血ADAMTS4在颈动脉斑块稳定性评估中的价值研究

发布时间：2018-06-06 16:20

本文选题：ADAMTS4 + 颈动脉狭窄　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本试验旨在探讨粥样硬化性颈动脉狭窄患者血含I型血小板结合蛋白基序的解聚蛋白样金属蛋白酶4(ADAMTS4)的水平与颈动脉斑块稳定性的相关性,探讨其在颈动脉斑块稳定性评估及对缺血性脑卒中风险预测的临床价值。方法:采用前瞻性研究方法,入选就诊于山西医科大学第二医院血管外科60名颈动脉狭窄、欲行颈动脉内膜剥脱术的患者,留取患者入院24小时肘静脉血、颈动脉内膜剥脱术(CEA)后的颈动脉粥样硬化斑块标本,据病理组织分型将其分为稳定斑块组和易损斑块组。对照组选自我院体检中心存在动脉粥样硬化但多普勒超声检查提示未见明显颈动脉斑块的患者,年龄60-80岁,共30名;患者血ADAMTS4水平将采用酶联免疫吸附法测定。按需采用单因素方差分析、Pearson卡方检验、多因素logistic回归分析、ROC(receiver operating characteristic curve,感受性曲线)等方法进行统计学分析。结果:易损斑块组血ADAMTS4升高程度显著高于稳定斑块组和对照组,差异有统计学意义(p0.001),稳定斑块组血ADAMTS4水平较对照组增高,但差异无统计学意义(p0.05);logistic回归分析显示:症状型颈动脉狭窄组与非症状型颈动脉狭窄组相比,斑块为易损斑块的概率更高(p0.05,OR=12.429,95%CI=3.601-42.902),血ADAMTS4水平高组与血ADAMTS4水平低组相比,斑块为易损斑块的概率更高(p0.05,OR=8.240,95%CI=1.512-22.915);ROC曲线分析显示:曲线下面积为0.943,95%CI=0.887-0.999。当血ADAMTS4=100.935ng/ml时,达到最大检测效能,灵敏度=83.3%,特异度=1-7.6%=92.4%。结论:ADAMTS4可作为判断颈动脉粥样硬化斑块,尤其是易损斑块稳定性的潜在生化指标,对缺血性脑卒中的预防、早期诊断和寻找新的治疗靶点等方面有积极的临床意义。
[Abstract]:Objective: to investigate the relationship between the level of depolymerized proteinase-like metalloproteinase-4 (ADAMTS4) and carotid plaque stability in patients with atherosclerotic carotid stenosis. To evaluate the stability of carotid plaque and its clinical value in predicting the risk of ischemic stroke. Methods: a prospective study was carried out in 60 patients with carotid artery stenosis and carotid endarterectomy in the second Hospital of Shanxi Medical University. Carotid atherosclerotic plaque specimens after carotid endarterectomy were divided into stable plaque group and vulnerable plaque group according to pathological classification. The control group was selected from 30 patients aged 60-80 years with atherosclerosis but no obvious carotid plaques were detected by Doppler ultrasound. The serum ADAMTS4 level of the patients was determined by enzyme-linked immunosorbent assay (Elisa). Single factor variance analysis and Pearson chi-square test and multivariate logistic regression analysis were used to analyze the receptivity curve of receiver operating characteristic curve,. Results: the level of ADAMTS4 in the vulnerable plaque group was significantly higher than that in the stable plaque group and the control group, the difference was statistically significant (p 0.001). The serum ADAMTS4 level in the stable plaque group was higher than that in the control group. But there was no significant difference in logistic regression analysis between symptomatic carotid artery stenosis group and non-symptomatic carotid artery stenosis group. Compared with non-symptomatic carotid artery stenosis group, the probability of plaque being vulnerable plaque was higher than that of non-symptomatic carotid artery stenosis group, and the probability of plaque was higher than that of non-symptomatic carotid artery stenosis group, and the risk of plaque was higher than that of non-symptomatic carotid artery stenosis group. The incidence of plaque was higher in symptomatic carotid artery stenosis group than in non-symptomatic carotid artery stenosis group. The probability that the patch is a vulnerable patch is higher than that of a vulnerable patch. The analysis of ROC curve shows that the area under the curve is 0.94395 / 0.887-0.999. When the blood was ADAMTS4=100.935ng/ml, the maximum detection efficiency was achieved, the sensitivity was 83.3%, and the specificity was 1-7. 6 and 92. 4%. ConclusionADAMTS4 can be used as a potential biochemical index for judging the stability of carotid atherosclerotic plaques, especially vulnerable plaques, and has a positive clinical significance in the prevention of ischemic stroke, early diagnosis and finding new therapeutic targets.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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