腹主動脈瘤腔內(nèi)修復(fù)術(shù)前后血清miRNA-29a的表達(dá)及其意義探討
發(fā)布時間：2018-07-15 17:35
【摘要】：研究背景腹主動脈瘤(AAA)為一種動脈直徑大于正常1.5倍的具有破裂傾向的嚴(yán)重主動脈退行性疾病。其發(fā)病率隨著年齡的增長呈逐年上升趨勢,嚴(yán)重威脅人類生命健康。腔內(nèi)修復(fù)術(shù)以其微創(chuàng)、圍手術(shù)期病死率及并發(fā)癥率低、手術(shù)及住院時間短、術(shù)后恢復(fù)快等特點(diǎn),成為大部分AAA患者的一線治療策略。而術(shù)后瘤體進(jìn)一步增大是患者再次入院行二次干預(yù)的主要原因。以往均以物理方式對AAA進(jìn)行隨訪,近年來研究表明血液標(biāo)志物與AAA的發(fā)生發(fā)展有關(guān),其中miRNA-29a被證實(shí)與瘤體直徑的大小相關(guān),而針對AAA腔內(nèi)修復(fù)術(shù)前后血清miRNA-29a的表達(dá)與瘤體直徑大小關(guān)系尚未有研究報道。目的探討AAA腔內(nèi)修復(fù)術(shù)前后血清miRNA-29a的表達(dá)及其與臨床相關(guān)指標(biāo)之間的關(guān)系材料與方法收集2014年11月至2015年12月就診的AAA者60例。將患者分為腔內(nèi)修復(fù)組和動態(tài)觀察組,對腔內(nèi)修復(fù)組于術(shù)前及術(shù)后3月、6月、12月共4個時間點(diǎn)上行腹主動脈CTA,及RT-PCR技術(shù)檢測血清miRNA-29a的相對表達(dá)量,記錄CTA上瘤體直徑的變化和血清miRNA-29a表達(dá)水平的關(guān)系。動態(tài)觀察組于初次門診及以后6月、12月共3個時間點(diǎn)上行上述影像學(xué)和血液學(xué)隨訪。以SPSS 18.0及GraphPad Prism軟件進(jìn)行統(tǒng)計分析,分析血清miRNA-29a的表達(dá)水平與臨床及影像參數(shù)間的相關(guān)性,以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果動態(tài)觀察組9例患者出現(xiàn)瘤體直徑增大大于5 mm/6個月并伴有腹痛等臨床癥狀,遂納入腔內(nèi)修復(fù)組。腔內(nèi)修復(fù)組49例中術(shù)后死亡5例,其中2例于住院期間死于呼吸循環(huán)衰竭,腎功能衰竭;3例于術(shù)后2月內(nèi)死于急性心衰。隨訪時間12至20個月,中位時間15個月,55例患者在隨訪期間,無失訪。所有患者血清miRNA-29a擴(kuò)增良好,60例患者瘤體最大直徑與血清miRNA-29a表達(dá)水平呈負(fù)相關(guān),相關(guān)系數(shù)r =-0.600,相關(guān)性檢驗(yàn)分析差異具有顯著統(tǒng)計學(xué)意義(P0.05);術(shù)前兩組血清miRNA-29a相對表達(dá)量(腔內(nèi)修復(fù)組vs動態(tài)觀察組=19.56± 3.83 vs 22.88 ± 4.42)具有統(tǒng)計學(xué)差異(P0.05);腔內(nèi)修復(fù)組血清miRNA-29a各時間點(diǎn)的相對表達(dá)量為:術(shù)前(19.56 ±3.83)、術(shù)后3月(20.34 ± 4.73)、術(shù)后6月(21.78 ±4.65)、術(shù)后12月(22.92 ±4.14),統(tǒng)計分析各組的相對表達(dá)量差異具有統(tǒng)計學(xué)意義(P0.05)。動脈瘤體最大直徑由術(shù)前(5.66±1.00cm)降至術(shù)后 3 月(4.87 ± 1.70 cm)、術(shù)后 6 月(4.12 ± 0.99 cm)、術(shù)后 12 月(3.70 ± 0.89 cm),統(tǒng)計分析各時間點(diǎn)上瘤體最大直徑均有統(tǒng)計學(xué)差異(P0.05)。腔內(nèi)修復(fù)組患者不同時間點(diǎn)上瘤體最大直徑和相應(yīng)血清miRNA-29a的表達(dá)水平相關(guān)性為術(shù)前(r =-0.508,P0.05)、術(shù)后 3 個月(r =-0.504,P0.05)、術(shù)后 6個月(r=-0.540,P0.05)及術(shù)后12個月(r =-0.503,P0.05)。瘤體最大直徑的大小及性別在血清miRNA-29a高低表達(dá)組中差異有統(tǒng)計學(xué)意義(P0.05),而對年齡高低、有無高血壓、是否累及髂總動脈及瘤體成角大小的比較無統(tǒng)計學(xué)差異(P0.05)。結(jié)論腹主動脈瘤患者血清miRNA-29a表達(dá)量隨瘤體直徑的增大而降低;腹主動脈瘤腔內(nèi)修復(fù)術(shù)后瘤體直徑的大小和血清miRNA-29a的表達(dá)水平成負(fù)相關(guān);血清miRNA-29a的術(shù)前水平與性別、瘤體直徑大小相關(guān),與年齡高低、是否患有高血壓、是否累及髂總動脈及瘤體成角大小無關(guān);血清miRNA-29a可能為評估腹主動脈瘤腔內(nèi)修復(fù)術(shù)前后瘤體直徑變化的潛在的生物學(xué)標(biāo)志物。
[Abstract]:Background abdominal aortic aneurysm (AAA) is a severe aortic degenerative disease with an arterial diameter greater than 1.5 times more than normal. Its incidence is increasing year by year with age increasing, which is a serious threat to human life and health. Endovascular repair is a minimally invasive procedure, low mortality and complication rate in the perioperative period, operation and hospitalization. Short, quick recovery and so on, and become the first line treatment strategy of most AAA patients. And the further enlargement of the tumor is the main cause of the two intervention. In the past, AAA was followed up in physical way. In recent years, the study showed that the blood markers were related to the development of AAA, and miRNA-29a was confirmed with the tumor. The relationship between the size of the body diameter and the relationship between the expression of serum miRNA-29a and the diameter of the tumor before and after AAA endovascular repair has not been reported. Objective to explore the expression of serum miRNA-29a and the relationship between the serum and the related indexes of the AAA endovascular repair before and after the AAA endovascular repair, and to collect the AAA 60 from November 2014 to December 2015. Patients were divided into intracavitary repair group and dynamic observation group. The abdominal aorta CTA was performed at 4 time points before and after the operation in March, June, December, and the relative expression of serum miRNA-29a was detected by RT-PCR technique. The relationship between the changes of the diameter of the tumor on CTA and the level of miRNA-29a expression on the serum was recorded. The dynamic observation group was in the first door. The imaging and hematological follow-up were performed at 3 time points in June and December. The statistical analysis was carried out by SPSS 18 and GraphPad Prism software. The correlation between the expression level of serum miRNA-29a and the clinical and imaging parameters was analyzed. The difference of P0.05 was statistically significant. The diameter of 9 patients in the dynamic observation group was increased. More than 5 mm/6 months and abdominal pain and other clinical symptoms were included in the endovascular repair group. 5 cases died after operation in 49 cases of endovascular repair group, of which 2 died of respiratory and circulatory failure and renal failure during hospitalization; 3 cases died of acute heart failure in February. The follow-up time was 12 to 20 months, median time was 15 months, 55 patients were no lost during follow-up period, no loss during follow up period, no loss of patients during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up, no loss during follow-up period, no loss. All patients' serum miRNA-29a amplification was good. The maximum diameter of the tumor body was negatively correlated with the level of serum miRNA-29a expression in 60 patients. The correlation coefficient R =-0.600, the correlation test and analysis difference had significant statistical significance (P0.05). The relative expression of serum miRNA-29a in the two groups before operation (=19.56 + 3.83 vs 22.88 in the dynamic observation group of the endovascular repair group) There was a statistical difference (P0.05). The relative expression of miRNA-29a at each time point of serum in the endovascular repair group was (19.56 + 3.83), March (20.34 + 4.73), June (21.78 + 4.65) and December (22.92 + 4.14) after operation (22.92 + 4.14). The difference of relative expression of each group was statistically significant (P0.05). The maximum diameter of the aneurysm body was determined by the statistical analysis (P0.05). The preoperative (5.66 + 1.00cm) decreased to March (4.87 + 1.70 cm), June (4.12 + 0.99 cm), and December (3.70 + 0.89 cm). Statistical analysis of the maximum diameter of the tumor at each time point was statistically different (P0.05). The correlation between the maximum diameter of the tumor body at different time points and the expression level of corresponding serum miRNA-29a at different time points in the endovascular repair group was related to the correlation of the level of the expression level of the corresponding serum. Preoperative (R =-0.508, P0.05), 3 months postoperatively (R =-0.504, P0.05), 6 months after operation (r=-0.540, P0.05) and 12 months after the operation (R =-0.503, P0.05). The size of the maximum diameter of the tumor and the sex in the serum miRNA-29a high and low expression group were statistically significant, but there was no hypertension for the age, whether there was the involvement of the common iliac artery and the tumor. There was no statistical difference between the angle and size of the abdominal aortic aneurysm (P0.05). Conclusion the miRNA-29a expression in the sera of the abdominal aortic aneurysm decreased with the increase of the diameter of the tumor. The size of the tumor body after the endovascular repair of the abdominal aortic aneurysm was negatively correlated with the level of the expression of serum miRNA-29a; the preoperative level of serum miRNA-29a was related to the size of the tumor and the size of the tumor. Age, whether or not hypertension, is not related to the size of the common iliac artery and the angle of the tumor, and serum miRNA-29a may be a potential biomarker for assessing the changes in the diameter of the tumor before and after endovascular repair of the abdominal aortic aneurysm.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.3
本文編號：2124843
[Abstract]:Background abdominal aortic aneurysm (AAA) is a severe aortic degenerative disease with an arterial diameter greater than 1.5 times more than normal. Its incidence is increasing year by year with age increasing, which is a serious threat to human life and health. Endovascular repair is a minimally invasive procedure, low mortality and complication rate in the perioperative period, operation and hospitalization. Short, quick recovery and so on, and become the first line treatment strategy of most AAA patients. And the further enlargement of the tumor is the main cause of the two intervention. In the past, AAA was followed up in physical way. In recent years, the study showed that the blood markers were related to the development of AAA, and miRNA-29a was confirmed with the tumor. The relationship between the size of the body diameter and the relationship between the expression of serum miRNA-29a and the diameter of the tumor before and after AAA endovascular repair has not been reported. Objective to explore the expression of serum miRNA-29a and the relationship between the serum and the related indexes of the AAA endovascular repair before and after the AAA endovascular repair, and to collect the AAA 60 from November 2014 to December 2015. Patients were divided into intracavitary repair group and dynamic observation group. The abdominal aorta CTA was performed at 4 time points before and after the operation in March, June, December, and the relative expression of serum miRNA-29a was detected by RT-PCR technique. The relationship between the changes of the diameter of the tumor on CTA and the level of miRNA-29a expression on the serum was recorded. The dynamic observation group was in the first door. The imaging and hematological follow-up were performed at 3 time points in June and December. The statistical analysis was carried out by SPSS 18 and GraphPad Prism software. The correlation between the expression level of serum miRNA-29a and the clinical and imaging parameters was analyzed. The difference of P0.05 was statistically significant. The diameter of 9 patients in the dynamic observation group was increased. More than 5 mm/6 months and abdominal pain and other clinical symptoms were included in the endovascular repair group. 5 cases died after operation in 49 cases of endovascular repair group, of which 2 died of respiratory and circulatory failure and renal failure during hospitalization; 3 cases died of acute heart failure in February. The follow-up time was 12 to 20 months, median time was 15 months, 55 patients were no lost during follow-up period, no loss during follow up period, no loss of patients during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up, no loss during follow-up period, no loss. All patients' serum miRNA-29a amplification was good. The maximum diameter of the tumor body was negatively correlated with the level of serum miRNA-29a expression in 60 patients. The correlation coefficient R =-0.600, the correlation test and analysis difference had significant statistical significance (P0.05). The relative expression of serum miRNA-29a in the two groups before operation (=19.56 + 3.83 vs 22.88 in the dynamic observation group of the endovascular repair group) There was a statistical difference (P0.05). The relative expression of miRNA-29a at each time point of serum in the endovascular repair group was (19.56 + 3.83), March (20.34 + 4.73), June (21.78 + 4.65) and December (22.92 + 4.14) after operation (22.92 + 4.14). The difference of relative expression of each group was statistically significant (P0.05). The maximum diameter of the aneurysm body was determined by the statistical analysis (P0.05). The preoperative (5.66 + 1.00cm) decreased to March (4.87 + 1.70 cm), June (4.12 + 0.99 cm), and December (3.70 + 0.89 cm). Statistical analysis of the maximum diameter of the tumor at each time point was statistically different (P0.05). The correlation between the maximum diameter of the tumor body at different time points and the expression level of corresponding serum miRNA-29a at different time points in the endovascular repair group was related to the correlation of the level of the expression level of the corresponding serum. Preoperative (R =-0.508, P0.05), 3 months postoperatively (R =-0.504, P0.05), 6 months after operation (r=-0.540, P0.05) and 12 months after the operation (R =-0.503, P0.05). The size of the maximum diameter of the tumor and the sex in the serum miRNA-29a high and low expression group were statistically significant, but there was no hypertension for the age, whether there was the involvement of the common iliac artery and the tumor. There was no statistical difference between the angle and size of the abdominal aortic aneurysm (P0.05). Conclusion the miRNA-29a expression in the sera of the abdominal aortic aneurysm decreased with the increase of the diameter of the tumor. The size of the tumor body after the endovascular repair of the abdominal aortic aneurysm was negatively correlated with the level of the expression of serum miRNA-29a; the preoperative level of serum miRNA-29a was related to the size of the tumor and the size of the tumor. Age, whether or not hypertension, is not related to the size of the common iliac artery and the angle of the tumor, and serum miRNA-29a may be a potential biomarker for assessing the changes in the diameter of the tumor before and after endovascular repair of the abdominal aortic aneurysm.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.3
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