬蛋白酶　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討基質(zhì)金屬蛋白酶12啟動(dòng)子序列多態(tài)性與主動(dòng)脈夾層發(fā)病的相關(guān)性。方法：選取2012年9月至2014年12月于昆明醫(yī)科大學(xué)第四附屬醫(yī)院心血管外科成人Stanford A型急性主動(dòng)脈夾層行手術(shù)治療并康復(fù)出院的45例患者為實(shí)驗(yàn)組,選取同期心肌梗死行冠脈搭橋術(shù)的35例患者為對照組,采用Sanger法對MMP-12啟動(dòng)子區(qū)域進(jìn)行測序,將測序結(jié)果與MMP-12啟動(dòng)子區(qū)域參考序列(NM_002426.4)進(jìn)行掃描比對,尋找可能存在的單核苷酸多態(tài)性位點(diǎn),以及單核苷酸多態(tài)性位點(diǎn)與主動(dòng)脈夾層發(fā)病的相關(guān)性。結(jié)果：根據(jù)MMP-12啟動(dòng)子序列測序結(jié)果,與MMP-12參考序列(NM 002426.4)啟動(dòng)子區(qū)域進(jìn)行比較后,發(fā)現(xiàn)該區(qū)域共存在以下2個(gè)SNP位點(diǎn)：第220位的核苷酸T轉(zhuǎn)變?yōu)镃,第645位核苷酸C轉(zhuǎn)換為T。其中最常見的基因多態(tài)性為第220位核苷酸T轉(zhuǎn)變?yōu)镃,并且均出現(xiàn)在實(shí)驗(yàn)組(14.4%)。MMP-12第220位核苷酸等位基因T和C在實(shí)驗(yàn)組中與對照中的分布具有統(tǒng)計(jì)學(xué)差異(x2=11.01,P0.05)。其中,實(shí)驗(yàn)組中核苷酸C的頻率較對照組中核苷酸C的頻率高(0%),因此,具有核苷酸C的突變可能導(dǎo)致人群罹患AD的可能性較大(OR=0.8-56, 95%CI=0.786-0.931)。而第645位核苷酸等位基因C和T在實(shí)驗(yàn)組和對照組中的分布無統(tǒng)計(jì)‘學(xué)差異(x 2=0.783,P0.05),因此C645T多態(tài)性可能與AD的發(fā)病關(guān)系不大,實(shí)驗(yàn)組中核苷酸T的頻率(1.1%)與對照組中核苷酸T的頻率(0%)相差不大,具有核苷酸T的突變可能與AD的發(fā)病相關(guān)性不大(OR=0.989, 95%CI=0.967-1.011)。結(jié)論：在實(shí)驗(yàn)組和對照組中共發(fā)現(xiàn)MMP-12基因啟動(dòng)子中存在2個(gè)多態(tài)性位點(diǎn)(第220位的核苷酸T轉(zhuǎn)變?yōu)镃,第645位核昔酸C轉(zhuǎn)換為T),其中T220C多態(tài)性與主動(dòng)脈夾層的發(fā)病有著一定的相關(guān)性,核苷酸C的突變可能導(dǎo)致人群罹患AD的可能性較大,而C645T多態(tài)性與AD的發(fā)病關(guān)系可能相關(guān)性不大。目的:探卻孫氏手術(shù)基礎(chǔ)上加用升主動(dòng)脈-股動(dòng)脈旁路移植術(shù)治療復(fù)雜型A型主動(dòng)掀夾層手術(shù)時(shí)化的選擇。方法:31例復(fù)雜型A型主動(dòng)脈夾層患者,年齡(49±15).歲,體質(zhì)量(73±15)kg,均采用孫氏手術(shù),術(shù)前監(jiān)測患者督功能,并應(yīng)用320排容積CT經(jīng)行胸腹主動(dòng)脈CTA掃描結(jié)果,計(jì)算降主動(dòng)脈真腔最小面積和同一平面降主動(dòng)脈面積,復(fù)溫階段監(jiān)測患者上、下肢血壓及1h內(nèi)尿量。對于真腔最小面積小、降主動(dòng)脈遠(yuǎn)端無破口、術(shù)中尿量少、上下肢壓差大于60 mmHg的12例患者進(jìn)一步進(jìn)行行升股旁路移植術(shù)。結(jié)果;影響選擇升-股旁路移植術(shù)的的相關(guān)手術(shù)時(shí)機(jī)因素有:(1)腎動(dòng)脈平面及1^^上降主動(dòng)脈真腔最小面積占同一平面降主動(dòng)脈面積的百分比1.5%^(2)上肢收縮壓與下肢收縮壓壓差20 mmHg;(3)手術(shù)復(fù)溫階段尿量偏少,或者利尿效果不佳;.(4)降主動(dòng)脈遠(yuǎn)端無破曰。結(jié)論:對復(fù)雜型A型主動(dòng)脈夾層患者的真腹最小面積、上下肢收縮壓壓差、復(fù)溫階段尿量及降主動(dòng)脈遠(yuǎn)端破口進(jìn)行監(jiān)測,可決定是否加做升-股旁路移植術(shù),.對患者的預(yù)后有著積極的意義。目的:探討義用了孫氏手術(shù)+升主動(dòng)脈-股動(dòng)脈旁路移植術(shù)盾對Stanford A型主動(dòng)脈夾層患者遠(yuǎn)期預(yù)后情況。方法:選取選頃2012年9月至2014年12月于昆明醫(yī)科大學(xué)第四附屬醫(yī)院屯、血管外科采用了孫氏手術(shù)+升主動(dòng)脈一股動(dòng)脈旁路移植術(shù)治療后康復(fù)出院的12例主動(dòng)脈夾層患者,術(shù)后1月、3月、6月、1年監(jiān)測患者腎功能、通過胸主動(dòng)脈X椙緾T掃描,對降主動(dòng)脈的面積及其真腔的面積測算并與術(shù)前情況比較,同時(shí)4次監(jiān)測旁路血管面積大小并進(jìn)行比對。結(jié)果:(1)旁路血管的1年內(nèi)面積未出現(xiàn)明思變化,其1年內(nèi)通暢率較高;(2)皆功能1年內(nèi)較術(shù)前未見明顯損害;(3)降主動(dòng)脈未見較術(shù)前未見明顯擴(kuò)張;(4).降主動(dòng)脈真腔較術(shù)前明盈擴(kuò)張,增加了下半身的灌注。結(jié)論:對于真控較小,下半身灌注較差的患者積極采用升-股旁路移植術(shù)對患者遠(yuǎn)期的巧后有著積極的意義
[Abstract]:Objective: To investigate the correlation between matrix metalloproteinase 12 promoter polymorphism and the incidence of aortic dissection. Methods: 45 cases from September 2012 to December 2014 on the type of cardiovascular surgery, the Fourth Affiliated Hospital of Kunming Medical University, A Stanford of adult acute aortic dissection underwent surgical treatment and hospital patients as the experimental group, 35 cases of myocardial infarction were selected for coronary artery bypass grafting the patients in the control group, Sanger method was used for sequencing the promoter region of MMP-12, the sequencing results with the MMP-12 promoter region (NM_002426.4) of the reference sequence scanning, searching for polymorphisms found that may exist, and the correlation between single nucleotide polymorphism and the incidence of aortic dissection. Results: according to the MMP-12 promoter sequence the results of MMP-12, and the reference sequence (NM 2426.4) to compare the promoter region, the coexistence of In the following 2 SNP loci: T 220th nucleotides into C, conversion of 645th nucleotide C T. where gene polymorphism is the most common 220th nucleotides of T into C, and appeared in the experimental group (14.4%).MMP-12 220th nucleotide alleles T and C in the experimental group and distribution in contrast with statistical difference (x2=11.01, P0.05). The nucleotide C in the experimental group than the control group in the frequency of nucleotide C high frequency (0%), therefore, mutation has nucleotide C may lead to the possibility of a larger population with AD (OR=0.8-56, 95%CI= and 0.786-0.931). No statistical differences in the distribution of 645th "nucleotide alleles C and T in the experimental group and the control group in (x 2=0.783, P0.05), the C645T polymorphism may be associated with the pathogenesis of AD is not related, the nucleotide T in the experimental group the frequency (1.1%) in the control group and the nucleoside acid T frequency (0%) with little difference There is little correlation between the incidence of T nucleotide mutations may be associated with AD (OR=0.989, 95%CI=0.967-1.011). Conclusion: in the experimental group and the control group were found to have 2 polymorphisms in the MMP-12 promoter (220th nucleotides of T into C, 645th nucleotide C converted to T), the incidence of T220C polymorphism with aortic dissection has certain correlation, C mutation may lead to the possibility of developing AD population is large, and the relationship between the C645T polymorphism and the pathogenesis of AD may be of little relevance. Objective: To explore it on the basis of sun's procedure for ascending aorta artery to femoral artery bypass grafting for the treatment of complex type A type active when the lift dissection surgery. Methods: 31 cases of complex type A aortic dissection patients, age (49 + 15). The age, body weight (73 + 15) kg, using sun's procedure, preoperative monitoring of patient monitoring function, and the application of 320 slice volume CT after thoracic abdominal aorta Arterial CTA scan results, calculate the minimum area of aortic true lumen and the same plane descending aorta area, rewarming phase monitoring of patients, blood pressure and urine volume of lower limb 1H. As for the minimum area of small true lumen of descending aorta, without distal hemomediastinum, intraoperative volume of urine, 12 cases of upper extremity pressure greater than 60 mmHg with a further increase of femoral bypass grafting. Results; influence the choice of L - related surgery femoral bypass grafting time factors are: (1) renal artery plane and 1^^ reduced the percentage of 1.5%^ minimum area for the same level of aortic true lumen of descending aorta area (2) the difference of systolic blood pressure and upper limb pressure 20 mmHg the lower limb systolic blood pressure; (3) operation during the rewarming period, urine volume less than normal, or poor diuretic effect.; (4) the descending aorta distal broken said. Conclusion: the patients with complex type A aortic dissection was abdominal minimum area of upper and lower limbs, systolic pressure, rewarming period, urine volume and descending aorta The distal crevasses monitoring, can decide whether to do or femoral bypass grafting., has a positive significance on the prognosis of patients. Objective: To explore the meaning of sun's operation and ascending aortic femoral artery bypass grafting shield for Stanford type A aortic dissection patients with long-term prognosis. Methods: selected in September 2012 to December 2014 in the Fourth Affiliated Hospital of Kunming Medical University village, vascular surgery using the sun's operation and rehabilitation of 12 patients with aortic dissection were an ascending aortic artery bypass grafting after treatment, after January, March, June, 1 patients with renal function monitoring, through the thoracic aorta X Chang Chan T scan area calculation of drop the area and the aortic true lumen and preoperative conditions, while 4 bypass monitoring area and compared. Results: (1) bypass 1 years the area does not appear bright think of change, the patency rate of 1 years is High; (2) all functions within 1 years postoperatively had no obvious damage; (3) the descending aorta was compared with preoperative no obvious expansion; (4) the descending aorta. The true lumen compared with preoperative Mingying expansion, increased body perfusion. Conclusion: to control really small, poor body perfusion patients with positive the femoral bypass grafting on patients after long-term coincidence is of positive significance

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 陳吉匡;;D-二聚體水平與急性主動(dòng)脈夾層關(guān)系探討[J];浙江中西醫(yī)結(jié)合雜志;2013年08期

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本文編號(hào)：1623998