冠心病猝死者CAS斑块成分与稳定性的相关性研究

发布时间：2018-06-21 16:33

本文选题：猝死 + 冠状动脉粥样硬化　；参考：《重庆医科大学》2017年硕士论文

【摘要】：第一部分冠心病猝死者CAS斑块成分分析目的:对冠心病猝死(sudden coronary death,SCD)者冠状动脉粥样硬化(Coronary atherosclerosis,CAS)斑块成分进行分析。方法:分组:非冠心病组(A组),冠心病非猝死组(B组),冠心病猝死组(C组)。回顾性分析相应患者的临床资料和尸体解剖资料,并通过特殊染色进一步分析斑块成分(脂质、纤维及钙盐)的相对含量。结果:A组56例,平均年龄39.54±11.16岁,冠状动脉仅轻微病变。B组59例,平均年龄55.64±14.11岁,冠状动脉III级狭窄发生率最高,以左前降支(Left anterior descending,LAD)最易发生病变。C组56例,平均年龄53.36±13.91岁,发病前存在明显诱因30例,冠状动脉IV级狭窄发生率最高,LAD最易发生病变。HE染色及特殊染色发现,A组冠状动脉内膜下仅散在泡沫细胞,而B组及C组冠状动脉均有不同程度脂质沉积及纤维组织增生;B组有38例冠状动脉钙盐沉积,C组有41例冠状动脉钙盐沉积;B组脂质、纤维及钙盐相对含量(%)分别为53.53±16.23、27.07±9.78、19.39±13.46,C组脂质、纤维及钙盐相对含量(%)分别为44.00±12.00、31.63±9.29、24.37±10.08,且C组脂质、纤维及钙盐相对含量与B组差异均有统计学意义(P0.05);B组及C组患者中均存在不同程度机体慢性炎症,以慢性支气管炎、慢性肾盂肾炎为主,且C组慢性炎症率最高。结论:冠状动脉狭窄程度越大越易导致SCD,且CAS斑块成分(尤其是钙盐)影响着斑块的稳定性。第二部分冠心病猝死者CAS斑块中骨相关蛋白表达与斑块稳定性的相关性研究目的:探讨CAS斑块中炎症因子,如C-反应蛋白(C reactive protein,CRP)与骨相关蛋白表达、钙盐沉积及斑块稳定性的相关性。方法:分组:非冠心病组(A组),冠心病非猝死组(B组),冠心病猝死组(C组)。对冠状动脉行免疫组化及Western Blot实验,检测CAS斑块中平滑肌a-肌动蛋白(alpha smooth muscle actin,a-SM-actin)、CRP、骨形成蛋白2(bone morphogenetic protein-2,BMP2)、基质金属蛋白酶9(matrix metalloproteinase 9,MMP9)及基质金属蛋白酶组织抑制剂1(tissue inhibitor of metalloproteinase 1,TIMP1)等蛋白表达情况。结果:a-SM-actin在B组及C组CAS斑块中表达;CRP在在A组、B组及C组中表达逐渐增强;BMP2、MMP9及TIMP1在A组中均无明显表达,但在B组及C组中表达,且C组表达较B组差异有统计学意义(P0.05);CRP与BMP2、MMP9、TIMP1表达量均呈线性正相关(r值分别为0.988、0.995、0.990,P0.01)。结论:在慢性炎症作用下,CAS斑块中骨相关蛋白(如BMP2)表达及钙盐沉积,MMP9、TIMP1高表达及MMP9/TIMP1比例失衡,均会破坏斑块稳定性引起斑块破裂而导致SCD发生。
[Abstract]:Part I Analysis of plaque composition in sudden coronary death objective: to analyze the plaque composition of coronary atherosclerotic lesion (CAS) in patients with sudden coronary death (SCD). Methods: group A was divided into three groups: group A, group B and group C, respectively. The clinical data and autopsy data of the patients were analyzed retrospectively, and the relative contents of plaque components (lipid, fiber and calcium salt) were further analyzed by special staining. Results the mean age of 56 cases was 39.54 卤11.16 years old in group A, 59 cases in group B (mean 55.64 卤14.11 years old), and 56 cases in group C (mean age 53.36 卤13.91 years). There were 30 cases of obvious inducement before the onset of coronary artery. The incidence of grade IV stenosis of coronary artery was the highest. He staining and special staining showed that foam cells were only scattered under the intima of coronary artery in group A. In group B and C, there were 38 cases of coronary artery calcium deposit and 41 cases of coronary artery calcium deposit in group B, the relative contents of fiber and calcium salt were 53.53 卤16.2327.07 卤9.8819.39 卤13.46C, respectively, in group B and C, there were 38 cases in group B and 41 cases in group B, and the relative contents of fiber and calcium salt in group B were 53.53 卤16.2327.07 卤9.8819.39 卤13.46C, respectively. The relative contents of fiber and calcium salt were 44.00 卤12.00 卤31.63 卤9.29 卤24.37 卤10.08, respectively. The relative contents of lipid, fiber and calcium salt in group C were significantly different from those in group B (P 0.05) and group C (P < 0.05). The rate of chronic pyelonephritis was the highest in group C. Conclusion: coronary artery stenosis is more likely to lead to SCD, and CAS plaque composition (especially calcium salt) affects plaque stability. Part two the correlation between the expression of bone related protein and plaque stability in patients with sudden coronary heart death objective: to investigate the expression of inflammatory factors, such as C-reactive protein C reactive protein, and bone related protein in CAS plaques. Correlation between calcium salt deposition and plaque stability. Methods: group A was divided into three groups: group A, group B and group C, respectively. Immunohistochemistry and Western blot were performed on coronary artery. The expression of 伪 -actin alpha smooth muscle, bone morphogenetic protein 2(bone morphogenetic protein-2 BMP2, matrix metalloproteinase 9(matrix metalloproteinase 9 MMP9 and tissue inhibitor of matrix metalloproteinase (1(tissue inhibitor of metalloproteinase 1 / TIMP 1) were detected. Results the expression of BMP2MMP9 and TIMP1 in CAS plaques of group B and C increased gradually, but not in group B and C, but not in group B and C. Compared with group B, the expression of CRP in group C was significantly higher than that in group B. There was a positive linear correlation between the expression of CRP and the expression of TIMP1 in BMP2MMP9MMP9. The positive correlation between CRP and TIMP1 in group C was 0.988- 0.995and 0.990P0.01respectively. Conclusion: the expression of bone related protein (such as BMP2), the high expression of MMP9 / TIMP1 and the imbalance of MMP9 / TIMP1 ratio in CAS plaque caused by chronic inflammation will destroy the plaque stability and lead to the rupture of plaque and lead to the occurrence of SCD.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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