本文選題：急性主動脈綜合征　切入點：主動脈夾層　出處：《天津醫(yī)科大學》2015年碩士論文

【摘要】：目的:探討基質金屬蛋白酶(MMP)-2,8,9,12在急性主動脈綜合征患者中的表達及臨床意義。方法:選取天津醫(yī)科大學總醫(yī)院2013年3月—2015年3月50例急性主動脈綜合征入院患者為研究對象,其中Stanford A型主動脈夾層(AD)患者28例,Stanford B型AD患者12例,主動脈壁間血腫及穿透性潰瘍患者10例。根據疾病種類不同分為主動脈夾層組和主動脈壁間血腫及穿透性潰瘍組。其中每組病人根據不同的治療方式分為兩組:手術組及保守組。其中主動脈夾層組行外科手術患者18例,行胸主動動脈腔內支架隔絕術(TEVAR)患者8例,保守組患者14例;主動脈壁間血腫及穿透性潰瘍組內行TEVAR患者5例,保守組5例。對于血漿中MMP表達的研究,本實驗以同期入院行體格檢查的患者20例作為對照組。1.采用酶聯(lián)免疫吸附法(ELISA)分析MMP在主動脈夾層組、主動脈壁間血腫及穿透性潰瘍組與對照組患者血漿中的表達2.通過隨訪評價患者生存康復情況、手術治療的安全性及MMP在血漿中水平的變化。結果:1.MMP-2,8,9,12在主動脈夾層組、主動脈壁間血腫及穿透性潰瘍組與對照組血漿中均有表達。其中主動脈夾層組患者血漿中MMP-8,9,12的表達高于對照組(P0.05),MMP-2的表達無明顯差異;主動脈壁間血腫及穿透性潰瘍組患者血漿中MMP-8,9的表達高于對照組(P0.05),MMP-2,12的表達無明顯差異。2.雜交手術治療Stanford A型AD手術成功率100%,隨訪期間1例患者死亡,余患者生存良好;TEVAR治療Stanford B型AD及主動脈壁間血腫與穿透性潰瘍手術成功率100%,隨訪期間無死亡患者。3.對于Stanford A型AD手術組患者,術后主動脈近端、中點及最大主動脈直徑位置可見主動脈直徑及假腔直徑減小(P0.05),且MMP-8,9在血漿中的表達水平較術前減少(P0.05),MMP-2,12的表達無明顯差別;對于Stanford B型AD手術組患者,術后主動脈近端、中點及最大主動脈直徑位置可見主動脈直徑及假腔直徑減小(P0.05),且MMP-8,9在血漿中的表達水平較術前減少(P0.05),MMP-2,12的表達無明顯差別;對于主動脈壁間血腫及穿透性潰瘍手術組患者,術后主動脈近端、中點及最大主動脈直徑位置可見主動脈直徑及血腫直徑減小(P0.05),MMP-9在血漿中的表達水平在術后半月及術后1-3月均較術前減少(P0.05),MMP-2,8,12的表達無明顯差別。4.對于Stanford B型AD保守組患者,1-3月內復查主動脈計算機斷層血管成像(CTA)示近端假腔直徑、中點假腔直徑、最大主動脈直徑及最大假腔直徑較前增大(P0.05),且MMP-9在血漿中的表達較前增高(P0.05),MMP-2,8,12的表達無明顯差別。5.MMP與各截面主動脈、假腔(血腫)、真腔(管腔)直徑進行相關分析得出:MMP-8與最大假腔(血腫)直徑呈正相關(P0.05),MMP-9與最大主動脈直徑、最大假腔(血腫)直徑呈正相關(P0.05)。結論:1.雜交手術及TEVAR治療對于急性主動脈綜合征的患者安全、有效,促進主動脈重塑,近中期效果好。2.MMP家族(特別是MMP-8,9)可作為AAS診斷參考指標之一。3.MMP-8,9有可能成為急性主動脈綜合征判斷預后的重要指標。
[Abstract]:Objective: To investigate the expression of matrix metalloproteinase (MMP) -2,8,9,12 in acute aortic syndrome patients the expression and clinical significance. Methods: 50 cases in General Hospital Affiliated to Tianjin Medical University from March 2013 to March 2015 of acute aortic syndrome patients as the research object, the Stanford type A aortic dissection (AD) in 28 cases, 12 cases of patients with Stanford type B aortic AD. Intramural hematoma and penetrating ulcer in 10 patients. According to the different kinds of illness for aortic dissection and aortic intramural hematoma and penetrating ulcer group. The patients in each group according to different treatment methods are divided into two groups: operation group and conservative group. Among the 18 cases of patients with aortic dissection group underwent surgery for thoracic aortic artery stent graft (TEVAR) in 8 cases, 14 cases of conservative groups; 5 cases of aortic intramural hematoma and penetrating ulcer group underwent TEVAR patients, a conservative group of 5 cases for blood. Study on the expression of MMP in plasma, in this experiment, 20 cases of physical examination for patients admitted in the same period as the control group.1. by enzyme-linked immunosorbent assay (ELISA) analysis of MMP in aortic dissection group, aortic intramural hematoma and penetrating ulcer group and control group in plasma of patients with the expression of the 2. patients were followed up and evaluated with survival and rehabilitation the safety of surgical treatment, changes in plasma levels of MMP and 1.MMP-2,8,9,12. Results: in aortic dissection group, aortic intramural hematoma and penetrating ulcer group and control group were expressed in plasma. The expression of MMP-8,9,12 in aortic dissection patients plasma is higher than that of control group (P0.05), no significant difference between the expression of MMP-2; the expression of aortic intramural hematoma and penetrating ulcer in patients with plasma MMP-8,9 group is higher than that of control group (P0.05), the expression of MMP-2,12 had no significant difference in surgical treatment of Stanford type A.2. hybrid AD surgery The follow-up period was 100%, 1 patients died, the survival of patients with more than good; TEVAR treatment of Stanford B type AD aortic intramural hematoma and penetrating ulcer surgery success rate was 100%. No patients died during follow-up for.3. Stanford A type AD group, postoperative aortic proximal point and maximum aortic diameter showed aortic position the false lumen diameter and diameter (P0.05), and the expression level of MMP-8,9 in plasma decreased (P0.05), there was no significant difference between the expression of MMP-2,12; for Stanford type B AD patients undergoing surgery, postoperative aortic proximal point and maximum aortic diameter position visible aortic diameter and false lumen diameter (P0.05), and the expression level of MMP-8,9 in plasma decreased (P0.05), there was no significant difference between the expression of MMP-2,12; the aortic intramural hematoma and penetrating ulcer patients for surgery, postoperative aortic proximal, middle point and the most Large aortic diameter position visible aortic diameter and hematoma diameter (P0.05), the expression level of MMP-9 in plasma in half month after operation and 1-3 months after operation were significantly reduced (P0.05), MMP-2,8,12 expression had no significant difference for.4. Stanford B AD conservative group, 1-3 months after aortic CT vascular imaging (CTA) showed proximal false lumen diameter, the midpoint of the false lumen diameter, maximum aortic diameter and the maximum diameter of false lumen was increased (P0.05), and the expression of MMP-9 in plasma was higher than before (P0.05), the expression of MMP-2,8,12 showed no significant difference between the.5.MMP and the cross section of the aorta, the false lumen (hematoma), really cavity diameter (Guan Qiang) were obtained: MMP-8 and the maximum diameter of false lumen (hematoma) was positively correlated (P0.05), MMP-9 and maximum aortic diameter, the largest diameter of false lumen (hematoma) was positively correlated (P0.05). Conclusion: 1. hybrid surgery and TEVAR therapy for acute active Patients with pulse syndrome are safe, effective and effective in promoting aortic remodeling. The.2.MMP family (especially MMP-8,9) can be used as a reference index for AAS diagnosis..3.MMP-8,9 may become an important indicator of prognosis in acute aortic syndrome.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.3

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