血浆sCD40L及sP-selectin与大动脉粥样硬化型脑梗死的关系

发布时间：2018-04-03 20:47

  本文选题：sCD40L　切入点：sP-selectin　出处：《青岛大学》2017年硕士论文

【摘要】：目的:通过检测大动脉粥样硬化(LAA)型脑梗死病人血浆可溶性CD40L(s CD40L)及可溶性P-选择素(s P-selectin)的水平,结合LAA型脑梗死病人脑动脉粥样硬化病变广泛程度、微栓子信号以及NIHSS评分,分析血浆s CD40L及s P-selectin与LAA型脑梗死的关系,进一步探讨LAA型脑梗死的发病相关机制。方法:选择我院神经内科病区入院病人,严格按照TOAST病因分型标准筛选120例急性LAA型脑梗死入院病人为研究对象,正常对照组60例。为评价脑梗死病人脑动脉粥样硬化病变的广泛程度,将120例LAA型脑梗死病人按照脑动脉狭窄(动脉狭窄程度≥50%)支数分为单支(n=40)、双支(n=34)及三支及以上病变(n=46)3个亚组;为评价脑梗死病人脑动脉粥样硬化斑块的稳定性,对病例组中责任病灶涉及颈内动脉(ICA)系统病变的病人行微栓子信号(MES)监测,MES阳性13例,MES阴性68例。所有脑梗死患者住院期间行NIHSS评分以评价脑梗死急性期神经功能缺损程度。我们应用酶联免疫吸附法(ELISA)测定病例组及正常对照组的血浆s CD40L及s P-selectin水平,并分析s CD40L及s P-selectin与LAA型脑梗死的关系。此外,我们通过受试者工作曲线(ROC)分析s CD40L及s P-selectin诊断LAA型脑梗死的灵敏度和特异度,并比较曲线下面积,分析两指标对LAA型脑梗死的诊断优势。结果:LAA型脑梗死病人血浆s CD40L及s P-selectin水平显著高于对照组(t=-11.960、-13.036,P0.001),且两者水平分别为LAA型脑梗死的独立危险因素(OR=1.006、1.100,P=0.016、0.033)。血浆s CD40L及s P-selectin水平在病例组的单支病变、双支病变、多支病变3个亚组中差异具有显著性意义(P0.01),通过Bonferroni方法进一步分析发现多支病变亚组血浆s CD40L及s P-selectin水平显著高于单支病变亚组(P0.01);此外,通过Spearman相关性分析得出病例组s CD40L及s P-selectin水平与脑动脉病变支数正相关(r=0.330、0.359,P0.001);MES阳性组病人血浆s CD40L及s P-selectin显著高于MES阴性组(P0.001)。120例急性LAA型脑梗死病人NIHSS评分与血浆s CD40L及s P-selectin水平分别与成正相关关系(r=0.490、0.415,P0.001);此外,我们的数据还显示在LAA型脑梗死病人中,血浆s CD40L与s P-selectin两者的水平是显著正相关的(r=0.712,P0.001)。应用ROC曲线分析,s CD40L诊断LAA型脑梗死的ROC曲线下面积0.887,以307.00 pg/m L为截断点时,灵敏度81.7%,特异度91.7%;s P-selectin诊断LAA型脑梗死的ROC曲线下面积0.920,以22.62ng/m L为截断点时,灵敏度86.7%,特异度90%。两者对LAA型脑梗死诊断效能比较无统计学差异(Z=1.26,P=0.2077)。结论:血浆可溶性CD40L以及可溶性P-selectin水平升高提示大动脉粥样硬化型脑梗死病人的脑动脉粥样硬化病变累及范围广泛、斑块稳定性差,以及急性期神经功能缺损程度重。两者通过血小板活化以及炎症反应等机制参与动脉粥样硬化的病理过程,可作为LAA型脑梗死脑动脉粥样硬化病变严重程度的临床检测标志物。
[Abstract]:Objective: to detect the levels of plasma soluble CD40L(s CD40L and soluble P- selectin P-selectin in patients with cerebral infarction of large artery atherosclerosis (LAA) type, combined with the extent of atherosclerosis lesion, microembolus signal and NIHSS score in patients with LAA type cerebral infarction.To analyze the relationship between plasma s CD40L and s P-selectin and LAA type cerebral infarction, and to further explore the pathogenesis of LAA type cerebral infarction.Methods: 120 patients with acute LAA type cerebral infarction were selected according to the criteria of etiological classification of TOAST and 60 cases of normal control group.To evaluate the extent of atherosclerotic lesions in patients with cerebral infarction, 120 patients with LAA type cerebral infarction were divided into three subgroups according to the number of branches of cerebral artery stenosis (arterial stenosis 鈮，

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