脑梗死患者APC、APS及AT-Ⅲ等生物标志物与颈动脉粥样硬化的相关性分析

发布时间：2018-08-06 18:46

【摘要】：目的:脑梗死(cerebral infarction)又称缺血性脑卒中(Ischemic stroke),是指因脑部血液循环障碍,缺血、缺氧所致的局限性脑组织的缺血性坏死或软化。脑梗死是脑血管病中最常见的类型,约占全部脑血管病的70%,《柳叶刀》(Lancet)杂志发布的《全球疾病负担研究》显示,在2010和2013年,脑卒中在中国仍然是位列第1位的死因。同时韩国的NEW-TOAST分型及中国缺血性卒中亚型(CISS分型)均提示动脉粥样硬化性脑梗死占比最高,故研究APC、APS、AT-Ⅲ等生物标志物对动脉粥样硬化形成的影响对脑梗死的预防及治疗有重要价值。方法:连续收集2015年10月至2016年3月发病入住承德医学院附属医院神经内科的患者,经头颅螺旋CT诊断符合中华医学会神经病学分会脑血管病学组标准的脑梗死患者共计502例,其中男性患者304例,女性患者198例,年龄45-80岁,平均(60.75±9.435)岁。超声检查用由专业超声医师操作,采用美国索诺声便携彩超仪M-Turbo完成颈动脉超声检查(探头频率13-6 MHz1),检查患者双侧颈总动脉(commom carotid artery,CCA)、颈内动脉(internal carotid artery,ICA)、颈外动脉(external cartied artery,ECA)、椎动脉(vertebral artery,VA)、锁骨下动脉(subclavian artery,SA)。将502例患者根据颈部血管动脉粥样硬化程度分为正常组(c IMT1.0mm)、颈动脉内膜增厚组(1.0≤c IMT1.5mm)和颈动脉斑块形成组。所有患者均于入院后24小时内采集清晨空腹静脉血。由我院检验科完成血浆活化蛋白C(actived protein C)、活化蛋白S(actived protein S)与抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ),同型半胱氨酸(Hcy)、高敏感C反应蛋白(hs-C reactive protein,hs-CRP)、总胆红素(Total bilirubin,TBIL)、直接胆红素(Direct bilirubin,DBIL)、总胆固醇(Total cholesterol,TCH)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL),胱抑素C等相关指标的测定。采用SPSS19.0统计软件处理,计量资料使用`x±s表示,数据经正态性检验符合正态分布,且满足方差齐性要求,样本均数比较采用独立样本T检验,多组间均数比较采用单因素方差分析,计数资料采用卡方检验,颈动脉粥样硬化影响因素采用Logistic回归,P0.05为差异有统计学意义。结果:患者一般资料比较3组患者性别构成、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白差异无统计学意义。血糖水平比较,颈动脉斑块组c IMT增厚组c IMT正常组,但c IMT增厚组与c IMT正常组之间差异无统计学差异(P0.05);年龄水平比较,颈动脉斑块组c IMT增厚组c IMT正常组,且各组间差异具有统计学意义(P0.05)。3组患者中,AT-Ⅲ水平比较,颈部血管正常组高于颈动脉内膜增厚组高于颈动脉斑块形成组,且各组间差异具有统计学意义(P0.05);在APC、APS水平中,c IMT正常组及c IMT增厚组与颈动脉斑块形成组之间具有统计学差异(P0.05),而c IMT正常组与c IMT增厚组之间无明显差异(P0.05);胱抑素C水平方面,颈动脉斑块形成组(0.946±0.223 mmol/L)高于颈动脉内膜增厚组(0.866±0.142mmol/L),也高于颈动脉内膜正常组(0.855±0.191mmol/L),其差异具有统计学意义(P0.05),但是颈动脉内膜增厚组与颈动脉内膜正常组之间差异无统计学意义(P0.05)。Logistic回归分析结果显示高hs-CRP水平以及高Cyst-C水平为颈动脉粥样硬化斑块形成的危险因素,而高APC、APS、AT-Ⅲ水平则是其保护性因素。结论:APC、APS、AT-Ⅲ、Hcy、Cyst-C、hs-CRP与颈动脉粥样硬化存在密切相关性,高APC、APS、AT-Ⅲ为颈动脉粥样硬化的保护性因素,高Hcy、Cyst-C、hs-CRP是颈动脉粥样硬化的危险因素。血浆Hcy、Cyst-C、hs-CRP水平可反映颈动脉粥样硬化程度。
[Abstract]:Objective: cerebral infarction (cerebral infarction), also known as ischemic stroke (Ischemic stroke), refers to ischemic necrosis or softening of localized brain tissue caused by cerebral blood circulation disorder, ischemia and hypoxia. Cerebral infarction is the most common type of cerebrovascular disease, accounting for about 70% of all cerebral vascular diseases, < < Lancet 'magazine published < global. The disease burden study shows that stroke in China is still the first leading cause of death in 2010 and 2013. Both the NEW-TOAST classification of Korea and the ischemic stroke type (CISS type) in China all suggest the highest proportion of atherosclerotic cerebral infarction. Therefore, the effects of biomarkers such as APC, APS, and AT- III on the formation of atherosclerosis are studied. The prevention and treatment of cerebral infarction have important value. Methods: the patients who had been admitted to Affiliated Hospital of Chengde Medical College from October 2015 to March 2016 were collected, and 502 cases of cerebral infarction were diagnosed by the spiral CT of the head of the Chinese Medical Association, which were in accordance with the standard of cerebrovascular disease group of the Chinese Medical Association. Among them, 304 cases were male patients. 198 patients, aged 45-80 years, mean (60.75 + 9.435) years of age. Ultrasound examination was performed by a professional ultrasonic physician. The carotid ultrasound examination (probe frequency 13-6 MHz1) was performed by the sono portable color Doppler M-Turbo in the United States. The bilateral common carotid artery (commom carotid artery, CCA), the internal carotid artery (internal carotid artery, ICA), and the external carotid artery were examined. External cartied artery (ECA), vertebral artery (vertebral artery, VA), subclavian artery (subclavian artery, SA). 502 patients were divided into normal group (C IMT1.0mm), carotid intima thickening group (1) and carotid plaque formation group according to the degree of vascular atherosclerosis in the neck. All patients were collected within 24 hours after admission. Plasma activated protein C (actived protein C), active protein S (actived protein S) and antithrombin III (antithrombin III, AT- III), homocysteine (Hcy), Gao Min sensing C reaction protein, total bilirubin, direct bilirubin, and direct bilirubin were completed in the Department of Laboratory Department of our hospital. Ilirubin, DBIL), total cholesterol (Total cholesterol, TCH), triglyceride (Triglyceride, TG), high density lipoprotein (High density lipoprotein, HDL), low density lipoprotein (Low), cystatin and other related indicators. According to normal distribution, and meet the requirement of homogeneity of variance, the average number of samples was compared with independent sample T test. Single factor analysis of variance was used to compare the average number of multiple groups. Counting data was checked by chi square test. The factors of carotid atherosclerosis were affected by Logistic regression. The difference of P0.05 was statistically significant. Results: the general data of the patients were compared to 3 groups. Sex composition, triglyceride, cholesterol, high density lipoprotein and low density lipoprotein were not statistically significant. Blood sugar levels were compared, the C IMT thickening group of carotid plaque group was C IMT, but there was no statistical difference between the C IMT thickening group and the normal C IMT group (P0.05); the age level was compared with the C IMT thickening group of the carotid plaque group. The difference between the groups was statistically significant (P0.05) group.3, and the level of AT- III in the normal group of the neck was higher than that of the carotid artery intima group, which was higher than that of the carotid artery plaque formation group, and the difference between the groups was statistically significant (P0.05). In the APC, APS level, the C IMT normal group and the C IMT thickening group and the carotid plaque formation group. There was statistical difference (P0.05), but there was no significant difference between the normal group of C IMT and the thickening group of C IMT (P0.05). The level of cystatin C, the carotid plaque formation group (0.946 + 0.223 mmol/L) was higher than the carotid intima thickening group (0.866 + 0.142mmol/L), and higher than that of the normal carotid artery intima group (0.855 + 0.191mmol/L), and the difference was statistically significant. P0.05) but there was no statistically significant difference between the carotid intima thickening group and the normal carotid artery intima (P0.05).Logistic regression analysis showed that high H s-CRP level and high Cyst-C level were the risk factors for the formation of carotid atherosclerotic plaque, while the high APC, APS, and AT- III levels were its protective factors. Conclusion: APC, APS, AT- III, Hcy, Cyst-C, hs-CRP is closely related to carotid atherosclerosis. High APC, APS and AT- III are protective factors for carotid atherosclerosis. High Hcy, Cyst-C, and hs-CRP are risk factors for carotid atherosclerosis. The level of plasma Hcy, Cyst-C, and hs-CRP can reflect the degree of carotid atherosclerosis.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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