慢性血栓栓塞性肺动脉高压单核细胞组织因子和炎性因子表达的研究

发布时间：2018-06-29 07:21

本文选题：慢性血栓栓塞性肺动脉高压 + 组织因子　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:检测纤维蛋白原(Fg)、D-二聚体、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、单核趋化蛋白-1(MCP-1)、组织因子(TF)和单核细胞TF(TF m RNA)在慢性血栓栓塞性肺动脉高压(CTEPH)患者的表达情况,了解CTEPH的血凝状态,CRP、TNF-α、MCP-1与CTEPH疾病严重程度及其与TF之间的关系,探讨单核细胞组织因子和炎性因子在CTEPH发生发展中的可能作用。方法:入选2013年6月至2014年10月于福建医科大学附属第一医院诊为CTEPH的患者10例、急性肺栓塞(PTE)患者20例,排除CTEPH的肺动脉高压(PH)患者15例,选取20例在本院体检中心体检健康者作为对照组,选用凝固法检测血中Fg的含量,免疫比浊法检测血中D-二聚体和CRP含量,用酶联免疫吸附分析(ELISA)法分别检测血浆中TNF-α、MCP-1、TF抗原含量,发色底物法测定血浆中TF活性,Percoll密度梯度离心法分离外周血单核细胞,选用逆转录-聚合酶链反应(RT-PCR法)检测单核细胞TF m RNA表达,将各项检测指标进行相关性分析。结果:(1)CTEPH患者血浆Fg(4.404±0.563)、D-二聚体水平(1.075±1.507)较正常人(2.668±0.425,0.181±0.076)高,其中Fg水平升高差异有统计学意义(P=0.00010.01),D-二聚体升高无统计学意义(P=0.3900.05)。CTEPH组患者肺动脉平均压79.7±21.193mm Hg,与血浆Fg水平呈正相关(r=0.843,P=0.002㩳0.05),与血浆D-二聚体水平无相关性(r=-0.082,P=0.8210.05)。(2)CTEPH患者血浆CRP含量(26.440±5.175)较正常人(2.417±1.707)高,差异有统计学意义(P=0.00010.01),其中CTEPH患者肺动脉平均压与CRP水平呈正相关(r=0.922,P=0.001㩳0.05);CTEPH患者血浆TNF-α(32.340±4.525)、MCP-1水平(45.487±16.522)均高于对照组(12.116±7.404,22.267±8.594),差异有统计学意义(P=0.0001㩳0.01,P=0.008㩳0.01);其中CTEPH患者肺动脉平均压与MCP-1水平呈正相关(r=0.661,P=0.037㩳0.05),与TNF-α水平无关(r=0.487,P=0.1540.05)。(3)CTEPH患者血浆TF活性(24.350±6.103)和TF抗原(45.677±12.061)含量均高于对照组(20.236±3.293,27.924±3.333),其中TF抗原含量升高差异有统计学意义(P=0.0060.01),TF活性升高差异无统计学意义(P=0.3180.05)。CTEPH患者血中单核细胞TF m RNA(0.332±0.019)表达高于对照组(0.248±0.007),差异有统计学意义(P=0.0001㩳0.01),与血浆TF抗原含量相关性分析显示二者呈正相关(r=0.826,P=0.003㩳0.01)。CTEPH患者血浆TF抗原含量与CRP(r=0.733,P=0.016㩳0.05)、TNF-α(r=0.662,P=0.037㩳0.05)、MCP-1(r=0.696,P=0.025㩳0.05)之间相关性分析均提示它们之间存在相关性。结论:CTEPH患者血中单核细胞TF m RNA表达高于对照组,与血浆TF抗原含量呈显著正相关,提示CTEPH血源性组织因子可能主要来自于单核细胞;CTEPH患者血浆TF抗原含量与炎性因子CRP、TNF-α、MCP-1的高表达具有良好的相关性,提示TF、CRP、TNF-α和MCP-1可能在CTEPH的炎症-凝血-血栓循环中发挥具有重要作用。
[Abstract]:Objective: to detect the expression of fibrinogen (Fg), D- two polymer, C- reactive protein (CRP), tumor necrosis factor alpha (TNF- alpha), mononuclear chemotactic protein -1 (MCP-1), tissue factor (TF) and mononuclear TF (TF m RNA) in chronic thromboembolic pulmonary hypertension. Degree and its relationship with TF to explore the possible role of monocyte tissue factor and inflammatory factor in the development of CTEPH. Methods: from June 2013 to October 2014, 10 patients who were diagnosed as CTEPH in the First Affiliated Hospital of Fujian Medical University, 20 cases of acute pulmonary embolism (PTE), and 15 cases of pulmonary arterial hypertension (PH) of CTEPH were excluded. 20 cases of healthy people in the physical examination center of our hospital were selected as the control group. The content of Fg in blood was detected by coagulation method. The content of D- two polymer and CRP in blood was detected by immunization turbidimetry. The content of TNF- alpha, MCP-1, TF antigen in plasma was detected by enzyme linked immunosorbent assay (ELISA). The activity of TF in plasma was measured by chromogenic substrate method and the Percoll density gradient was measured. Centrifugation was used to separate peripheral blood mononuclear cells. The expression of TF m RNA in mononuclear cells was detected by reverse transcription polymerase chain reaction (RT-PCR). The results were as follows: (1) the plasma Fg (4.404 + 0.563) of CTEPH patients and the level of D- two polymer (1.075 + 1.507) were higher than those of normal people (2.668 + 0.425,0.181 + 0.076), and the level of Fg increased The difference was statistically significant (P=0.00010.01). The increase of D- two polymer was not statistically significant (P=0.3900.05) in group.CTEPH, the average pressure of pulmonary artery was 79.7 + 21.193mm Hg, and there was a positive correlation with the plasma Fg level (r=0.843, P=0.002? 0.05), and no correlation with the level of plasma D- two polymer (r= -0.082,). (2) the plasma concentration (26.440 + 5.175) was more positive. The difference was statistically significant (P=0.00010.01). The average pressure of pulmonary artery in CTEPH patients was positively correlated with CRP (r=0.922, P=0.001? 0.05); the plasma TNF- alpha (32.340 + 4.525) and MCP-1 level (45.487 + 16.522) in CTEPH patients were higher than those in the group (12.116 + 7.404,22.267 + 8.594), and the difference was statistically significant (P=0.0001? 0.01, P). =0.008? 0.01); the average pressure of pulmonary artery in CTEPH patients was positively correlated with the level of MCP-1 (r=0.661, P=0.037? 0.05), not related to the level of TNF- alpha (r=0.487, P=0.1540.05). (3) the plasma TF activity (24.350 + 6.103) and TF antigen (45.677 + 12.061) in patients with CTEPH were higher than those of the control group (20.236 + 3.293,27.924 3.333). Statistical significance (P=0.0060.01), the increase of TF activity was not statistically significant (P=0.3180.05), the expression of TF m RNA (0.332 + 0.019) in the blood of.CTEPH patients was higher than that of the control group (0.248 + 0.007), the difference was statistically significant (P=0.0001? 0.01), and the correlation analysis with the plasma TF antigen content showed that the two was positively correlated (r=0.826, P=0.003? 0.01).CTEPH. The correlation analysis between the plasma TF antigen content and CRP (r=0.733, P=0.016? 0.05), TNF- alpha (r=0.662, P=0.037? 0.05), MCP-1 (r=0.696, P=0.025? 0.05) all indicated their correlation. Conclusion: the expression of the mononuclear cell TF in the blood of CTEPH patients is higher than that of the control group, which is significantly correlated with the plasma antigen content, suggesting the origin of blood origin. The tissue factor may mainly come from monocyte; the plasma TF antigen content of CTEPH patients has good correlation with the high expression of inflammatory factors CRP, TNF- alpha and MCP-1, suggesting that TF, CRP, TNF- alpha and MCP-1 may play an important role in the inflammation coagulation thrombus cycle of CTEPH.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1

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