阻塞性睡眠呼吸暂停综合征致缺血性脑卒中炎性机制的相关研究

发布时间：2018-01-01 20:32

本文关键词：阻塞性睡眠呼吸暂停综合征致缺血性脑卒中炎性机制的相关研究　出处：《昆明医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：通过检测血浆炎症因子可溶性血管内皮蛋白C受体(soluble endothelial protein C receptor, SEPCR)、急性时相血清淀粉样蛋白A (acute phase serum amyloid A, SAA)、可溶性CD40配体(soluble CD40ligand, SCD40L)水平,分析其与阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)、.缺血性脑卒中的相关性,以探讨OSAS导致缺血性脑卒中可能的炎症反应机制。方法：收集昆明医科大学第二附属医院神经内科于2011年11月至2012年11月期间住院病人120例,其中无缺血性脑卒中的OSAS组病人30例(A组),无OSAS的缺血性脑卒中组病人30例(B组),合并OSAS的缺血性脑卒中组病人30例(C组),共90例作为观察组；并选取同期无OSAS及缺血性脑卒中的病人30例作为对照组(D组)。记录患者的一般情况,包括性别、年龄、身高、体重、吸烟史及高血压病、糖尿病等既往病史,对有缺血性脑卒中的患者进行神经功能缺损量表(National Institutes of Health Stroke Scale, NIHSS)评分,并记录分值。所有入选病例均于入院次日采集空腹静脉血3ml,测定血浆SEPCR、 SAA、 SCD40L及血超敏C-反应蛋白(high sensitive C reactive protein, HS-CRP)、同型半胱氨酸(Homocysteine, HCY)、纤维蛋白原(Fgrinogen, Fg)。对所有入选病例均进行颈部血管超声,多导睡眠呼吸监测检查,并分别记录颈动脉内-中膜厚度(intima-media thickness, IMT)、呼吸暂停指数(apnea hypopnea index, AHI)、最低动脉血氧饱和度(minimal arterial oxygen saturation, SaO2min)。应用SPSS17.0统计学软件对相关因素进行相关性分析。结果：A、 B、 C、D四组整体在性别、AHI、 SaO2min、体重指数(BMI)、 IMT、 Fg、 HCY、 SEPCR、SAA、 SCD40L、 NIHSS评分存在统计学差异。组间比较结果显示,AHI、SaO2min、 BMI、 IMT、 Fg、 HCY、 SEPCR、 SAA、 SCD40L、NIHSS在A-C、 B-C、 A-D、 C-D组间存在统计学差异,而在A-B组间无明显统计学差异；AHI在B-D组间、NIHSS评分在A-D组间无明显统计学差异。AHI与NIHSS评分密切相关,呈线性正相关。SEPCR、 SAA、 SCD40L与AHI、 NIHSS评分、IMT、 HCY、 Fg正相关,与SaO2min负相关。结论：OSAS是缺血性脑卒中的独立危险因素；OSAS患者系统性炎症,直接或间接刺激血SEPCR、SAA、 SCD40L水平升高,诱发炎症机制,促进动脉内膜增厚,参与动脉粥样硬化过程,揭示了OSAS可能通过炎症反应机制独立导致缺血性脑卒中的发生发展。
[Abstract]:Objective: to detect the plasma inflammatory factors of soluble endothelial protein C receptor (soluble endothelial protein C receptor, SEPCR), acute phase serum amyloid A (acute phase serum amyloid A, SAA), soluble CD40 ligand (soluble CD40ligand, SCD40L) level, and the analysis of obstructive sleep apnea syndrome (obstructive sleep apnea, syndrome, OSAS). The correlation of ischemic stroke, to explore the mechanism of the OSAS induced inflammatory response in ischemic stroke may.
Methods: collect the neurology department of the Second Affiliated Hospital of Kunming Medical University from November 2011 to November 2012 120 cases of hospitalized patients, 30 cases of group OSAS patients without ischemic stroke (A group), 30 patients with non OSAS ischemic stroke patients (B group), 30 patients with OSAS in ischemic stroke patients (C group), a total of 90 cases were selected as the observation group; and OSAS and ischemic stroke in 30 patients as control group (group D). Record the general condition of patients, including gender, age, height, weight, smoking history, hypertension, diabetes and other medical history, the neurological deficit scale for ischemic stroke patients (National Institutes of Health Stroke Scale, NIHSS) score, and record the score. All the cases were in the hospital the next day fasting venous blood 3ml, plasma SEPCR, SAA, SCD40L and serum high-sensitivity C- reactive protein (hig H sensitive C reactive protein, HS-CRP), homocysteine (Homocysteine, HCY), fibrinogen (Fgrinogen, Fg). All selected cases were performed neck vascular ultrasound, polysomnography examination and recording of carotid artery intima-media thickness (intima-media, thickness, IMT), apnea index (apnea hypopnea index, AHI), the lowest arterial oxygen saturation (minimal arterial oxygen saturation, SaO2min). SPSS17.0 was used to analysis the correlation of related factors.
Results: A, B, C, D four groups in the overall gender, AHI, SaO2min, body mass index (BMI), IMT, Fg, HCY, SEPCR, SAA, SCD40L, NIHSS, there were significant differences between the groups score. The comparison results show that AHI, SaO2min, BMI, IMT, Fg, HCY, SEPCR, SAA SCD40L, NIHSS, B-C, A-D, in A-C, there was significant difference between the C-D group, but no statistically significant difference in A-B between group AHI; in group B-D, NIHSS score in group A-D between.AHI and NIHSS had no statistically significant difference was closely related to a linear positive correlation between.SEPCR, SAA, SCD40L and AHI, NIHSS IMT, HCY, Fg score, positive correlation, negative correlation with SaO2min.
Conclusion: OSAS is an independent risk factor for ischemic stroke; OSAS patients with systemic inflammation, directly or indirectly stimulate the blood SEPCR, SAA, SCD40L levels increased, induced inflammation, promote intimal thickening, participate in the process of atherosclerosis, revealed by OSAS might lead to inflammatory reaction mechanism independent of occurrence and development of ischemic stroke.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3;R766

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