腹主动脉瘤腔内修复术前后血清miRNA-29a的表达及其意义探讨
发布时间：2018-07-15 17:35
【摘要】：研究背景腹主动脉瘤(AAA)为一种动脉直径大于正常1.5倍的具有破裂倾向的严重主动脉退行性疾病。其发病率随着年龄的增长呈逐年上升趋势,严重威胁人类生命健康。腔内修复术以其微创、围手术期病死率及并发症率低、手术及住院时间短、术后恢复快等特点,成为大部分AAA患者的一线治疗策略。而术后瘤体进一步增大是患者再次入院行二次干预的主要原因。以往均以物理方式对AAA进行随访,近年来研究表明血液标志物与AAA的发生发展有关,其中miRNA-29a被证实与瘤体直径的大小相关,而针对AAA腔内修复术前后血清miRNA-29a的表达与瘤体直径大小关系尚未有研究报道。目的探讨AAA腔内修复术前后血清miRNA-29a的表达及其与临床相关指标之间的关系材料与方法收集2014年11月至2015年12月就诊的AAA者60例。将患者分为腔内修复组和动态观察组,对腔内修复组于术前及术后3月、6月、12月共4个时间点上行腹主动脉CTA,及RT-PCR技术检测血清miRNA-29a的相对表达量,记录CTA上瘤体直径的变化和血清miRNA-29a表达水平的关系。动态观察组于初次门诊及以后6月、12月共3个时间点上行上述影像学和血液学随访。以SPSS 18.0及GraphPad Prism软件进行统计分析,分析血清miRNA-29a的表达水平与临床及影像参数间的相关性,以P0.05为差异有统计学意义。结果动态观察组9例患者出现瘤体直径增大大于5 mm/6个月并伴有腹痛等临床症状,遂纳入腔内修复组。腔内修复组49例中术后死亡5例,其中2例于住院期间死于呼吸循环衰竭,肾功能衰竭;3例于术后2月内死于急性心衰。随访时间12至20个月,中位时间15个月,55例患者在随访期间,无失访。所有患者血清miRNA-29a扩增良好,60例患者瘤体最大直径与血清miRNA-29a表达水平呈负相关,相关系数r =-0.600,相关性检验分析差异具有显著统计学意义(P0.05);术前两组血清miRNA-29a相对表达量(腔内修复组vs动态观察组=19.56± 3.83 vs 22.88 ± 4.42)具有统计学差异(P0.05);腔内修复组血清miRNA-29a各时间点的相对表达量为:术前(19.56 ±3.83)、术后3月(20.34 ± 4.73)、术后6月(21.78 ±4.65)、术后12月(22.92 ±4.14),统计分析各组的相对表达量差异具有统计学意义(P0.05)。动脉瘤体最大直径由术前(5.66±1.00cm)降至术后 3 月(4.87 ± 1.70 cm)、术后 6 月(4.12 ± 0.99 cm)、术后 12 月(3.70 ± 0.89 cm),统计分析各时间点上瘤体最大直径均有统计学差异(P0.05)。腔内修复组患者不同时间点上瘤体最大直径和相应血清miRNA-29a的表达水平相关性为术前(r =-0.508,P0.05)、术后 3 个月(r =-0.504,P0.05)、术后 6个月(r=-0.540,P0.05)及术后12个月(r =-0.503,P0.05)。瘤体最大直径的大小及性别在血清miRNA-29a高低表达组中差异有统计学意义(P0.05),而对年龄高低、有无高血压、是否累及髂总动脉及瘤体成角大小的比较无统计学差异(P0.05)。结论腹主动脉瘤患者血清miRNA-29a表达量随瘤体直径的增大而降低;腹主动脉瘤腔内修复术后瘤体直径的大小和血清miRNA-29a的表达水平成负相关;血清miRNA-29a的术前水平与性别、瘤体直径大小相关,与年龄高低、是否患有高血压、是否累及髂总动脉及瘤体成角大小无关;血清miRNA-29a可能为评估腹主动脉瘤腔内修复术前后瘤体直径变化的潜在的生物学标志物。
[Abstract]:Background abdominal aortic aneurysm (AAA) is a severe aortic degenerative disease with an arterial diameter greater than 1.5 times more than normal. Its incidence is increasing year by year with age increasing, which is a serious threat to human life and health. Endovascular repair is a minimally invasive procedure, low mortality and complication rate in the perioperative period, operation and hospitalization. Short, quick recovery and so on, and become the first line treatment strategy of most AAA patients. And the further enlargement of the tumor is the main cause of the two intervention. In the past, AAA was followed up in physical way. In recent years, the study showed that the blood markers were related to the development of AAA, and miRNA-29a was confirmed with the tumor. The relationship between the size of the body diameter and the relationship between the expression of serum miRNA-29a and the diameter of the tumor before and after AAA endovascular repair has not been reported. Objective to explore the expression of serum miRNA-29a and the relationship between the serum and the related indexes of the AAA endovascular repair before and after the AAA endovascular repair, and to collect the AAA 60 from November 2014 to December 2015. Patients were divided into intracavitary repair group and dynamic observation group. The abdominal aorta CTA was performed at 4 time points before and after the operation in March, June, December, and the relative expression of serum miRNA-29a was detected by RT-PCR technique. The relationship between the changes of the diameter of the tumor on CTA and the level of miRNA-29a expression on the serum was recorded. The dynamic observation group was in the first door. The imaging and hematological follow-up were performed at 3 time points in June and December. The statistical analysis was carried out by SPSS 18 and GraphPad Prism software. The correlation between the expression level of serum miRNA-29a and the clinical and imaging parameters was analyzed. The difference of P0.05 was statistically significant. The diameter of 9 patients in the dynamic observation group was increased. More than 5 mm/6 months and abdominal pain and other clinical symptoms were included in the endovascular repair group. 5 cases died after operation in 49 cases of endovascular repair group, of which 2 died of respiratory and circulatory failure and renal failure during hospitalization; 3 cases died of acute heart failure in February. The follow-up time was 12 to 20 months, median time was 15 months, 55 patients were no lost during follow-up period, no loss during follow up period, no loss of patients during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up, no loss during follow-up period, no loss. All patients' serum miRNA-29a amplification was good. The maximum diameter of the tumor body was negatively correlated with the level of serum miRNA-29a expression in 60 patients. The correlation coefficient R =-0.600, the correlation test and analysis difference had significant statistical significance (P0.05). The relative expression of serum miRNA-29a in the two groups before operation (=19.56 + 3.83 vs 22.88 in the dynamic observation group of the endovascular repair group) There was a statistical difference (P0.05). The relative expression of miRNA-29a at each time point of serum in the endovascular repair group was (19.56 + 3.83), March (20.34 + 4.73), June (21.78 + 4.65) and December (22.92 + 4.14) after operation (22.92 + 4.14). The difference of relative expression of each group was statistically significant (P0.05). The maximum diameter of the aneurysm body was determined by the statistical analysis (P0.05). The preoperative (5.66 + 1.00cm) decreased to March (4.87 + 1.70 cm), June (4.12 + 0.99 cm), and December (3.70 + 0.89 cm). Statistical analysis of the maximum diameter of the tumor at each time point was statistically different (P0.05). The correlation between the maximum diameter of the tumor body at different time points and the expression level of corresponding serum miRNA-29a at different time points in the endovascular repair group was related to the correlation of the level of the expression level of the corresponding serum. Preoperative (R =-0.508, P0.05), 3 months postoperatively (R =-0.504, P0.05), 6 months after operation (r=-0.540, P0.05) and 12 months after the operation (R =-0.503, P0.05). The size of the maximum diameter of the tumor and the sex in the serum miRNA-29a high and low expression group were statistically significant, but there was no hypertension for the age, whether there was the involvement of the common iliac artery and the tumor. There was no statistical difference between the angle and size of the abdominal aortic aneurysm (P0.05). Conclusion the miRNA-29a expression in the sera of the abdominal aortic aneurysm decreased with the increase of the diameter of the tumor. The size of the tumor body after the endovascular repair of the abdominal aortic aneurysm was negatively correlated with the level of the expression of serum miRNA-29a; the preoperative level of serum miRNA-29a was related to the size of the tumor and the size of the tumor. Age, whether or not hypertension, is not related to the size of the common iliac artery and the angle of the tumor, and serum miRNA-29a may be a potential biomarker for assessing the changes in the diameter of the tumor before and after endovascular repair of the abdominal aortic aneurysm.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.3
本文编号：2124843
[Abstract]:Background abdominal aortic aneurysm (AAA) is a severe aortic degenerative disease with an arterial diameter greater than 1.5 times more than normal. Its incidence is increasing year by year with age increasing, which is a serious threat to human life and health. Endovascular repair is a minimally invasive procedure, low mortality and complication rate in the perioperative period, operation and hospitalization. Short, quick recovery and so on, and become the first line treatment strategy of most AAA patients. And the further enlargement of the tumor is the main cause of the two intervention. In the past, AAA was followed up in physical way. In recent years, the study showed that the blood markers were related to the development of AAA, and miRNA-29a was confirmed with the tumor. The relationship between the size of the body diameter and the relationship between the expression of serum miRNA-29a and the diameter of the tumor before and after AAA endovascular repair has not been reported. Objective to explore the expression of serum miRNA-29a and the relationship between the serum and the related indexes of the AAA endovascular repair before and after the AAA endovascular repair, and to collect the AAA 60 from November 2014 to December 2015. Patients were divided into intracavitary repair group and dynamic observation group. The abdominal aorta CTA was performed at 4 time points before and after the operation in March, June, December, and the relative expression of serum miRNA-29a was detected by RT-PCR technique. The relationship between the changes of the diameter of the tumor on CTA and the level of miRNA-29a expression on the serum was recorded. The dynamic observation group was in the first door. The imaging and hematological follow-up were performed at 3 time points in June and December. The statistical analysis was carried out by SPSS 18 and GraphPad Prism software. The correlation between the expression level of serum miRNA-29a and the clinical and imaging parameters was analyzed. The difference of P0.05 was statistically significant. The diameter of 9 patients in the dynamic observation group was increased. More than 5 mm/6 months and abdominal pain and other clinical symptoms were included in the endovascular repair group. 5 cases died after operation in 49 cases of endovascular repair group, of which 2 died of respiratory and circulatory failure and renal failure during hospitalization; 3 cases died of acute heart failure in February. The follow-up time was 12 to 20 months, median time was 15 months, 55 patients were no lost during follow-up period, no loss during follow up period, no loss of patients during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up period, no loss during follow-up, no loss during follow-up period, no loss. All patients' serum miRNA-29a amplification was good. The maximum diameter of the tumor body was negatively correlated with the level of serum miRNA-29a expression in 60 patients. The correlation coefficient R =-0.600, the correlation test and analysis difference had significant statistical significance (P0.05). The relative expression of serum miRNA-29a in the two groups before operation (=19.56 + 3.83 vs 22.88 in the dynamic observation group of the endovascular repair group) There was a statistical difference (P0.05). The relative expression of miRNA-29a at each time point of serum in the endovascular repair group was (19.56 + 3.83), March (20.34 + 4.73), June (21.78 + 4.65) and December (22.92 + 4.14) after operation (22.92 + 4.14). The difference of relative expression of each group was statistically significant (P0.05). The maximum diameter of the aneurysm body was determined by the statistical analysis (P0.05). The preoperative (5.66 + 1.00cm) decreased to March (4.87 + 1.70 cm), June (4.12 + 0.99 cm), and December (3.70 + 0.89 cm). Statistical analysis of the maximum diameter of the tumor at each time point was statistically different (P0.05). The correlation between the maximum diameter of the tumor body at different time points and the expression level of corresponding serum miRNA-29a at different time points in the endovascular repair group was related to the correlation of the level of the expression level of the corresponding serum. Preoperative (R =-0.508, P0.05), 3 months postoperatively (R =-0.504, P0.05), 6 months after operation (r=-0.540, P0.05) and 12 months after the operation (R =-0.503, P0.05). The size of the maximum diameter of the tumor and the sex in the serum miRNA-29a high and low expression group were statistically significant, but there was no hypertension for the age, whether there was the involvement of the common iliac artery and the tumor. There was no statistical difference between the angle and size of the abdominal aortic aneurysm (P0.05). Conclusion the miRNA-29a expression in the sera of the abdominal aortic aneurysm decreased with the increase of the diameter of the tumor. The size of the tumor body after the endovascular repair of the abdominal aortic aneurysm was negatively correlated with the level of the expression of serum miRNA-29a; the preoperative level of serum miRNA-29a was related to the size of the tumor and the size of the tumor. Age, whether or not hypertension, is not related to the size of the common iliac artery and the angle of the tumor, and serum miRNA-29a may be a potential biomarker for assessing the changes in the diameter of the tumor before and after endovascular repair of the abdominal aortic aneurysm.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.3
【参考文献】
相关期刊论文 前4条
1 余婧;王伟;黄建华;;腹主动脉瘤药物干预的研究进展[J];中国血管外科杂志(电子版);2016年02期
2 冯洪涛;李红普;;miRNA-29a对平滑肌细胞增殖凋亡的影响[J];重庆医学;2015年35期
3 白帆;刘有军;谢进生;丁金立;王枫;赵夕;任晓辰;乔爱科;;血流动力学的医学应用与发展[J];医用生物力学;2013年06期
4 符洋;黄建华;汤恢焕;;腹主动脉瘤发病机制及药物治疗的研究进展[J];中国普通外科杂志;2009年06期
相关硕士学位论文 前1条
1 田壮博;miRNA-29a在肾下型腹主动脉瘤中表达及意义[D];中南大学;2012年
，本文编号：2124843
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2124843.html
最近更新
教材专著
