C-反应蛋白血清水平及基因多态性与大动脉粥样硬化型脑梗死预后的相关性研究

发布时间：2018-01-28 03:57

  本文关键词： C-反应蛋白 预后 动脉粥样硬化型 脑梗死 C-反应蛋白 基因多态性 基因 预后 大动脉粥样硬化型 脑梗死　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：C-反应蛋白(C-reactive protein,CRP)水平及其基因多态性可能影响脑梗死预后。但关于CRP水平及基因多态性与大动脉粥样硬化型(Large-artery atherosclerosis,LAA)脑梗死预后的关系尚不明了。本课题旨在探讨CRP水平及其基因多态性与LAA脑梗死预后的相关性。第一章CRP血清水平与大动脉粥样硬化型脑梗死预后的相关研究目的:探讨LAA脑梗死急性期CRP血清水平与患者长期神经功能缺失状态及主要血管复发事件的相关性。方法:以南京卒中登记系统为基础,前瞻性登记2012年1月至2014年6月首次发作的LAA脑梗死患者。收集患者一般临床资料及发病2周内静脉血。对所有纳入研究的患者进行为期1年的随访,记录患者1年mRS评分及主要血管复发事件。分别采用多元Logistic回归分析和Cox比例风险模型对患者1年神经功能缺失状态及主要血管复发事件进行分析。结果:本研究共收集符合纳入标准患者625例(男性458例)。经过1年随访,共63例患者发生主要血管复发事件。相比CPR≤2.40mg/l组患者,CPR2.40 mg/l组患者1年神经功能恢复状态明显较差(P = 0.007)。Log CRP水平越高,患者1年神经功能恢复状态越差(P= 0.002)。按性别进行分层,在男性组和女性组中CRP水平均为1年神经功能恢复状态独立预测指标。相比CPR≤2.40 mg/l组患者,CPR2.40 mg/l组患者1年主要血管复发事件较多(P = 0.036),校正可能混杂因素后,两组主要血管复发事件无显著统计学差异(P = 0.110)。结论:LAA脑梗死发病2周内CRP血清水平可预测患者1年神经功能恢复状态,但不能预测患者1年主要血管复发事件的发生。第二章CRP基因多态性与大动脉粥样硬化型脑梗死预后的相关性目的:探讨中国汉族人群中CRP基因多态性与LAA脑梗死患者发病3个月的神经功能恢复状态的相关性。方法:以南京卒中登记系统为基础,前瞻性登记2013年8月至2015年10月首次发作的LAA脑梗死患者。根据GWAS研究报道,筛选出5个与亚洲人群CRP 血清水平相关的 CRP 基因位点(rs876537,rs2794520,rs3093059,rs7553007及rs11265260)进行基因分型。记录患者3个月mRS评分。结果:共690例患者(男性507例)纳入研究。CRP基因rs3093059(显性模型:OR = 2.49;95%CI 1.55-4.00;隐性模型:OR = 3.67;95%CI 1.22-11.03)和rs11265260(显性模型:OR = 2.51;95%CI 1.56-4.02;隐性模型:OR = 4.70;95%CI1.63-13.56)与患者3个月预后不良显著相关。相比CACAC单倍体,单倍体 TCCCC(OR = 2.54;95%CI 1.14-5.68)和 TACAC(OR = 2.40;95%CI,1.24-4.64)增加患者3个月预后不良风险。结论:在中国汉族人群中,CRP基因rs3093059和rs11265260基因多态性与LAA脑梗死患者3个月神经功能恢复状态相关。
[Abstract]:C-reactive protein. The level of CRP and its gene polymorphism may affect the prognosis of cerebral infarction. Large-artery atherosclerosis. LAA). The relationship between the prognosis of cerebral infarction and the level of CRP, its gene polymorphisms and the prognosis of cerebral infarction in LAA is not clear. Chapter 1: the serum level of CRP and the prognosis of atherosclerotic cerebral infarction. The objectives of the study are as follows:. To investigate the correlation between the serum level of CRP in acute phase of cerebral infarction (LAA) and the long-term neurological deficit and recurrent events in patients with acute cerebral infarction. Methods: based on the Nanjing Stroke Registration system. Prospective registration of patients with LAA cerebral infarction from January 2012 to June 2014. General clinical data were collected and venous blood was collected within 2 weeks of onset. All patients included in the study were included in the study for a period of one year. Follow up. The 1-year mRS score and major vessel recurrence events were recorded. Multivariate Logistic regression analysis and Cox proportional risk model were used to evaluate the 1-year neurological deficit and major vascular recurrence in patients. Results:. A total of 625 patients who met the inclusion criteria were collected in this study (. Male 458 cases were followed up for 1 year. A total of 63 patients had major vascular recurrence events, compared with CPR 鈮，

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