本文選題：猝死 + 冠狀動脈粥樣硬化�。� 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：第一部分冠心病猝死者CAS斑塊成分分析目的:對冠心病猝死(sudden coronary death,SCD)者冠狀動脈粥樣硬化(Coronary atherosclerosis,CAS)斑塊成分進行分析。方法:分組:非冠心病組(A組),冠心病非猝死組(B組),冠心病猝死組(C組)�；仡櫺苑治鱿鄳颊叩呐R床資料和尸體解剖資料,并通過特殊染色進一步分析斑塊成分(脂質、纖維及鈣鹽)的相對含量。結果:A組56例,平均年齡39.54±11.16歲,冠狀動脈僅輕微病變。B組59例,平均年齡55.64±14.11歲,冠狀動脈III級狹窄發(fā)生率最高,以左前降支(Left anterior descending,LAD)最易發(fā)生病變。C組56例,平均年齡53.36±13.91歲,發(fā)病前存在明顯誘因30例,冠狀動脈IV級狹窄發(fā)生率最高,LAD最易發(fā)生病變。HE染色及特殊染色發(fā)現(xiàn),A組冠狀動脈內膜下僅散在泡沫細胞,而B組及C組冠狀動脈均有不同程度脂質沉積及纖維組織增生;B組有38例冠狀動脈鈣鹽沉積,C組有41例冠狀動脈鈣鹽沉積;B組脂質、纖維及鈣鹽相對含量(%)分別為53.53±16.23、27.07±9.78、19.39±13.46,C組脂質、纖維及鈣鹽相對含量(%)分別為44.00±12.00、31.63±9.29、24.37±10.08,且C組脂質、纖維及鈣鹽相對含量與B組差異均有統(tǒng)計學意義(P0.05);B組及C組患者中均存在不同程度機體慢性炎癥,以慢性支氣管炎、慢性腎盂腎炎為主,且C組慢性炎癥率最高。結論:冠狀動脈狹窄程度越大越易導致SCD,且CAS斑塊成分(尤其是鈣鹽)影響著斑塊的穩(wěn)定性。第二部分冠心病猝死者CAS斑塊中骨相關蛋白表達與斑塊穩(wěn)定性的相關性研究目的:探討CAS斑塊中炎癥因子,如C-反應蛋白(C reactive protein,CRP)與骨相關蛋白表達、鈣鹽沉積及斑塊穩(wěn)定性的相關性。方法:分組:非冠心病組(A組),冠心病非猝死組(B組),冠心病猝死組(C組)。對冠狀動脈行免疫組化及Western Blot實驗,檢測CAS斑塊中平滑肌a-肌動蛋白(alpha smooth muscle actin,a-SM-actin)、CRP、骨形成蛋白2(bone morphogenetic protein-2,BMP2)、基質金屬蛋白酶9(matrix metalloproteinase 9,MMP9)及基質金屬蛋白酶組織抑制劑1(tissue inhibitor of metalloproteinase 1,TIMP1)等蛋白表達情況。結果:a-SM-actin在B組及C組CAS斑塊中表達;CRP在在A組、B組及C組中表達逐漸增強;BMP2、MMP9及TIMP1在A組中均無明顯表達,但在B組及C組中表達,且C組表達較B組差異有統(tǒng)計學意義(P0.05);CRP與BMP2、MMP9、TIMP1表達量均呈線性正相關(r值分別為0.988、0.995、0.990,P0.01)。結論:在慢性炎癥作用下,CAS斑塊中骨相關蛋白(如BMP2)表達及鈣鹽沉積,MMP9、TIMP1高表達及MMP9/TIMP1比例失衡,均會破壞斑塊穩(wěn)定性引起斑塊破裂而導致SCD發(fā)生。
[Abstract]:Part I Analysis of plaque composition in sudden coronary death objective: to analyze the plaque composition of coronary atherosclerotic lesion (CAS) in patients with sudden coronary death (SCD). Methods: group A was divided into three groups: group A, group B and group C, respectively. The clinical data and autopsy data of the patients were analyzed retrospectively, and the relative contents of plaque components (lipid, fiber and calcium salt) were further analyzed by special staining. Results the mean age of 56 cases was 39.54 鹵11.16 years old in group A, 59 cases in group B (mean 55.64 鹵14.11 years old), and 56 cases in group C (mean age 53.36 鹵13.91 years). There were 30 cases of obvious inducement before the onset of coronary artery. The incidence of grade IV stenosis of coronary artery was the highest. He staining and special staining showed that foam cells were only scattered under the intima of coronary artery in group A. In group B and C, there were 38 cases of coronary artery calcium deposit and 41 cases of coronary artery calcium deposit in group B, the relative contents of fiber and calcium salt were 53.53 鹵16.2327.07 鹵9.8819.39 鹵13.46C, respectively, in group B and C, there were 38 cases in group B and 41 cases in group B, and the relative contents of fiber and calcium salt in group B were 53.53 鹵16.2327.07 鹵9.8819.39 鹵13.46C, respectively. The relative contents of fiber and calcium salt were 44.00 鹵12.00 鹵31.63 鹵9.29 鹵24.37 鹵10.08, respectively. The relative contents of lipid, fiber and calcium salt in group C were significantly different from those in group B (P 0.05) and group C (P < 0.05). The rate of chronic pyelonephritis was the highest in group C. Conclusion: coronary artery stenosis is more likely to lead to SCD, and CAS plaque composition (especially calcium salt) affects plaque stability. Part two the correlation between the expression of bone related protein and plaque stability in patients with sudden coronary heart death objective: to investigate the expression of inflammatory factors, such as C-reactive protein C reactive protein, and bone related protein in CAS plaques. Correlation between calcium salt deposition and plaque stability. Methods: group A was divided into three groups: group A, group B and group C, respectively. Immunohistochemistry and Western blot were performed on coronary artery. The expression of 偽 -actin alpha smooth muscle, bone morphogenetic protein 2(bone morphogenetic protein-2 BMP2, matrix metalloproteinase 9(matrix metalloproteinase 9 MMP9 and tissue inhibitor of matrix metalloproteinase (1(tissue inhibitor of metalloproteinase 1 / TIMP 1) were detected. Results the expression of BMP2MMP9 and TIMP1 in CAS plaques of group B and C increased gradually, but not in group B and C, but not in group B and C. Compared with group B, the expression of CRP in group C was significantly higher than that in group B. There was a positive linear correlation between the expression of CRP and the expression of TIMP1 in BMP2MMP9MMP9. The positive correlation between CRP and TIMP1 in group C was 0.988- 0.995and 0.990P0.01respectively. Conclusion: the expression of bone related protein (such as BMP2), the high expression of MMP9 / TIMP1 and the imbalance of MMP9 / TIMP1 ratio in CAS plaque caused by chronic inflammation will destroy the plaque stability and lead to the rupture of plaque and lead to the occurrence of SCD.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

【參考文獻】

相關期刊論文 前10條

1 聶倩云;魏澤紅;鄧貴菁;董淵;余華;鄒星;李永國;李劍波;唐任寬;;慢性炎癥與冠狀動脈粥樣硬化的病理學相關性分析[J];重慶醫(yī)科大學學報;2016年12期

2 陳偉偉;高潤霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;顧東風;楊躍進;鄭哲;蔣立新;胡盛壽;;《中國心血管病報告2015》概要[J];中國循環(huán)雜志;2016年06期

3 魏曉;歐三桃;;骨形態(tài)發(fā)生蛋白4與血管鈣化的相關性[J];中國動脈硬化雜志;2016年05期

4 王林全;;檢測MMP2、MMP9水平對預測冠狀動脈粥樣斑塊穩(wěn)定性的研究[J];現(xiàn)代診斷與治療;2016年07期

5 李明;黃京璐;王小廣;蓋連磊;盛立會;王懷勇;權力;成建定;陳憶九;劉超;羅斌;;廣東地區(qū)622例猝死案例的流行病學調查[J];中國法醫(yī)學雜志;2015年01期

6 閔望先;樊冀閩;;冠狀動脈粥樣硬化性心臟病患者C-反應蛋白水平的變化及臨床意義[J];中國醫(yī)藥導報;2014年02期

7 王文;朱曼璐;王擁軍;吳兆蘇;高潤霖;孔靈芝;胡盛壽;;《中國心血管病報告2012》概要[J];中國循環(huán)雜志;2013年06期

8 李宇;高閱春;任學軍;李海宴;陳方;;冠狀動脈粥樣硬化斑塊與MMP2、MMP9水平的關系[J];海南醫(yī)學院學報;2014年01期

9 高閱春;何繼強;姜騰勇;陳方;;冠心病患者冠狀動脈病變嚴重程度與冠心病危險因素的相關分析[J];中國循環(huán)雜志;2012年03期

10 呂傳君;鄒延新;張月華;;女性冠心病患者冠狀動脈造影特點與危險因素分析[J];臨床內科雜志;2011年07期

相關碩士學位論文 前2條

1 孫鑫;冠心病猝死的法醫(yī)病理學研究[D];鄭州大學;2015年

2 李登新;SCN5A基因多態(tài)性與心臟性猝死的相關性研究[D];華中科技大學;2012年

，

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