脑动脉粥样硬化患者痰湿质、瘀血质与内皮祖细胞的相关研究

发布时间：2019-05-03 19:23

【摘要】：目的及意义:探究40～65岁脑动脉粥样硬化(Cerebral Atherosclerosis,CAD)患者中痰湿质、瘀血质与循环内皮祖细胞(Endothelial Progenitor Cells,EPCs)数量的关系,为从中西医结合方面探究血管自我更新修复以防治脑动脉粥样硬化提供新思路。研究方法:本研究入选2016年2月至2017年2月福建省立医院神经内科门诊及病房40～65岁经中医体质问卷筛选出的痰湿质、瘀血质、平和质患者,根据脑动脉粥样硬化筛查与诊断规范(2014版)判别CAD病变及其程度,将无CAD的平和质患者设为对照组,CAD的痰湿质、瘀血质患者设为实验组,并利用流式细胞仪检测其外周血EPCs的数量,分析比较人口统计学资料和血管危险因素,以探究EPCs数量与40～65岁CAD患者痰湿质、血瘀质的关系。.结果:1、本课题共收录患者120例,痰湿质46例,瘀血质49例,对照组(无CAD平和质)25例;CAD组95例,其中轻度CAD 62例,中重度CAD 33例;女性44例(36.67%),平均年龄53.5±6.7岁:CAD相关危险因素中高血压占70.00%,高脂血症占44.20%。2、多项Logiistic回归模型分析CAD痰湿质、瘀血质的影响因素,结果:高血压为CAD痰湿质、瘀血质的独立预测因素;EPCs数量与CAD瘀血质呈负相关;CAD瘀血质常见于既往有卒中/TIA病史者。3、多变量二元Logistic回归模型分析CAD的影响因素,结果:EPCs为CAD的保护因素,年龄、高血压为CAD的危险因素,大多数卒中/TIA病史的患者有CAD。4、多变量二元Logistic回归模型分析CAD程度(轻度、中重度)影响因素,结果:EPCs数量与CAD程度呈负相关,瘀血质是中重度脑动脉粥样硬化的独立预测因素因素。5、ROC曲线分析结果:可认为EPCs用于判别对CAD有意义,EPCs数量越小为CAD的可能性越大,EPCs所对应的最佳诊断界值为0.115%。结论:1、EPCs可能是动脉粥样硬化的一个保护性因素,其作用可能与促进血管更新、延缓衰老有关,但抗血管衰老的机制有待进一步研究。2、EPCs数量与CAD瘀血质呈负相关,瘀血质为脑动脉粥样硬化的独立危险因素,其作用机制可能与血流动力学及凝血功能异常有关。尚未发现EPCs与CAD痰湿质的关系。
[Abstract]:Objective and significance: to investigate the relationship between the quantity of circulating endothelial progenitor cell (Endothelial Progenitor Cells,EPCs) and phlegm wet matter, blood stasis and circulating endothelial progenitor cell (Endothelial Progenitor Cells,EPCs) in 40-65-year-old patients with cerebral atherosclerosis (Cerebral Atherosclerosis,CAD). To explore the combination of traditional Chinese and western medicine to explore vascular self-renewal repair in the prevention and treatment of cerebral atherosclerosis to provide a new way of thinking. Methods: from February 2016 to February 2017, the patients were selected from the outpatient department and ward of Fujian Provincial Hospital from February 2016 to February 2017 at the age of 40 and 65 years old, who were screened out by traditional Chinese Medicine Constitution questionnaire (TCM Constitution questionnaire), and the patients with phlegm dampness, blood stasis and mild quality were selected. According to the criteria for screening and diagnosis of cerebral atherosclerosis (2014 edition), the patients without CAD were divided into the control group, the phlegm damp group and the blood stasis group, and the patients without CAD were divided into the experimental group and the control group, according to the criteria for screening and diagnosis of cerebral atherosclerosis (2014 edition). The quantity of EPCs in peripheral blood was measured by flow cytometry, and the demographic data and vascular risk factors were analyzed and compared to explore the relationship between the quantity of EPCs and phlegm, damp and blood stasis in CAD patients aged 65 years old. Results: (1) there were 46 cases of phlegm-dampness, 49 cases of blood stasis, 25 cases of control group (no CAD level), 95 cases of CAD group, including 62 cases of mild CAD, 33 cases of moderate and severe CAD, and 42 cases of mild CAD and 33 cases of moderate and severe CAD. There were 44 women (36.67%) with an average age of 53.5 卤6.7 years: hypertension accounted for 70.00% in CAD-related risk factors and hyperlipidemia accounted for 44.20%. Multiple Logiistic regression models were used to analyze the influencing factors of phlegm-dampness and blood stasis in CAD. Results: hypertension was an independent predictor of phlegm-dampness and blood stasis in CAD. There was a negative correlation between the quantity of EPCs and the blood stasis quality of CAD. CAD blood stasis was commonly seen in patients with previous stroke / TIA history. 3. Multivariate binary Logistic regression model was used to analyze the influential factors of CAD. Results: EPCs was the protective factor of CAD, age and hypertension were risk factors of CAD. Most of the patients with stroke / TIA history had CAD.4, multivariate binary Logistic regression model to analyze the influencing factors of CAD degree (mild, moderate and severe). Results: there was a negative correlation between the number of EPCs and the degree of CAD. Blood stasis is an independent predictor of moderate or severe cerebral atherosclerosis. 5. Roc curve analysis: it can be concluded that EPCs can be used to distinguish CAD, and the smaller the number of EPCs is, the more likely it is that the number of EPCs is CAD. The optimal diagnostic threshold for EPCs is 0.115%. Conclusion: 1. EPCs may be a protective factor of atherosclerosis, and its effect may be related to promoting blood vessel renewal and delaying aging, but the mechanism of anti-aging needs to be further studied. 2. There is a negative correlation between the number of CAD and blood stasis. Blood stasis is an independent risk factor of cerebral atherosclerosis, and its mechanism may be related to hemodynamic and coagulation dysfunction. The relationship between EPCs and CAD was not found.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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