血清PCSK9与伴发脑梗死患者的脑动脉粥样硬化及他汀降脂效果的相关性研究

发布时间：2018-03-29 08:45

本文选题：PCSK9　切入点：动脉粥样硬化　出处：《吉林大学》2017年硕士论文

【摘要】：目的:探讨在动脉粥样硬化性脑梗死患者中血清PCSK9水平与脑动脉粥样硬化程度及多项动脉粥样硬化危险因素的关系,并探讨血清PCSK9水平与口服他汀类药物降脂效果的关系。方法:选取于2015年12月至2016年12月期间在吉林大学第一医院行CA和TCD的神经内科动脉粥样硬化性脑梗死患者为研究对象,收集其空腹血标本,记录患者一般临床资料,包括年龄、性别、高血压病史、糖尿病史、高血脂病史、既往服药史、吸烟史、饮酒史、家族史,及常规血清生化指标如血脂、空腹血糖、叶酸、维生素B12、尿酸、同型半胱氨酸等。记录患者CA、TCD资料,根据AS病变程度分组,具体分为无斑块组、斑块组(CA颈动脉斑块形成,但血管未见狭窄)、轻度狭窄组(狭窄率50%)、中度狭窄组(狭窄率50%~69%)、重度狭窄(狭窄率70%~99%)或闭塞组(CA及TCD均未探及相关血管的确切的血流信号)。用ELISA方法检测入组患者血清PCSK9的水平。对使用他汀类药物降脂治疗的患者,我们通过随访评估其他汀类药物治疗前后血脂代谢指标的改变。利用统计学方法对血清PCSK9水平与脑动脉粥样硬化程度、动脉粥样硬化危险因素、口服他汀类药物降脂效果进行相关性分析。结果:1.本研究中血清PCSK9水平中位数为130.76ng/ml,第25百分位数为105.71 ng/ml,第75百分位数为157.54 ng/ml。女性患者与男性血清PCSK9之间存在统计学差异(P0.05),女性PCSK9水平稍高。2.血清PCSK9水平和脑动脉粥样硬化程度呈正相关,具有统计学意义(P0.01)。3.血清PCSK9水平与SBP、FBG、TG、LDL-C、TC呈正相关,有统计学意义(P0.05)。以血清PCSK9水平为因变量,进行多元回归分析,结果提示血清PCSK9水平与TG、LDL-C、TC三种危险因素关系更为密切。4.经过短期(一个月)他汀治疗,血清TC、TG、LDL-C均较治疗前下降,HDL-C较治疗前上升(P0.01)。血清PCSK9水平与各血脂组份的下降值无明显相关性(P0.05)。结论:1.女性PCSK9水平高于男性。2.血清PCSK9水平与脑动脉粥样硬化程度及其多项危险因素呈正相关。3.血清PCSK9水平与他汀降脂效果无明显相关性。
[Abstract]:Objective: to investigate the relationship between serum PCSK9 level and degree of cerebral atherosclerosis and risk factors of atherosclerosis in patients with atherosclerotic cerebral infarction. To explore the relationship between serum PCSK9 level and the effect of oral statins on reducing blood lipid. Methods: the patients with atherosclerotic cerebral infarction (ACI) who were treated with CA and TCD in the first Hospital of Jilin University from December 2015 to December 2016 were selected as subjects. Fasting blood samples were collected and general clinical data were recorded, including age, sex, history of hypertension, history of diabetes, history of hyperlipidemia, history of medication, history of smoking, history of drinking alcohol, family history, and routine serum biochemical parameters such as blood lipid. Fasting blood glucose, folic acid, vitamin B12, uric acid, homocysteine and so on. However, no stenosis was found in mild stenosis group (stenosis rate 50%), moderate stenosis group (stenosis rate 50%), severe stenosis group (stenosis rate 7099%) or occlusion group, CA and TCD did not detect the exact blood flow signals of the related vessels. The level of serum PCSK9 in patients treated with statins. We were followed up to evaluate the changes of serum lipid metabolism before and after treatment with other statins. Serum PCSK9 levels and the degree of cerebral atherosclerosis, risk factors of atherosclerosis were measured by statistical methods. Results: 1.The median serum PCSK9 level in this study was 130.76 ng / ml, the 25th percentile was 105.71 ng / ml, and the 75th percentile was 157.54 ng / ml. The serum PCSK9 level was positively correlated with the degree of cerebral atherosclerosis. There was a positive correlation between serum PCSK9 level and serum PCSK9 level, and there was a significant correlation between serum PCSK9 level and LDL-CTC. The multivariate regression analysis was carried out with the serum PCSK9 level as a dependent variable. The results suggest that the serum PCSK9 level is more closely related to the three risk factors of TGG LDL-CfTC. The levels of serum TCU TGG LDL-C decreased and HDL-C increased compared with those before treatment. There was no significant correlation between serum PCSK9 level and the decrease of serum lipid components. Conclusion: 1. The level of PCSK9 in women is higher than that in men. 2. The level of serum PCSK9 and the degree of cerebral atherosclerosis and the degree of cerebral atherosclerosis. There was no significant correlation between serum PCSK9 level and statin effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33

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