宝石能谱CT结合血清HMGB1、Hs-CRP对颈动脉粥样硬化斑块的初步研究

发布时间：2018-01-16 06:17

本文关键词：宝石能谱CT结合血清HMGB1、Hs-CRP对颈动脉粥样硬化斑块的初步研究　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:以彩色多普勒超声(Color Doppler Flow Imaging,CDFI)对颈动脉斑块进行初筛,以宝石能谱CT(Gemstone Spectral Imaging,GSI)对斑块进行更精确的检测,对斑块组成进行能谱分析及定量测定斑块内钙脂相对含量,结合血清高迁移率族蛋白1(High Mobility Group Box-1 protein,HMGB1)、超敏C反应蛋白(Hypersensitive C-reactive protein,Hs-CRP)的变化,进而探讨血清HMGB1、Hs-CRP在斑块易损性中的作用。方法:选择100例彩色多普勒超声筛查出颈部动脉含斑块的患者,进一步行宝石能谱CT扫描确诊含斑块的有49例,此49例患者组成病例组,能谱评价后将其分为易损斑块组(21例)和稳定斑块组(28例)两组,测定此49例患者斑块成分的钙脂含量比值。选取20例彩色多普勒超声筛查出颈动脉无斑块患者为对照组。所有69例患者均留取血清标本,采用免疫学方法测定血清中HMGB1浓度、Hs-CRP浓度。结果:1.能谱分析显示,稳定斑块组相对易损斑块组含钙量增多,易损斑块组相对稳定斑块组含脂量较多,易损斑块组、稳定斑块组斑块内钙脂配对浓度(g/L)分别为0.205(0.042,0.207)、0.227(0.225,0.228)。易损斑块组斑块内钙脂浓度低于稳定斑块组,结果有显著意义(p0.001)。2.能谱CT扫描共检出21例易损斑块,28例稳定斑块。易损斑块组中,颈总动脉段有7例(33.3%),颈总动脉段分叉部11例(52.4%),颈外动脉段3例(14.3%)。稳定斑块组中,颈总动脉段11例(39.3%),颈总动脉段分叉部15例(53.6%),颈外动脉段2例(7.1%)。3.易损斑块组、稳定斑块组、对照组血清HMGB1(ng/ml)分别为2.19(1.98,2.87)、2.00(1.78,2.50)、0.68(0.34,0.93)。斑块组血清HMGB1水平高于对照组,差异有意义(p0.001),易损斑块组血清HMGB1水平高于稳定斑块组,结果无意义(p=0.1633)。4.易损斑块组、稳定斑块组、对照组血清Hs-CRP(mg/L)分别为4.28(3.76,5.45)、1.41(1.21,1.67)、0.39(0.18,0.66),易损斑块组血清Hs-CRP水平较另两组显著增高,稳定斑块组血清Hs-CRP水平较对照组水平显著增高,二者结果均具有统计学差异(p0.001)。5.血清HMGB1与斑块内钙脂浓度无相关性(r=-0.10654,p=0.4662),血清HMGB1与血清Hs-CRP呈正相关(r=0.73443,p0.001),血清Hs-CRP与斑块内钙脂浓度呈负相关(r=-0.71367,p0.001)。结论:1.宝石CT在能谱定性评价动脉粥样硬化斑块成分及定量测定斑块内钙脂相对含量方面成果显著。2.血清HMGB1可能介入了斑块的生成,尚不能认为HMGB1的水平高低反映了斑块易损性变化。3.血清Hs-CRP可能与动脉粥样硬化的序贯性进展有关,且高水平的Hs-CRP提示了斑块的高度易破裂性。4.血清HMGB1与Hs-CRP共同参与了动脉粥样硬化的病理性炎性损害机制。
[Abstract]:Objective: using color Doppler ultrasound (Color Doppler, Flow Imaging, CDFI) of the carotid artery plaque was screened by Gemstone CT (Gemstone Spectral Imaging, GSI) are more accurate detection of plaque, the plaque composition of spectrum determination of relative content of calcium plaque lipid analysis and quantitative analysis, combined with serum high mobility group 1 (High Mobility Group Box-1 protein protein, HMGB1), high sensitive C reactive protein (Hypersensitive C-reactive, protein, Hs-CRP) and to explore the changes of serum HMGB1, Hs-CRP in plaque vulnerability. Methods: 100 cases of color Doppler ultrasound in screening of cervical artery plaque containing patients, further for gemstone CT scan confirmed containing plaque in 49 cases, 49 cases of patients with this patient group, spectrum evaluation will be divided into vulnerable plaque group (21 cases) and stable plaque group (28 cases) in two groups, the 49 patients with plaque composition determination of calcium The ratio of fat content. A total of 20 patients with color Doppler ultrasound screening of carotid plaques in patients with the control group. All 69 patients were collected and serum samples, the concentration of HMGB1, concentration of Hs-CRP in serum by immunological methods. Results: 1. energy spectrum analysis showed that the stable plaque group relative vulnerable plaque group calcium content increased, vulnerability plaque group relatively stable plaque group containing more fat, vulnerable plaque group, stable plaque group plaque calcium concentration (g/L) paired fat were 0.205 (0.042,0.207), 0.227 (0.225,0.228). Plaque plaque group calcium grease concentration is lower than the stable plaque group, the results were significant (p0.001).2. spectrum CT scan detected 21 cases of vulnerable plaque, 28 cases of stable plaque. Vulnerable plaque group, common carotid artery, 7 cases (33.3%), common carotid artery bifurcation in 11 cases (52.4%), 3 cases of external carotid artery segment (14.3%). The stable plaque group, common carotid artery, 11 cases (39.3%), neck The total artery bifurcation in 15 cases (53.6%), 2 cases of external carotid artery segment (7.1%).3. plaque group, stable plaque group, the control group of serum HMGB1 (ng/ml) were 2.19 (1.98,2.87), 2 (1.78,2.50), 0.68 (0.34,0.93). The serum level of HMGB1 plaque group was higher than the control group, the difference is meaning (p0.001), vulnerable plaque group and the serum HMGB1 level was higher in stable plaque group, the significance of (p=0.1633).4. plaque group, stable plaque group, the control group of serum Hs-CRP (mg/L) were 4.28 (3.76,5.45), 1.41 (1.21,1.67), 0.39 (0.18,0.66), the serum level of Hs-CRP in vulnerable plaque group than the other two group significantly increased the serum level of Hs-CRP in stable plaque group than the control group significantly increased, the two results were statistically difference (p0.001) of.5. HMGB1 in serum and calcium plaque lipid concentration had no correlation (r=-0.10654, p=0.4662), serum HMGB1 was positively correlated with serum Hs-CRP (r=0.73443, p0.001), serum Hs-CRP With the plaque calcium lipid concentration was negatively correlated (r=-0.71367, p0.001). Conclusion: 1. CT gem energy spectrum at the qualitative evaluation of atherosclerotic plaque composition and quantitative determination of the relative content of calcium plaque lipid results significantly.2. of serum HMGB1 may be involved in plaque formation, still can not believe that the level of HMGB1 reflects the changes of plaque vulnerability.3. the serum Hs-CRP may be associated with the sequential progression of atherosclerosis, and a high level of Hs-CRP suggests that the height of.4. plaque rupture of serum HMGB1 and Hs-CRP are involved in the pathological damage of inflammatory atherosclerosis and mechanism.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R543.4

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