基质金属蛋白酶在急性主动脉综合征中的表达研究

发布时间：2018-03-29 08:41

本文选题：急性主动脉综合征　切入点：主动脉夹层　出处：《天津医科大学》2015年硕士论文

【摘要】：目的:探讨基质金属蛋白酶(MMP)-2,8,9,12在急性主动脉综合征患者中的表达及临床意义。方法:选取天津医科大学总医院2013年3月—2015年3月50例急性主动脉综合征入院患者为研究对象,其中Stanford A型主动脉夹层(AD)患者28例,Stanford B型AD患者12例,主动脉壁间血肿及穿透性溃疡患者10例。根据疾病种类不同分为主动脉夹层组和主动脉壁间血肿及穿透性溃疡组。其中每组病人根据不同的治疗方式分为两组:手术组及保守组。其中主动脉夹层组行外科手术患者18例,行胸主动动脉腔内支架隔绝术(TEVAR)患者8例,保守组患者14例;主动脉壁间血肿及穿透性溃疡组内行TEVAR患者5例,保守组5例。对于血浆中MMP表达的研究,本实验以同期入院行体格检查的患者20例作为对照组。1.采用酶联免疫吸附法(ELISA)分析MMP在主动脉夹层组、主动脉壁间血肿及穿透性溃疡组与对照组患者血浆中的表达2.通过随访评价患者生存康复情况、手术治疗的安全性及MMP在血浆中水平的变化。结果:1.MMP-2,8,9,12在主动脉夹层组、主动脉壁间血肿及穿透性溃疡组与对照组血浆中均有表达。其中主动脉夹层组患者血浆中MMP-8,9,12的表达高于对照组(P0.05),MMP-2的表达无明显差异;主动脉壁间血肿及穿透性溃疡组患者血浆中MMP-8,9的表达高于对照组(P0.05),MMP-2,12的表达无明显差异。2.杂交手术治疗Stanford A型AD手术成功率100%,随访期间1例患者死亡,余患者生存良好;TEVAR治疗Stanford B型AD及主动脉壁间血肿与穿透性溃疡手术成功率100%,随访期间无死亡患者。3.对于Stanford A型AD手术组患者,术后主动脉近端、中点及最大主动脉直径位置可见主动脉直径及假腔直径减小(P0.05),且MMP-8,9在血浆中的表达水平较术前减少(P0.05),MMP-2,12的表达无明显差别;对于Stanford B型AD手术组患者,术后主动脉近端、中点及最大主动脉直径位置可见主动脉直径及假腔直径减小(P0.05),且MMP-8,9在血浆中的表达水平较术前减少(P0.05),MMP-2,12的表达无明显差别;对于主动脉壁间血肿及穿透性溃疡手术组患者,术后主动脉近端、中点及最大主动脉直径位置可见主动脉直径及血肿直径减小(P0.05),MMP-9在血浆中的表达水平在术后半月及术后1-3月均较术前减少(P0.05),MMP-2,8,12的表达无明显差别。4.对于Stanford B型AD保守组患者,1-3月内复查主动脉计算机断层血管成像(CTA)示近端假腔直径、中点假腔直径、最大主动脉直径及最大假腔直径较前增大(P0.05),且MMP-9在血浆中的表达较前增高(P0.05),MMP-2,8,12的表达无明显差别。5.MMP与各截面主动脉、假腔(血肿)、真腔(管腔)直径进行相关分析得出:MMP-8与最大假腔(血肿)直径呈正相关(P0.05),MMP-9与最大主动脉直径、最大假腔(血肿)直径呈正相关(P0.05)。结论:1.杂交手术及TEVAR治疗对于急性主动脉综合征的患者安全、有效,促进主动脉重塑,近中期效果好。2.MMP家族(特别是MMP-8,9)可作为AAS诊断参考指标之一。3.MMP-8,9有可能成为急性主动脉综合征判断预后的重要指标。
[Abstract]:Objective: To investigate the expression of matrix metalloproteinase (MMP) -2,8,9,12 in acute aortic syndrome patients the expression and clinical significance. Methods: 50 cases in General Hospital Affiliated to Tianjin Medical University from March 2013 to March 2015 of acute aortic syndrome patients as the research object, the Stanford type A aortic dissection (AD) in 28 cases, 12 cases of patients with Stanford type B aortic AD. Intramural hematoma and penetrating ulcer in 10 patients. According to the different kinds of illness for aortic dissection and aortic intramural hematoma and penetrating ulcer group. The patients in each group according to different treatment methods are divided into two groups: operation group and conservative group. Among the 18 cases of patients with aortic dissection group underwent surgery for thoracic aortic artery stent graft (TEVAR) in 8 cases, 14 cases of conservative groups; 5 cases of aortic intramural hematoma and penetrating ulcer group underwent TEVAR patients, a conservative group of 5 cases for blood. Study on the expression of MMP in plasma, in this experiment, 20 cases of physical examination for patients admitted in the same period as the control group.1. by enzyme-linked immunosorbent assay (ELISA) analysis of MMP in aortic dissection group, aortic intramural hematoma and penetrating ulcer group and control group in plasma of patients with the expression of the 2. patients were followed up and evaluated with survival and rehabilitation the safety of surgical treatment, changes in plasma levels of MMP and 1.MMP-2,8,9,12. Results: in aortic dissection group, aortic intramural hematoma and penetrating ulcer group and control group were expressed in plasma. The expression of MMP-8,9,12 in aortic dissection patients plasma is higher than that of control group (P0.05), no significant difference between the expression of MMP-2; the expression of aortic intramural hematoma and penetrating ulcer in patients with plasma MMP-8,9 group is higher than that of control group (P0.05), the expression of MMP-2,12 had no significant difference in surgical treatment of Stanford type A.2. hybrid AD surgery The follow-up period was 100%, 1 patients died, the survival of patients with more than good; TEVAR treatment of Stanford B type AD aortic intramural hematoma and penetrating ulcer surgery success rate was 100%. No patients died during follow-up for.3. Stanford A type AD group, postoperative aortic proximal point and maximum aortic diameter showed aortic position the false lumen diameter and diameter (P0.05), and the expression level of MMP-8,9 in plasma decreased (P0.05), there was no significant difference between the expression of MMP-2,12; for Stanford type B AD patients undergoing surgery, postoperative aortic proximal point and maximum aortic diameter position visible aortic diameter and false lumen diameter (P0.05), and the expression level of MMP-8,9 in plasma decreased (P0.05), there was no significant difference between the expression of MMP-2,12; the aortic intramural hematoma and penetrating ulcer patients for surgery, postoperative aortic proximal, middle point and the most Large aortic diameter position visible aortic diameter and hematoma diameter (P0.05), the expression level of MMP-9 in plasma in half month after operation and 1-3 months after operation were significantly reduced (P0.05), MMP-2,8,12 expression had no significant difference for.4. Stanford B AD conservative group, 1-3 months after aortic CT vascular imaging (CTA) showed proximal false lumen diameter, the midpoint of the false lumen diameter, maximum aortic diameter and the maximum diameter of false lumen was increased (P0.05), and the expression of MMP-9 in plasma was higher than before (P0.05), the expression of MMP-2,8,12 showed no significant difference between the.5.MMP and the cross section of the aorta, the false lumen (hematoma), really cavity diameter (Guan Qiang) were obtained: MMP-8 and the maximum diameter of false lumen (hematoma) was positively correlated (P0.05), MMP-9 and maximum aortic diameter, the largest diameter of false lumen (hematoma) was positively correlated (P0.05). Conclusion: 1. hybrid surgery and TEVAR therapy for acute active Patients with pulse syndrome are safe, effective and effective in promoting aortic remodeling. The.2.MMP family (especially MMP-8,9) can be used as a reference index for AAS diagnosis..3.MMP-8,9 may become an important indicator of prognosis in acute aortic syndrome.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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