【摘要】： 背景: 在飛行人員中冠心病心肌梗塞時(shí)有發(fā)生,對(duì)飛行安全是一種嚴(yán)重威脅,可能導(dǎo)致飛行員空中突然失能而產(chǎn)生嚴(yán)重后果。冠心病心肌梗塞最重要的病理因素是冠狀動(dòng)脈粥樣硬化致血管管腔狹窄,而動(dòng)脈粥樣硬化的病因目前尚未完全清楚,大量研究表明動(dòng)脈粥樣硬化與多種危險(xiǎn)因素有直接的關(guān)系,在各種危險(xiǎn)因素作用下,動(dòng)脈內(nèi)皮損傷,導(dǎo)致內(nèi)皮功能紊亂,并逐漸形成動(dòng)脈粥樣硬化病變。對(duì)冠心病的防治,只有綜合全面地改善多因子危險(xiǎn)譜,才能使危險(xiǎn)得以較大幅度的降低,故控制危險(xiǎn)因素是預(yù)防冠心病的根本。研究表明35～59歲的男性發(fā)生冠心病的危險(xiǎn)至少有80%可歸因于高脂血癥、高血壓、吸煙這三個(gè)因素。在我軍飛行員人群中,冠心病危險(xiǎn)因素分布情況如何,其分布是否與普通人群不同尚待研究。另遺傳因素在冠心病發(fā)生中的作用也是不容忽視的,目前許多研究檢測了基因多態(tài)性與冠心病心肌梗塞的關(guān)系。血凝素樣氧化低密度脂蛋白受體-1(LOX-1)是1997年由日本學(xué)者首先發(fā)現(xiàn)的,是氧化低密度脂蛋白(ox-LDL)的特異性受體。LOX-1在動(dòng)脈內(nèi)皮細(xì)胞、巨噬細(xì)胞、血管平滑肌細(xì)胞、成纖維細(xì)胞和血小板上均有表達(dá),在高血壓、糖尿病、高脂血癥等促進(jìn)動(dòng)脈粥樣硬化發(fā)生的病理?xiàng)l件下表達(dá)增加,在動(dòng)脈粥樣硬化斑塊中也發(fā)現(xiàn)存在高表達(dá)。研究發(fā)現(xiàn)LOX-1基因3′UTR C/T多態(tài)性與動(dòng)脈粥樣硬化及急性心肌梗塞的危險(xiǎn)性相關(guān)。我軍飛行員中LOX-1基因多態(tài)性是否與冠心病的發(fā)生有關(guān),是否影響血脂水平等其它冠心病危險(xiǎn)因素,尚待研究。 目的: 1、調(diào)查我軍飛行人員冠心病相關(guān)危險(xiǎn)因素的暴露情況,分析飛行員冠心病危險(xiǎn)因素分布與普通人群是否存在差異; 2、檢測飛行員LOX-1基因3′UTR C/T多態(tài)性情況,探討LOX-1基因多態(tài)性與飛行員冠心病及其危險(xiǎn)因素的關(guān)系。 方法: 1、制定《飛行員冠心病危險(xiǎn)因素調(diào)查表》,采用現(xiàn)況調(diào)查的方法對(duì)297名飛行員的一般情況及健康狀況進(jìn)行詳細(xì)的調(diào)查,分析飛行員冠心病危險(xiǎn)因素分布情況。采用u-檢驗(yàn)、單因素方差分析及Logistic回歸分析進(jìn)行統(tǒng)計(jì)分析; 2、應(yīng)用實(shí)時(shí)熒光PCR技術(shù),采用病例-對(duì)照研究的設(shè)計(jì)方法,檢測20例經(jīng)冠狀動(dòng)脈造影證實(shí)為冠狀動(dòng)脈粥樣硬化的飛行員和20例健康對(duì)照飛行員LOX-1基因多態(tài)性,比較該基因多態(tài)性在兩組中的分布情況,以及該基因多態(tài)性與冠心病及其危險(xiǎn)因素的關(guān)系,采用兩樣本t檢驗(yàn)和χ2 -檢驗(yàn)進(jìn)行分析。 結(jié)果: 1、297例飛行員中吸煙、飲酒、飲食習(xí)慣不良、超重、血脂異常、高血壓、糖尿病等冠心病危險(xiǎn)因素占總?cè)藬?shù)的比例分別為62.63%、60.94%、48.82%、38.72%、26.60%、10.44%、3.03%。在35～44歲年齡段,吸煙和飲酒構(gòu)成比最高。飛行員冠心病危險(xiǎn)因素構(gòu)成與我國普通20歲以上男性人群有所不同,吸煙、飲酒、超重及血脂異常發(fā)生率顯著偏高,而高血壓、糖尿病患病率較低。多因素Logistic回歸分析顯示飛行員冠心病危險(xiǎn)因素包括:年齡超過45歲、高血壓病史、冠心病家族史、吸煙超過200支年、TC水平超過6.22mmol/l、HDL低于1.04mmol/l,其優(yōu)勢比(OR)值以年齡超過45歲為最高(12.78),其次為吸煙超過200支年(10.12)。將297名飛行員按吸煙量分組,比較各吸煙組間血脂水平發(fā)現(xiàn),吸煙量超過200支年組,血TC、TG、LDL-C、TC/HDL-C水平顯著高于不吸煙組及吸煙量低于100支年組,而HDL-C水平顯著低于后者(p㩳0.05)。 2、在我們所觀察的飛行員中LOX-1基因3′UTR C/T基因多態(tài)性表現(xiàn)出三種基因型,CC、CT及TT。在年齡、飛行時(shí)間、吸煙率、血脂、同型半胱氨酸等指標(biāo)無顯著差異的情況下,在病例組飛行員中T等位基因頻率較對(duì)照組高(0.50 vs 0.275, p㩳0.05),并CT+TT基因型頻率也顯著高于對(duì)照組(0.80 vs 0.50, p㩳0.05),另按基因型分組比較,TC、TG、HDL、LDL、吸煙率、Hcy等指標(biāo)無顯著性差異(p 0.05)。 結(jié)論: 1、目前我軍飛行員中廣泛存在著冠心病危險(xiǎn)因素,其中以吸煙所占比例最高。飛行員冠心病危險(xiǎn)因素分布與我國普通20歲以上男性人群有所不同,吸煙、飲酒、超重及血脂異常發(fā)生率較高,而高血壓、糖尿病患病率較低。與飛行員冠心病顯著相關(guān)的因素主要有年齡超過45歲、高血壓病史、冠心病家族史、吸煙超過200支年、總膽固醇水平超過6.22mmol/l、HDL低于1.04mmol/l。 2、吸煙是導(dǎo)致飛行員血脂代謝異常的因素之一。 3、LOX-1基因多態(tài)性與飛行員冠心病相關(guān),LOX-1基因3′UTR變異基因型(CT+TT)可能與飛行員冠心病患病風(fēng)險(xiǎn)有關(guān),T等位基因攜帶者可能存在更高的患病風(fēng)險(xiǎn),但LOX-1基因多態(tài)性與吸煙、血脂、Hcy等冠心病危險(xiǎn)因素?zé)o明顯相關(guān)性,提示LOX-1基因多態(tài)性可能是飛行員冠心病的一個(gè)獨(dú)立預(yù)測因素。
文內(nèi)圖片：
圖片說明：LOX-1在動(dòng)脈粥樣硬化發(fā)生發(fā)展過程中的作用注：示LOX-1的作用點(diǎn)
[Abstract]:Background: In flight personnel, coronary heart disease and myocardial infarction occur frequently, which is a serious threat to flight safety, which may lead to a sudden loss of air in the air of the pilot The most important pathological factors of myocardial infarction in coronary heart disease are the stenosis of the vascular lumen caused by coronary atherosclerosis, and the cause of atherosclerosis is not yet completely clear, and a large number of studies have shown that atherosclerosis has a direct relationship with a variety of risk factors and is made in various risk factors. With the use of lower and arterial endothelial damage, endothelial dysfunction is caused, and atherosclerosis is gradually formed. The prevention and treatment of coronary heart disease can only comprehensively improve the multi-factor risk spectrum, so that the risk can be reduced greatly, so the control risk factors are the prevention of coronary heart disease. The study shows that at least 80% of the risk of coronary heart disease in men from 35 to 59 years of age can be attributed to hyperlipidemia, hypertension, and smoking. Factors: The distribution of the risk factors of coronary heart disease in our pilot population is different from that of the general population. The role of another genetic factor in the occurrence of coronary heart disease is not to be ignored. At present, many studies have detected the gene polymorphism and the myocardial infarction of coronary heart disease. The relationship. Hemagglutinin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is first discovered by Japanese scholars in 1997, and is the specificity of oxidized low-density lipoprotein (ox-LDL). The receptor. LOX-1 is expressed in the vascular endothelial cells, macrophages, vascular smooth muscle cells, fibroblasts and platelets, and is expressed in the pathological conditions of hypertension, diabetes, and hyperlipidemia to promote the occurrence of atherosclerosis. An increase in the presence of high in atherosclerotic plaques Expression of LOX-1 gene 3-UUTR C/ T polymorphism and the risk of atherosclerosis and acute myocardial infarction It is related to whether the polymorphism of LOX-1 gene in our pilots is related to the occurrence of coronary heart disease, and whether the risk factors of other coronary heart diseases such as the level of blood lipid and other coronary heart disease have yet to be Research. Objective:1. To investigate the risk factors of coronary heart disease in the flight personnel of our army, and to analyze the risk factors of coronary heart disease in pilots. Is there a difference in the population;2. Test the pilot LOX-1 gene 3. The Study of the Polymorphism of the UTR C/ T and the Study on the Polymorphism of LOX-1 and the Caps of the Pilots heart disease and heart disease The relationship between the risk factors and the risk factors. Methods:1. The questionnaire of the risk factors of coronary heart disease of pilots was established. The general condition and health status of 297 pilots were investigated by the method of current status survey. The risk factors of coronary heart disease were analyzed in this paper. u-test, one-factor analysis of variance and L-test were used. the statistical analysis was carried out by the logistic regression analysis;2, real-time fluorescence was applied A case-control study was used to detect the polymorphism of LOX-1 gene in 20 pilots and 20 healthy control pilots confirmed by coronary angiography as coronary atherosclerosis and to compare the distribution of the gene polymorphism in the two groups. and the correlation between the polymorphism of the gene and the coronary heart disease and the risk factors system Results: The proportion of risk factors of coronary heart disease (CHD), such as smoking, drinking, bad diet, overweight, dyslipidemia, hypertension, and diabetes, were 62.63%, 60.94% and 48.82%, respectively. 38.72%, 26.60%, 10.44%,3 In the age group of 35 to 44, smoking and drinking are the highest. The risk factors of the coronary heart disease of the pilot are different from those of the men over the age of 20 years in China. Smoking, alcohol consumption, overweight The incidence of dyslipidemia is high, and the prevalence of hypertension and diabetes is low. The multivariate logistic regression analysis shows that the risk factors for coronary heart disease include: the age of over 45 years, the history of hypertension, family history of coronary heart disease, smoking more than 200 years, TC level of more than 6.22 mmol/ l and HDL lower than 1.04 mmol/ l, the odds ratio (OR) value is the highest (OR) value at an age of more than 45 years ( (12.78), followed by smoking for more than 200 years (10.12). A total of 297 pilots were grouped according to the amount of smoking, and the level of blood lipids in each of the smoking groups was compared, and the level of serum TC, TG, LDL-C, TC/ HDL-C was significantly higher than that of non-smoking group and less than 100 in the non-smoking group. in that support group, the level of HDL-C was significantly lower than the lat (p? 0.05).2. LOX-1 gene 3 in the pilot we observed The frequency of T allele in the pilot of the case group was higher than that of the control group (0.50 vs.275, p? 0.05) and the CT + TT genotype in the case of age, time of flight, smoking rate, blood fat, and homocysteine. The frequency was also significantly higher in the control group (0.80 vs. 0.50, p? 0.05), and the other by the genotype group, TC, TG, HD L,L There was no significant difference in the indexes of DL, smoking and Hcy (p.05). Conclusion: 1. There is a wide range of risk factors of coronary heart disease among our pilots, among which the proportion of smoking is the most. The risk factors of the coronary heart disease in pilots are similar to those of the men in the normal age of 20 years in China. The incidence of smoking, drinking, overweight and dyslipidemia is high, and the prevalence of hypertension and diabetes is low. The factors associated with the coronary heart disease of pilots are mainly of the age of over 45 years, the history of hypertension, family history of coronary heart disease, and smoking more than 200 years. with a total cholesterol level of more than 6.22 mmol/ l, HD, "L is lower than 1.04 mmol/ l.2, and smoking is one of the factors leading to the abnormal blood lipid metabolism of the pilot.3. The polymorphism of LOX-1 gene is related to the coronary heart disease of the pilot. The variant genotype (CT + TT) of LOX-1 gene may be related to the coronary heart disease of the pilot. Risk-related, T-allele carriers may have a higher risk of disease, but the LOX-1 gene polymorphism is associated with coronary heart disease such as smoking, blood lipid, and Hcy.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R541.4;R85

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