高龄脑动脉粥样硬化患者血瘀证与循环内皮祖细胞的相关研究

发布时间：2018-03-08 11:21

本文选题：高龄　切入点：脑动脉粥样硬化　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨高龄脑动脉粥样硬化患者的循环内皮祖细胞数量与脑动脉硬化程度、血瘀证的相关性,丰富中西医结合防治脑动脉硬化的研究。方法:1、前瞻性纳入2016年02月至2017年02月在我院神经科及老年科住院的高龄脑动脉粥样硬化患者,收集人口学资料、动脉粥样硬化相关危险因素、血液指标、中医辨证资料等。2、应用流式细胞仪检测研究对象的外周血内皮祖细胞数量。根据脑动脉粥样硬化筛查与诊断规范(2014版)将脑动脉粥样硬化分为轻度和中重度两组,脑动脉粥样硬化1级者为轻度组,2-3级者为中重度组,对比分析两组之间性别、年龄、循环内皮祖细胞数量、动脉粥样硬化危险因素、血瘀证分型是否存在差异。同时比较血瘀组和非血瘀组在性别、年龄、循环内皮祖细胞数量、动脉粥样硬化危险因素等方面是否有差异。结果:1、本研究共纳入122例符合条件的患者,年龄在80～96岁,平均年龄(84.20±3.90)岁,其中男性84例,女性38例。有高血压病史93例,有糖尿病病史43例,有冠心病病史49例,吸烟者28例和饮酒者16例。血瘀证102例,非血瘀证20例。2、血瘀组和非血瘀组在年龄、冠心病、内皮祖细胞计数、动脉粥样硬化程度方面有显著差异性(P0.05);血瘀证候积分与脑动脉硬化程度分级之间的相关性有统计学意义(P=0.001),呈正相关,相关系数为0.307;血瘀证候积分与内皮祖细胞数量之间的相关性具有统计学意义(P=0.003),呈负相关,相关系数为-0.265。3、所纳入的122例患者中脑动脉硬化程度为轻度的92例,中重度30例。在高龄脑动脉粥样硬化患者的多因素二项Logistic回归分析中,以脑动脉硬化程度为因变量,将脑动脉粥样硬化1级设定为轻度,2-3级设定为中重度,以性别、年龄、吸烟、饮酒、高血压、糖尿病、冠心病、内皮祖细胞数、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、血尿酸、肌酐、内皮祖细胞为协变量,(设定内皮祖细胞数量0.085%为少,内皮祖细胞数量≥0.085%为多。)调整诸种危险因素混杂因素后,内皮祖细胞的相对危险度(OR值)为0.13(95%CI:0.05～0.342),P0.001),具有统计学意义。结论;1、在高龄脑动脉粥样硬化患者中,脑动脉硬化程度越严重的患者循环内皮祖细胞的数量也越低,血瘀症状越严重,血瘀证候积分也越高;当参与血管修复的内皮祖细胞数量减少时,发生脑卒中的风险可能增高。2、高龄脑动脉粥样硬化辨证属于血瘀证型者占较大比例,血瘀积分较高者,动脉硬化程度也越严重,当辨证属血瘀证型者可适当使用活血化瘀药物,改善动脉硬化情况。
[Abstract]:Objective: to investigate the correlation between the number of circulating endothelial progenitor cells and the degree of cerebral arteriosclerosis and blood stasis syndrome in elderly patients with cerebral atherosclerosis. Methods from February 2016 to February 2017, the elderly patients with cerebral atherosclerosis hospitalized in neurology and geriatrics in our hospital were included in the study, and the demographic data were collected. Risk factors related to atherosclerosis, blood indicators, According to the criteria for screening and diagnosis of cerebral atherosclerosis (2014), cerebral atherosclerosis was divided into two groups: mild and moderate severe. Patients with grade 1 of cerebral atherosclerosis were moderate to severe group with mild grade 2-3. Sex, age, number of circulating endothelial progenitor cells, risk factors of atherosclerosis were compared and analyzed between the two groups. At the same time, the sex, age and the number of circulating endothelial progenitor cells were compared between blood stasis group and non-blood stasis group. Results there were 122 eligible patients in this study. The average age was 84.20 卤3.90 years, including 84 males and 38 females. 93 patients had a history of hypertension. There were 43 cases of diabetes mellitus, 49 cases of coronary heart disease, 28 cases of smokers and 16 cases of drinkers, 102 cases of blood stasis and 20 cases of non-blood stasis. There was significant difference in the degree of atherosclerosis (P 0.05), the correlation between the blood stasis syndrome score and the grade of cerebral arteriosclerosis was statistically significant (P = 0.001), and there was a positive correlation between the score of blood stasis syndrome and the grade of cerebral arteriosclerosis. The correlation coefficient was 0.307, the correlation between blood stasis syndrome score and the number of endothelial progenitor cells was statistically significant (P < 0.003), the correlation coefficient was -0.265.3, the degree of mesencephalic arteriosclerosis was mild in 92 cases. 30 cases of moderate or severe cerebral atherosclerosis. In the multivariate Logistic regression analysis of aged patients with cerebral atherosclerosis, the degree of cerebral atherosclerosis was regarded as dependent variable, and the grade 1 of cerebral atherosclerosis was set as mild grade 2-3, and the degree of cerebral atherosclerosis was set as moderate and severe, with sex and age. Smoking, drinking, hypertension, diabetes, coronary heart disease, endothelial progenitor cell count, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, serum uric acid, creatinine, Endothelial progenitor cells were covariates (the number of endothelial progenitor cells was less than 0.085%, and the number of endothelial progenitor cells was more than 0.085%.) after adjusting for the mixed factors of various risk factors, The relative risk ratio of endothelial progenitor cells (OR) was 0.13 ~ 95% CI: 0.05 ~ 0.342C ~ (0.001), which was statistically significant. Conclusion in elderly patients with cerebral atherosclerosis, the number of circulating endothelial progenitor cells in patients with severe cerebral atherosclerosis is also lower, and the symptoms of blood stasis are more serious. When the number of endothelial progenitor cells involved in vascular repair decreased, the risk of cerebral apoplexy may increase by 0.2. The degree of arteriosclerosis is more serious, when syndrome differentiation belongs to blood stasis syndrome, appropriate use of drugs to promote blood circulation and remove blood stasis to improve atherosclerosis.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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