血浆Caveolin-1对急性脑梗死rt-PA溶栓后出血转化预测意义的研究
发布时间：2018-07-24 10:20
【摘要】：目的脑梗死是严重危害人类身体健康和生命的主要疾病之一。发病后4.5h内静脉给予rt-PA的溶栓治疗是目前公认最有效的治疗方法。然而,溶栓治疗是一把双刃剑,出血转化(HT)为脑梗死溶栓后最严重的并发症。溶栓后出血转化发生的相关机制目前仍不明确,其中血脑屏障(BBB)损害学说被认为意义重大。研究表明,小窝蛋白-1(caveolin-1)、金属基质蛋白酶-9(MMP-9)之间相互作用,与血脑屏障完整性的破坏有关。临床试验中将caveolin-1、MMP-9作为生物学标志物,探索其与脑梗死患者静脉溶栓预后相关性的研究很少见。本课题拟通过检测脑梗死溶栓患者血浆caveolin-1、MMP-9的水平,探讨其与溶栓后出血转化的关系,对溶栓后出血转化的发生进行早期预判,减少溶栓后出血转化发生的风险。方法本实验共纳入40例患者,其中出血转化组3例,对照组37例。于患者入院溶栓前进行血液标本的采集及相关基本临床资料的收集。caveolin-1、MMP-9水平通过酶联免疫吸附试验(ELISA)方法进行检测。两组数据间比较及基线临床资料的统计分析应用统计学软件spss18.0进行分析。结果1脑梗死溶栓后出血转化组患者血浆caveolin-1、MMP-9的含量明显高于对照组(P㩳0.01)。2.预后不佳组患者(m RS=3~6分)血浆中caveolin-1表达水平较对照组增加(P㩳0.05)。3.所有入组脑梗死溶栓患者血浆caveolin-1、MMP-9的表达呈显著正相关(r=0.462,P㩳0.01)。4.患者年龄、血糖水平、caveolin-1、MMP-9水平是溶栓后出血转化发生可能的危险因素,通过多因素分析提示caveolin-1、MMP-9水平可能可以预测溶栓后出血转化的发生(P㩳0.05)。5.年龄、吸烟史、房颤、溶栓前NIHSS评分、血浆caveolin-1的表达可能是影响溶栓患者的预后的危险因素(P㩳0.05)。结论caveolin-1、MMP-9在溶栓后发生出血转化的患者血浆中表达增高。caveolin-1为影响溶栓后出血转化的发生及预后的重要危险因素。此结果支持caveolin-1、MMP-9可能成为预测脑梗死溶栓患者发生出血转化的有效指标,并可能成为治疗溶栓后出血转化的一个新的靶点。
[Abstract]:Objective Cerebral infarction is one of the major diseases that seriously endanger human health and life. Thrombolytic therapy by intravenous administration of rt-PA within 4.5 hours after onset of disease is recognized as the most effective treatment. However, thrombolytic therapy is a double-edged sword. Bleeding translates into (HT) as the most serious complication after thrombolysis in cerebral infarction. The mechanism of hemorrhage and transformation after thrombolysis is still unclear, among which the theory of blood-brain barrier (BBB) damage is considered to be of great significance. The interaction between fossa protein 1 (caveolin-1) and metalloproteinase-9 (MMP-9) is related to the damage of blood-brain barrier integrity. In clinical trials, caveolin-1 MMP-9 is used as a biomarker, and it is rare to explore its correlation with the prognosis of venous thrombolytic therapy in patients with cerebral infarction. The aim of this study was to detect the level of plasma caveolin-1 MMP-9 in patients with cerebral infarction, and to explore the relationship between the level of MMP-9 and bleeding transformation after thrombolytic therapy, to predict the occurrence of hemorrhage transformation after thrombolytic therapy and to reduce the risk of hemorrhage transformation after thrombolytic therapy. Methods A total of 40 patients were included in the study, including 3 cases in the bleeding conversion group and 37 cases in the control group. The blood samples were collected before thrombolytic therapy and the basic clinical data were collected. The level of MMP-9 was detected by enzyme linked immunosorbent assay (ELISA). The comparison between the two groups of data and the statistical analysis of baseline clinical data were analyzed by statistical software spss18.0. Results (1) the level of plasma caveolin-1 MMP-9 in patients with hemorrhage transformation after thrombolysis after cerebral infarction was significantly higher than that in control group (P0. 01). The expression of caveolin-1 in the patients with poor prognosis (mRSv 3 ~ 6) was higher than that in the control group (P0. 05). There was a significant positive correlation between the expression of plasma caveolin-1 and MMP-9 in all patients with thrombolytic therapy of cerebral infarction (r = 0.462P ~ (0.01) .4. Age, blood glucose level and MMP-9 level were the possible risk factors of hemorrhage transformation after thrombolytic therapy. It was suggested that the level of caveolin-1 MMP-9 might predict the occurrence of hemorrhage transformation after thrombolysis (P0. 05). Age, smoking history, atrial fibrillation, pre-thrombolytic NIHSS score and plasma caveolin-1 expression may be risk factors for prognosis of thrombolytic patients (P0. 05). Conclusion the increased expression of caveolin-1 MMP-9 in plasma of patients with hemorrhage and transformation after thrombolytic therapy is an important risk factor for the occurrence and prognosis of bleeding transformation after thrombolytic therapy. These results suggest that caveolin-1 MMP-9 may be an effective marker for predicting hemorrhage transformation in patients with cerebral infarction and may be a new target for the treatment of bleeding transformation after thrombolysis.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2141066
[Abstract]:Objective Cerebral infarction is one of the major diseases that seriously endanger human health and life. Thrombolytic therapy by intravenous administration of rt-PA within 4.5 hours after onset of disease is recognized as the most effective treatment. However, thrombolytic therapy is a double-edged sword. Bleeding translates into (HT) as the most serious complication after thrombolysis in cerebral infarction. The mechanism of hemorrhage and transformation after thrombolysis is still unclear, among which the theory of blood-brain barrier (BBB) damage is considered to be of great significance. The interaction between fossa protein 1 (caveolin-1) and metalloproteinase-9 (MMP-9) is related to the damage of blood-brain barrier integrity. In clinical trials, caveolin-1 MMP-9 is used as a biomarker, and it is rare to explore its correlation with the prognosis of venous thrombolytic therapy in patients with cerebral infarction. The aim of this study was to detect the level of plasma caveolin-1 MMP-9 in patients with cerebral infarction, and to explore the relationship between the level of MMP-9 and bleeding transformation after thrombolytic therapy, to predict the occurrence of hemorrhage transformation after thrombolytic therapy and to reduce the risk of hemorrhage transformation after thrombolytic therapy. Methods A total of 40 patients were included in the study, including 3 cases in the bleeding conversion group and 37 cases in the control group. The blood samples were collected before thrombolytic therapy and the basic clinical data were collected. The level of MMP-9 was detected by enzyme linked immunosorbent assay (ELISA). The comparison between the two groups of data and the statistical analysis of baseline clinical data were analyzed by statistical software spss18.0. Results (1) the level of plasma caveolin-1 MMP-9 in patients with hemorrhage transformation after thrombolysis after cerebral infarction was significantly higher than that in control group (P0. 01). The expression of caveolin-1 in the patients with poor prognosis (mRSv 3 ~ 6) was higher than that in the control group (P0. 05). There was a significant positive correlation between the expression of plasma caveolin-1 and MMP-9 in all patients with thrombolytic therapy of cerebral infarction (r = 0.462P ~ (0.01) .4. Age, blood glucose level and MMP-9 level were the possible risk factors of hemorrhage transformation after thrombolytic therapy. It was suggested that the level of caveolin-1 MMP-9 might predict the occurrence of hemorrhage transformation after thrombolysis (P0. 05). Age, smoking history, atrial fibrillation, pre-thrombolytic NIHSS score and plasma caveolin-1 expression may be risk factors for prognosis of thrombolytic patients (P0. 05). Conclusion the increased expression of caveolin-1 MMP-9 in plasma of patients with hemorrhage and transformation after thrombolytic therapy is an important risk factor for the occurrence and prognosis of bleeding transformation after thrombolytic therapy. These results suggest that caveolin-1 MMP-9 may be an effective marker for predicting hemorrhage transformation in patients with cerebral infarction and may be a new target for the treatment of bleeding transformation after thrombolysis.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
【参考文献】
相关期刊论文 前10条
1 谷远峰;陈会生;;五种评分系统对急性缺血性脑卒中静脉溶栓后出血转化风险预测差异的比较研究[J];解放军医药杂志;2016年03期
2 陈珂楠;郭舜源;耿昱;;脑灌注成像预测溶栓后出血转化风险的研究进展[J];中国卒中杂志;2015年02期
3 刘娜;徐树军;王淑荣;陈业鹏;周勇;冯艳春;;MMP-9、GFAP和FN浓度与脑梗死后出血转化的预测作用[J];中国现代医学杂志;2014年16期
4 张叶华;易健;刘柏炎;;Caveolin-1与中枢神经系统疾病[J];脑与神经疾病杂志;2014年03期
5 黄银辉;李明媚;陈振杰;林友榆;欧阳宛炯;卓识途;蔡若蔚;;急性缺血性脑卒中静脉溶栓后出血性转化危险因素分析[J];中国神经精神疾病杂志;2013年10期
6 韩晶;;rt-PA静脉溶栓治疗超早期脑梗死的临床疗效观察[J];中风与神经疾病杂志;2013年09期
7 张强;王嵘;;Caveolae及Caveolin-1对恶性脑肿瘤微血管通透性的影响[J];国际神经病学神经外科学杂志;2012年05期
8 贺涓涓;尚文锦;吴琪;洪华;;脑梗死静脉溶栓治疗后出血性转化临床分析[J];中国神经免疫学和神经病学杂志;2012年03期
9 赵红;张倩茹;卢晓梅;张海鹏;陈学新;;高压氧对局灶性脑缺血再灌注大鼠脑组织小窝蛋白-1、基质金属蛋白酶-9表达的影响[J];中国康复医学杂志;2011年06期
10 邓金木;汪峰;程远;;caveolin-1在血脑屏障开放中作用的研究[J];国际神经病学神经外科学杂志;2010年01期
，本文编号：2141066
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2141066.html
最近更新
教材专著
