急性期脑梗死伴有脑微出血患者血液中vWF及s-CD40L表达分析

发布时间：2018-04-04 21:53

本文选题：vWF　切入点：s-CD40L　出处：《河北大学》2017年硕士论文

【摘要】：研究背景及目的脑微出血(cerebral microbleeds,CMBs)是颅内微小血管损伤后血细胞通过损伤严重的血管内皮渗漏到周围组织,从而导致含铁血黄素沉积的一种亚临床表现。CMBs的出现标志着患者颅内血管出现受损情况,且患者具有出血倾向的状态。作为一种亚临床疾病,CMBs缺乏相应的神经功能障碍表现,目前,CMBs的诊断有赖于高强度核磁共振检查的磁敏感加权成像(susceptibility weighted imaging,SWI)及T2加权成像(T2*)序列,CMBs具体表现为圆形或者卵圆形,直径在2-5mm之间的低信号病灶。CMBs的发病率在不同人群中有所差别,研究表明,急性脑梗死患者CMBs的发病率约在40%左右,并且急性脑梗死合并CMBs与梗死后出血转化有一定的关联性。但是,迄今为止,脑微出血形成的具体机制尚不明确,目前研究结果考虑其形成原因可能与血管内皮功能障碍及炎症反应等因素关系密切。血管性血友病因子(Von Willebrand factor,v WF)作为一种蛋白多聚体,是一种大分子量物质,在人体凝血过程中发挥着十分重要的作用,目前已有研究表明,血管性血友病因子可以良好的反应内皮细胞活动度,是预测血管内皮功能状态的可靠标准。血管内可溶性CD40配体(soluble CD40ligand,s-CD40L)是目前研究发现较为可靠的血管炎性反应指标。综上,本研究选择收集急性期脑梗死患者血液中v WF及s-CD40L含量的检测结果,对血液中两项因子的含量检测结果进行分析,重点探寻两种因子与脑微出血(CMBs)的相关性。期望为临床脑微出血的诊疗有所帮助。方法收集2016年2月至2016年10月河北大学附属医院神经内科病房内住院的急性期脑梗死患者(发病6-72h之间)共150例,通过核磁共振特殊序列SWI检查将所有患者进行分组,其中包括急性期脑梗死合并微出血患者62例,急性期脑梗死不合并脑微出血患者88例,收集150例急性期脑梗死患者一般基础信息并进行OCSP分型,于发病2周内复查头部CT明确是否存在梗死后出血转化。收集门诊就诊的健康成人30例作为正常对照组。健康成人于体检当天静脉采血,脑梗死患者于入院当天行静脉采血,所有血液标本离心后-70℃冻存,待标本收集完成后,同一批次使用ELISA试剂盒完成v WF及s-CD40L含量测定。针对收集数据运用统计学方法处理,寻找微出血与患者一般基本信息、OCSP分型、v WF及s-CD40L含量之间蕴藏的相关关系,其中P0.05标志差异有统计学意义。结果1.急性期脑梗死合并CMBs患者及急性期脑梗死不合并CMBs患者静脉血v WF及s-CD40L含量较正常成人明显升高,其中急性期脑梗死合并CMBs患者静脉血中v WF及s-CD40L含量较急性期脑梗死不合并CMBs者升高(P0.001)。2.OCSP分型中不同急性期脑梗死分型患者v WF及s-CD40L含量不同,且各型患者间两种因子血清中含量差异明显(P0.001)。3.急性期脑梗死合并CMBs患者静脉血中v WF及s-CD40L含量与CMBs数量线性相关,随着CMBs的数量增加,v WF及s-CD40L含量也呈增加趋势(R=0.873,P0.001;R=0.762,P0.001)。4.经过多因素logistic回归分析表明年龄、高血压病、同型半胱氨酸及v WF可作为急性期脑梗死合并CMBs的独立危险因素。5.急性期脑梗死合并CMBs较急性期脑梗死不合并CMBs患者发生梗死后出血转化的可能性明显增高,且发生出血转化与CMBs个数之间正相关(R=0.704,P0.001)。结论1.脑微出血的发生与年龄、高血压病、同型半胱氨酸、v WF及s-CD40L含量关系密切。2.急性期脑梗死伴有脑微出血患者较单纯急性期脑梗死患者静脉血中v WF及sCD40L含量高。3.v WF及s-CD40L,特别是v WF可作为检测指标对急性期脑梗死患者出血倾向进行初步评估。4.急性期脑梗死发生出血转化与脑微出血之间存在相关性,发生出血转化与脑微出血个数正相关。
[Abstract]:Background and objective: cerebral microbleeds (cerebral microbleeds CMBs) is a very small intracranial vascular injury after severe injury of blood cells by vascular endothelial leakage into the surrounding tissue, resulting in a sub clinical manifestation of.CMBs hemosiderin deposition marks the intracranial vascular damage, and patients with bleeding tendency. As a kind of subclinical disease, CMBs lack of corresponding nerve dysfunction, at present, susceptibility weighted imaging in the diagnosis of CMBs depends on the high strength MRI (susceptibility weighted imaging, SWI) and T2 weighted imaging (T2*) sequence specific CMBs showed round or oval, the incidence of 2-5mm in diameter between the low signal.CMBs lesions rate was different in different population studies show that the incidence of CMBs in patients with acute cerebral infarction rate is about 40%, and acute cerebral infarction with CMB S and post infarction hemorrhage transformation have certain relevance. However, so far, the mechanism of the formation of the cerebral microbleeds is not clear, the results of the present study considered the relationship between reason and vascular endothelial dysfunction and inflammation factors closely. Von Willebrand factor (Von Willebrand factor, V WF) as a protein polymer, is a kind of high molecular weight substances play a very important role in the blood coagulation process, the present study has shown that von Willebrand factor can be a good response of endothelial cell activity, is a reliable standard predictive state of vascular endothelial function. Intravascular soluble CD40 ligand (soluble, CD40ligand, s-CD40L) is the present study found that inflammatory reaction index is more reliable. The detection results were collected in patients with cerebral infarction in acute stage of V WF and s-CD40L in this study, the blood The content of test results in two factor analysis, explores two factors with cerebral microbleeds (CMBs). The correlation between expectations for the clinical diagnosis and treatment of cerebral microbleeds in patients with acute cerebral infarction help. Methods from February 2016 to October 2016 in Hebei University Affiliated Hospital neurology ward in the hospital (onset 6-72h) a total of 150 cases. Through MRI sequence specific SWI examination of all patients were divided into two groups, including acute cerebral infarction with micro hemorrhage in 62 patients with acute cerebral infarction with cerebral microbleeds in patients with 88 cases, a total of 150 patients with acute cerebral infarction and the general basic information of the OCSP type, in the first 2 weeks after the head of CT is clear there are post infarction hemorrhage transformation. Healthy adults collected 30 outpatients as normal control group. Healthy adults to physical examination in the venous blood in patients with cerebral infarction in the hospital when As the venous blood of all blood samples after centrifugation at -70 deg.c freezing, after all the sample were collected, using the same batch ELISA kit for determination of V WF and s-CD40L content. The use of statistical methods for the collection of data processing, find the micro bleeding with the basic information, the OCSP type, is the relationship between V and WF the content of s-CD40L, which has statistical significance P0.05 symbol difference. Results of 1. patients with acute cerebral infarction with CMBs and acute cerebral infarction with CMBs venous blood of patients with V WF and the s-CD40L content was significantly higher in normal adults, including acute cerebral infarction with CMBs venous blood in patients with V WF and the s-CD40L content was not acute cerebral infarction with CMBs. (P0.001) in acute cerebral infarction of different.2.OCSP subtypes in patients with type V WF and different s-CD40L content, and various types of patients in two kinds of factors in serum had obvious difference (P0.001).3. Acute cerebral infarction with CMBs venous blood in patients with V WF and s-CD40L CMBs and the content of the number of linear correlation with the increase in the number of CMBs, V, WF and s-CD40L was also increased (R=0.873, P0.001; R=0.762, P0.001).4. after multivariate logistic regression analysis showed that age, hypertension, homocysteine and v WF as the acute cerebral infarction with CMBs independent risk factors of acute cerebral infarction with.5. CMBs in acute cerebral infarction patients without CMBs infarction hemorrhagic transformation after the possibility of increased significantly, and the occurrence of a positive correlation between the number of hemorrhagic transformation with CMBs (R=0.704, P0.001). With age, the conclusion of the 1. cerebral microbleeds in hypertensive. Homocysteine, V WF and s-CD40L content in patients with acute cerebral infarction with close.2. venous blood of patients with cerebral microbleeds in patients with acute cerebral infarction than in V WF and.3.v WF s and high sCD40L content -CD40L, especially V WF can be used as the detection index of patients with acute cerebral infarction hemorrhage tendency preliminary assessment of.4. in patients with acute cerebral infarction hemorrhage transformation and cerebral microbleeds there is a correlation between the occurrence of hemorrhagic transformation, and the number of cerebral microbleeds are related.

【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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