脑动脉瘤成瘤因素初探与动脉瘤患者中医证候研究

发布时间：2018-06-19 10:07

本文选题：脑动脉瘤 + 炎症反应　；参考：《广州中医药大学》2015年硕士论文

【摘要】：目的：脑动脉瘤破裂所引起的蛛网膜下腔出血是一种致死率、致残率极高的中风类型,脑动脉瘤的发生、发展机制尚不明了。目前的治疗针对已形成的动脉瘤,对于动脉瘤没有有效的防治措施,如何预防动脉瘤的发生发展是一个极具挑战性的课题。本研究基于一种新型的血流动力学性大鼠动脉瘤模型,对于动脉瘤的成瘤因素进行初步探讨；同时,收集脑动脉瘤患者的中医证候资料。初步探讨脑动脉瘤患者的中医证候类型以及动脉瘤围手术期的中医证候变化。为动脉瘤防治工作提供参考。方法：课题分为两个部分。第一部分为动物实验：大鼠分为2组(实验组、对照组),统计各组大鼠的死亡率,成瘤率(病理组织切片,进行HE染色、VG染色),进行免疫组化分析,监测各组大鼠的平均动脉收缩压,对比各组标本的脑血管管径、血管壁厚度。第二部分为临床回顾性研究：回顾广东省中医院神经五科在2013年1月-2014年12月期间,所收治的脑动脉瘤患者(经DSA诊断),纳入其中28例患者,使用证候量表分析其入院时中医症候分布情况,对比动脉瘤栓塞术围手术期证候变化情况。结果：第一部分实验结果：死亡率：对照组无非正常死亡,实验组20%(3/15)。成瘤率：对照组0%(0/15),实验组33%(4/12)。免疫组化可见动脉瘤壁上有巨噬细胞的染色。血压监测提示对照组收缩压无明显波动,实验组大鼠术后收缩压逐渐升高,实验组大鼠术后大脑前动脉管径和厚度逐渐增加。第二部分回顾性研究结果：共纳入28符合标准的脑动脉瘤患者,入院时中医证候积分以风证、火热证、痰证、血瘀证为高,术后风证、火热证、血瘀证积分下降明显,痰证积分下降不明显。结论：1.新型动脉瘤模型可稳定的产生动脉瘤,可用于动脉瘤的病因探究；MCP-1介导的血管壁上的慢性炎症反应可能与脑动脉瘤的发生发展关系密切。2、脑动脉瘤患者的证候规律为风证、火热证、血瘀证、痰证兼而为患；其中痰证在脑动脉瘤栓塞术后积分下降不明显,提示痰证可能为脑动脉瘤病程过程中持续存在的中医病理因素,可能是脑动脉瘤形成的重要因素。
[Abstract]:Objective: subarachnoid hemorrhage caused by rupture of cerebral aneurysm is a type of apoplexy with high mortality and disability rate. The current treatment is aimed at the formed aneurysms, there is no effective prevention and treatment for aneurysms, how to prevent the occurrence and development of aneurysms is a very challenging topic. Based on a new model of hemodynamic aneurysm in rats, the factors of aneurysm formation were preliminarily discussed. At the same time, TCM syndromes of cerebral aneurysm patients were collected. To explore the types of TCM syndromes of cerebral aneurysms and the changes of TCM syndromes in the perioperative period of aneurysms. To provide a reference for the prevention and treatment of aneurysms. Methods: the project was divided into two parts. The first part was animal experiment: rats were divided into two groups (experimental group, control group, the mortality rate and tumorigenesis rate (pathological section, HE staining, VG staining, immunohistochemical analysis). The mean systolic blood pressure of rats was monitored and the diameter of cerebral vessels and the thickness of vascular wall were compared. The second part is a clinical retrospective study: a retrospective study of 28 patients with cerebral aneurysms admitted from January 2013 to December 2014 in the Department of Neurology, Guangdong Provincial Hospital of traditional Chinese Medicine (DSA) was conducted. Syndrome scale was used to analyze the distribution of TCM symptoms at admission and to compare the changes of syndrome in perioperative period of aneurysm embolization. Results: the first part of the experiment: mortality: the control group is no more than normal death, experimental group 20 / 15. Tumour rate: control group 0 / 15, experimental group 33 / 12. Immunohistochemical staining showed macrophage staining on the wall of the aneurysm. Blood pressure monitoring showed that there was no obvious fluctuation of systolic blood pressure in the control group. The systolic blood pressure increased gradually in the experimental group and the diameter and thickness of the anterior cerebral artery increased gradually in the experimental group. The results of the second part of the retrospective study: 28 patients with cerebral aneurysms who met the criteria were included. The scores of TCM syndromes on admission were high in wind syndrome, fire heat syndrome, phlegm syndrome and blood stasis syndrome. The scores of wind syndrome, fire heat syndrome, blood stasis syndrome decreased significantly after operation. Phlegm syndrome integral drop is not obvious. Conclusion 1. A new type of aneurysm model can produce aneurysm stably, which can be used to explore the etiology of aneurysm. The chronic inflammatory reaction on the wall of blood vessel mediated by MCP-1 may be closely related to the occurrence and development of cerebral aneurysm. The syndrome pattern of cerebral aneurysm is wind syndrome. Heat syndrome, blood stasis syndrome, phlegm syndrome and phlegm syndrome were not significantly decreased after embolization of cerebral aneurysm, suggesting that phlegm syndrome may be a persistent pathological factor of TCM during the course of cerebral aneurysm. It may be an important factor in the formation of cerebral aneurysm.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743

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