急性脑梗死患者外周血内皮祖细胞的水平变化及相关性研究

发布时间：2018-02-12 04:14

  本文关键词： 急性脑梗死 内皮祖细胞 斑块性质 血管内皮生长因子 基质细胞衍生因子-1　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的动态观察急性脑梗死(Acute Cerebral Infarct,ACI)患者外周血内皮祖细胞(endothelial progenitor cells, EPCs)的水平变化,同时检测外周血血管内皮生长因子(vascular endothelial growth factor,VEGF)和基质细胞衍生因子-1(stromal cell-derived factor-1,SDF-1)的含量,以探讨急性脑梗死后EPCs的动员机制,为临床缺血性脑卒中的防治提供新的思路及理论基础。方法选择2015年01月01日至2015年12月31日入住宿州市立医院神经内科首次发病24h内急性脑梗死住院患者50例,同期选择该院体检中心年龄配对的健康体检者40例作为对照组。急性脑梗死患者根据TOAST分型、颈动脉有无斑块及斑块性质进行分组,其中,TOAST分型分为3组：大动脉粥样硬化型(Large artery atherosclerosis,LAA)26例,心源性栓塞型(Cardioembolism,CE)5例,小动脉闭塞型(Small artery occlusion lacunay,SAO)19例；颈动脉有无斑块分为2组：斑块组38例,无斑块组12例；斑块组根据斑块性质分为2组：易损斑块组25例和稳定斑块组13例。以CD133+KDR+细胞作为EPCs的标记,进行流式细胞分析,分别检测急性脑梗死患者发病后第1,5,10d的外周血EPCs数量,同时采用酶联免疫吸附法测定外周血VEGF和SDF-1的含量。EPCs变化率定义为(EPCssd-EPCs1d)与EPCs1d的比值。结果(1)脑梗死组患者外周血EPCs基线数量明显低于对照组(t=-6.046,P0.001)；收缩压、低密度脂蛋白可能是影响急性脑梗死组基线EPCs数量的独立危险因素。(2)脑梗死组患者TOAST各亚型外周血EPCs的基线数量均低于对照组,差异有统计学意义(P0.05),但TOAST各亚型之间外周血EPCs的基线数量差异无统计学意义(F=0.273,P=0.762)。(3)脑梗死组患者斑块组外周血EPCs基线数量低于无斑块组,差异有统计学意义(P0.05)；易损斑块组外周血EPCs基线数量高于稳定斑块组,差异有统计学意义(P0.05)。(4)脑梗死组患者外周血EPCs数量于第5d升高,第10d呈下降趋势。(5)脑梗死组患者外周血VEGF、SDF-1含量于第5d升高,第10d呈降低趋势。(6)脑梗死组患者外周血EPCs的变化率与第5d时VEGF、SDF-1含量呈正相关：第5d时VEGF含量与SDF-1含量呈正相关。结论急性脑梗死患者外周血EPCs基线数量较对照组明显降低,EPCs可能是急性脑梗死的一项重要危险因素。EPCs数量与颈动脉有无斑块、斑块性质具有一定相关性,表明EPCs可作为颈动脉粥样硬化及缺血性脑疾病的一项重要指标。急性脑梗死后外周血EPCs数量增加,提示脑缺血后EPCs可从骨髓动员至外周血中。急性脑梗死后外周血EPCs的动员可能与VEGF、SDF-1表达增加有关,三者之间可能相互作用、相互影响,共同参与缺血性脑疾病的血管新生、修复、神经元的保护等过程,对临床估测脑梗死患者的病情、预后具有一定的指导意义,可为缺血性脑卒中的治疗提供一条新途径。
[Abstract]:Objective to observe the dynamic changes of peripheral blood endothelial progenitor cells (EPCs) in patients with acute Cerebral infarction (ACI), and to detect the levels of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1) in peripheral blood of patients with acute cerebral infarction (ACI), including vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (-1stromal cell-derived factor-1). To explore the mobilization mechanism of EPCs after acute cerebral infarction. Methods from January 1st 2015 to December 31st 2015, 50 patients with acute cerebral infarction were admitted to the Department of Neurology, Suzhou City Hospital from January 1st 2015 to December 31st 2015. At the same time, 40 patients with age matched healthy physical examination were selected as control group. Patients with acute cerebral infarction were divided into two groups according to TOAST classification, whether carotid artery had plaques or not and the nature of plaques. Among them, TOAST was divided into 3 groups: large artery atherosclerotic LAA (n = 26), cardiac embolism (n = 5), small artery occlusion lacunayus (n = 19), carotid artery plaque (n = 38) and no plaque (n = 12). According to the plaque nature, the plaque group was divided into two groups: vulnerable plaque group (n = 25) and stable plaque group (n = 13). The number of EPCs in peripheral blood of patients with acute cerebral infarction was detected by flow cytometry with CD133 KDR cells as the marker of EPCs. At the same time, the contents of VEGF and SDF-1 in peripheral blood were determined by enzyme linked immunosorbent assay (Elisa). The change rate of EPCs was defined as the ratio of EPCssd-EPCs 1d to EPCs1d. The results showed that the number of EPCs baselines in patients with cerebral infarction was significantly lower than that in the control group (P 0.001), and the systolic blood pressure (SBP) was significantly lower than that in the control group (P < 0.05). Low density lipoprotein (LDL) may be an independent risk factor affecting baseline EPCs levels in acute cerebral infarction group. The baseline number of peripheral blood EPCs in patients with acute cerebral infarction was lower than that in control group. The difference was statistically significant (P 0.05), but there was no significant difference in the number of EPCs in peripheral blood among the subtypes of TOAST. The baseline number of EPCs in the patients with cerebral infarction was lower than that in the patients without plaque. The number of peripheral blood EPCs in the vulnerable plaque group was higher than that in the stable plaque group, and the difference was statistically significant. The level of VEGF SDF-1 in peripheral blood of patients with cerebral infarction increased on the 5th day. The change rate of EPCs in peripheral blood of patients with cerebral infarction was positively correlated with the level of VEGF SDF-1 on day 5 and the content of SDF-1 at day 5. Conclusion the baseline number of EPCs in peripheral blood of patients with acute cerebral infarction is higher than that of control group. Significant reduction of EPCs may be an important risk factor of acute cerebral infarction. The number of EPCs and carotid plaque, The character of plaques is correlated, which indicates that EPCs can be used as an important index of carotid atherosclerosis and ischemic brain disease. The number of EPCs in peripheral blood increases after acute cerebral infarction. The results suggest that EPCs can be mobilized from bone marrow to peripheral blood after cerebral ischemia. The mobilization of EPCs in peripheral blood after acute cerebral infarction may be related to the increased expression of VEGF SDF-1, which may interact with each other and participate in angiogenesis of ischemic brain disease. The process of repair and neuronal protection has a certain guiding significance for clinical evaluation of the condition and prognosis of patients with cerebral infarction and can provide a new approach for the treatment of ischemic stroke.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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