主动脉夹层发病机制及手术治疗方式的研究

发布时间：2018-03-17 08:43

本文选题：主动脉夹层　切入点：基质金属蛋白酶　出处：《昆明医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨基质金属蛋白酶12启动子序列多态性与主动脉夹层发病的相关性。方法：选取2012年9月至2014年12月于昆明医科大学第四附属医院心血管外科成人Stanford A型急性主动脉夹层行手术治疗并康复出院的45例患者为实验组,选取同期心肌梗死行冠脉搭桥术的35例患者为对照组,采用Sanger法对MMP-12启动子区域进行测序,将测序结果与MMP-12启动子区域参考序列(NM_002426.4)进行扫描比对,寻找可能存在的单核苷酸多态性位点,以及单核苷酸多态性位点与主动脉夹层发病的相关性。结果：根据MMP-12启动子序列测序结果,与MMP-12参考序列(NM 002426.4)启动子区域进行比较后,发现该区域共存在以下2个SNP位点：第220位的核苷酸T转变为C,第645位核苷酸C转换为T。其中最常见的基因多态性为第220位核苷酸T转变为C,并且均出现在实验组(14.4%)。MMP-12第220位核苷酸等位基因T和C在实验组中与对照中的分布具有统计学差异(x2=11.01,P0.05)。其中,实验组中核苷酸C的频率较对照组中核苷酸C的频率高(0%),因此,具有核苷酸C的突变可能导致人群罹患AD的可能性较大(OR=0.8-56, 95%CI=0.786-0.931)。而第645位核苷酸等位基因C和T在实验组和对照组中的分布无统计‘学差异(x 2=0.783,P0.05),因此C645T多态性可能与AD的发病关系不大,实验组中核苷酸T的频率(1.1%)与对照组中核苷酸T的频率(0%)相差不大,具有核苷酸T的突变可能与AD的发病相关性不大(OR=0.989, 95%CI=0.967-1.011)。结论：在实验组和对照组中共发现MMP-12基因启动子中存在2个多态性位点(第220位的核苷酸T转变为C,第645位核昔酸C转换为T),其中T220C多态性与主动脉夹层的发病有着一定的相关性,核苷酸C的突变可能导致人群罹患AD的可能性较大,而C645T多态性与AD的发病关系可能相关性不大。目的:探却孙氏手术基础上加用升主动脉-股动脉旁路移植术治疗复杂型A型主动掀夹层手术时化的选择。方法:31例复杂型A型主动脉夹层患者,年龄(49±15).岁,体质量(73±15)kg,均采用孙氏手术,术前监测患者督功能,并应用320排容积CT经行胸腹主动脉CTA扫描结果,计算降主动脉真腔最小面积和同一平面降主动脉面积,复温阶段监测患者上、下肢血压及1h内尿量。对于真腔最小面积小、降主动脉远端无破口、术中尿量少、上下肢压差大于60 mmHg的12例患者进一步进行行升股旁路移植术。结果;影响选择升-股旁路移植术的的相关手术时机因素有:(1)肾动脉平面及1^^上降主动脉真腔最小面积占同一平面降主动脉面积的百分比1.5%^(2)上肢收缩压与下肢收缩压压差20 mmHg;(3)手术复温阶段尿量偏少,或者利尿效果不佳;.(4)降主动脉远端无破曰。结论:对复杂型A型主动脉夹层患者的真腹最小面积、上下肢收缩压压差、复温阶段尿量及降主动脉远端破口进行监测,可决定是否加做升-股旁路移植术,.对患者的预后有着积极的意义。目的:探讨义用了孙氏手术+升主动脉-股动脉旁路移植术盾对Stanford A型主动脉夹层患者远期预后情况。方法:选取选顷2012年9月至2014年12月于昆明医科大学第四附属医院屯、血管外科采用了孙氏手术+升主动脉一股动脉旁路移植术治疗后康复出院的12例主动脉夹层患者,术后1月、3月、6月、1年监测患者肾功能、通过胸主动脉X椙緾T扫描,对降主动脉的面积及其真腔的面积测算并与术前情况比较,同时4次监测旁路血管面积大小并进行比对。结果:(1)旁路血管的1年内面积未出现明思变化,其1年内通畅率较高;(2)皆功能1年内较术前未见明显损害;(3)降主动脉未见较术前未见明显扩张;(4).降主动脉真腔较术前明盈扩张,增加了下半身的灌注。结论:对于真控较小,下半身灌注较差的患者积极采用升-股旁路移植术对患者远期的巧后有着积极的意义
[Abstract]:Objective: To investigate the correlation between matrix metalloproteinase 12 promoter polymorphism and the incidence of aortic dissection. Methods: 45 cases from September 2012 to December 2014 on the type of cardiovascular surgery, the Fourth Affiliated Hospital of Kunming Medical University, A Stanford of adult acute aortic dissection underwent surgical treatment and hospital patients as the experimental group, 35 cases of myocardial infarction were selected for coronary artery bypass grafting the patients in the control group, Sanger method was used for sequencing the promoter region of MMP-12, the sequencing results with the MMP-12 promoter region (NM_002426.4) of the reference sequence scanning, searching for polymorphisms found that may exist, and the correlation between single nucleotide polymorphism and the incidence of aortic dissection. Results: according to the MMP-12 promoter sequence the results of MMP-12, and the reference sequence (NM 2426.4) to compare the promoter region, the coexistence of In the following 2 SNP loci: T 220th nucleotides into C, conversion of 645th nucleotide C T. where gene polymorphism is the most common 220th nucleotides of T into C, and appeared in the experimental group (14.4%).MMP-12 220th nucleotide alleles T and C in the experimental group and distribution in contrast with statistical difference (x2=11.01, P0.05). The nucleotide C in the experimental group than the control group in the frequency of nucleotide C high frequency (0%), therefore, mutation has nucleotide C may lead to the possibility of a larger population with AD (OR=0.8-56, 95%CI= and 0.786-0.931). No statistical differences in the distribution of 645th "nucleotide alleles C and T in the experimental group and the control group in (x 2=0.783, P0.05), the C645T polymorphism may be associated with the pathogenesis of AD is not related, the nucleotide T in the experimental group the frequency (1.1%) in the control group and the nucleoside acid T frequency (0%) with little difference There is little correlation between the incidence of T nucleotide mutations may be associated with AD (OR=0.989, 95%CI=0.967-1.011). Conclusion: in the experimental group and the control group were found to have 2 polymorphisms in the MMP-12 promoter (220th nucleotides of T into C, 645th nucleotide C converted to T), the incidence of T220C polymorphism with aortic dissection has certain correlation, C mutation may lead to the possibility of developing AD population is large, and the relationship between the C645T polymorphism and the pathogenesis of AD may be of little relevance. Objective: To explore it on the basis of sun's procedure for ascending aorta artery to femoral artery bypass grafting for the treatment of complex type A type active when the lift dissection surgery. Methods: 31 cases of complex type A aortic dissection patients, age (49 + 15). The age, body weight (73 + 15) kg, using sun's procedure, preoperative monitoring of patient monitoring function, and the application of 320 slice volume CT after thoracic abdominal aorta Arterial CTA scan results, calculate the minimum area of aortic true lumen and the same plane descending aorta area, rewarming phase monitoring of patients, blood pressure and urine volume of lower limb 1H. As for the minimum area of small true lumen of descending aorta, without distal hemomediastinum, intraoperative volume of urine, 12 cases of upper extremity pressure greater than 60 mmHg with a further increase of femoral bypass grafting. Results; influence the choice of L - related surgery femoral bypass grafting time factors are: (1) renal artery plane and 1^^ reduced the percentage of 1.5%^ minimum area for the same level of aortic true lumen of descending aorta area (2) the difference of systolic blood pressure and upper limb pressure 20 mmHg the lower limb systolic blood pressure; (3) operation during the rewarming period, urine volume less than normal, or poor diuretic effect.; (4) the descending aorta distal broken said. Conclusion: the patients with complex type A aortic dissection was abdominal minimum area of upper and lower limbs, systolic pressure, rewarming period, urine volume and descending aorta The distal crevasses monitoring, can decide whether to do or femoral bypass grafting., has a positive significance on the prognosis of patients. Objective: To explore the meaning of sun's operation and ascending aortic femoral artery bypass grafting shield for Stanford type A aortic dissection patients with long-term prognosis. Methods: selected in September 2012 to December 2014 in the Fourth Affiliated Hospital of Kunming Medical University village, vascular surgery using the sun's operation and rehabilitation of 12 patients with aortic dissection were an ascending aortic artery bypass grafting after treatment, after January, March, June, 1 patients with renal function monitoring, through the thoracic aorta X Chang Chan T scan area calculation of drop the area and the aortic true lumen and preoperative conditions, while 4 bypass monitoring area and compared. Results: (1) bypass 1 years the area does not appear bright think of change, the patency rate of 1 years is High; (2) all functions within 1 years postoperatively had no obvious damage; (3) the descending aorta was compared with preoperative no obvious expansion; (4) the descending aorta. The true lumen compared with preoperative Mingying expansion, increased body perfusion. Conclusion: to control really small, poor body perfusion patients with positive the femoral bypass grafting on patients after long-term coincidence is of positive significance

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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