动脉粥样硬化脑梗死患者LP-PLA2水平与颅内外血管动脉粥样硬化及狭窄程度的相关性研究

发布时间：2018-03-15 09:15

本文选题：动脉粥样硬化　切入点：脑梗死　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨大动脉粥样硬化型脑卒中(LAA)患者血浆LP-PLA2水平与颅内外血管动脉粥样硬化及狭窄程度的相关性。方法:选取2015年12月~2016年12月我院神经内科收治的LAA患者60例作为研究对象,选取同期我院体检中心健康体检者40例作为对照组,采用双抗体夹心酶联免疫吸附法(ELISA)测定两组对象LP-PLA2水平,并同时检测血糖、血脂、同型半胱氨酸等生化指标,两组对象均行颈部血管超声观察颈动脉粥样硬化程度、有无动脉粥样硬化斑块以及斑块性质,并行头颈部CTA检查观察头颈部血管狭窄程度。应用SPSS 22.0统计软件处理研究数据。结果:1 LAA组的吸烟比例、饮酒比例、高血压比例、糖尿病比例均高于对照组,差异无统计学意义(P0.05),LAA组平均年龄、男性性别比例均低于对照组,差异亦无统计学意义(P0.05);2 LAA组LDL、TC、TG以及Fib水平均高于对照组,其差异有统计学意义(P0.05),对照组HDL水平高于LAA组,差异有统计学意义(P0.05);3 LAA组LP-PLA2水平和HCY水平均明显高于对照组,差异有统计学意义(P0.05);4 LAA组患者中,随神经功能缺损严重程度的增加,LP-PLA2水平呈现显著升高的趋势,组间比较差异有统计学意义(P=0.001);5 LAA组患者中,颈内动脉系统供血区域梗死患者共计34人,LPPLA2水平为156.26±31.46ng/ml,椎-基底动脉系统供血区域梗死患者共计21人,其LP-PLA2水平为164.68±21.17ng/ml,差异无统计学意义(P=0.247);6 LAA组不同位置血管狭窄各亚组之间,组间比较差异无统计学意义(P=0.695);7 LAA组患者共检出斑块者56例,其中稳定性斑块者11例,LP-PLA2水平为170.59±38.16ng/ml,易损性斑块者45例,LP-PLA2水平为192.86±37.29ng/ml,均显著高于无斑块组LP-PLA2水平112.38±26.17ng/ml,且差异有统计学意义(P=0.000);8 LAA组血管0级患者共5例,LP-PLA2水平为112.25±28.65ng/ml,1级患者共15例,LP-PLA2水平为149.76±31.18ng/ml,2级患者共32例,LP-PLA2水平为175.38±41.24ng/ml,3级患者共8例,LP-PLA2水平为185.59±39.52ng/ml,差异有统计学意义(P=0.002)。结论:本实验研究结果显示,血浆LP-PLA2可能是动脉粥样硬化脑梗死的新型危险因素,其水平的高低与动脉粥样硬化脑梗死患者的严重程度显著相关,并对该类患者颅内外血管的动脉粥样硬化严重程度有一定预测作用,能够辅助预测动脉粥样硬化斑块的稳定程度。早期检测LP-PLA2水平能够对动脉粥样硬化脑梗死患者的二级预防及个体化治疗提供一定的帮助,并对未来LP-PLA2特异性抑制剂的研制提供一定的临床依据。
[Abstract]:Objective: to investigate the relationship between plasma LP-PLA2 levels and the degree of atherosclerosis and stenosis in patients with atherosclerotic stroke. Methods: from December 2015 to December 2016, the patients with LAA in neurology department of our hospital were selected. 60 cases were included in the study. 40 healthy subjects in the same period were selected as control group. The levels of LP-PLA2 were measured by double antibody sandwich enzyme linked immunosorbent assay (Elisa), and blood glucose, blood lipids, homocysteine and other biochemical indexes were also detected. The degree of carotid atherosclerosis, whether or not atherosclerotic plaques and the nature of atherosclerotic plaques were observed by cervical vascular ultrasound in both groups. The degree of vascular stenosis in head and neck was observed by CTA. The data were processed by SPSS 22.0 software. Results the smoking, drinking, hypertension and diabetes rates in the LAA group were higher than those in the control group. There was no significant difference in average age, sex ratio of male and control group, and there was no significant difference in the levels of Fib and TG in LAA group. The difference was statistically significant (P 0.05). The level of HDL in control group was higher than that in LAA group. The levels of LP-PLA2 and HCY in P0.05 LAA group were significantly higher than those in the control group, and the LP-PLA2 level was significantly increased with the increase of the severity of neurological impairment in the P0.05 / 4 LAA group. There were significant differences between the two groups. In the 5 LAA group, 34 patients with internal carotid artery system infarction had LPLA2 level of 156.26 卤31.46 ng / ml, and 21 patients with vertebrobasilar artery supply area infarction. The level of LP-PLA2 was 164.68 卤21.17ng / ml, there was no significant difference between the two groups. There was no significant difference among the subgroups of vascular stenosis at different locations in the LAA group. There was no significant difference between the two groups in the detection of plaques in 56 cases in the group of 0.695ng / ml, and there was no significant difference between the two groups. The LP-PLA2 level in 11 patients with stable plaque was 170.59 卤38.16 ng / ml, and that in 45 patients with vulnerable plaque was 192.86 卤37.29 ng / ml, which was significantly higher than that in the plaque free group (112.38 卤26.17 ng / ml), and the difference was statistically significant in 5 patients with grade 0 of vascular grade 0 in P0.000 / 8 LAA group. The level of LP-PLA2 was 112.25 卤28.65 ng / ml 1. The level of LP-PLA2 was 149.76 卤31.18ng / ml 2 in 15 patients. The level of LP-PLA2 was 175.38 卤41.24ng / ml in 32 patients. The level of LP-PLA2 was 185.59 卤39.52ng / ml, the difference was statistically significant (P 0.002). Conclusion: the level of LP-PLA2 in 32 patients with LP-PLA2 is 175.38 卤41.24ng / ml, and the level of LP-PLA2 is 185.59 卤39.52ng / ml. Plasma LP-PLA2 may be a new risk factor for atherosclerotic cerebral infarction, and its level is significantly related to the severity of atherosclerotic cerebral infarction. And it can predict the severity of atherosclerosis of intracranial and external vessels in this kind of patients. Early detection of LP-PLA2 level can be helpful for secondary prevention and individualized treatment in patients with atherosclerotic cerebral infarction. It also provides some clinical basis for the development of LP-PLA2 specific inhibitors in the future.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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