睡眠呼吸暂停综合征患者血浆血栓调节蛋白及D-二聚体变化的初步分析

发布时间：2018-01-25 22:59

本文关键词： 睡眠呼吸暂停综合症血栓调节蛋白 D-二聚体脑血管疾病血管内皮细胞　出处：《汕头大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:探讨睡眠呼吸暂停综合征患者血管内皮细胞功能及凝血-纤溶系统功能的变化。方法:所有研究对象均为2008年2月-2009年2月北京大学深圳医院神经内科门诊就诊及病房收治的病人。经详细询问病史,记录身高、体重,计算体重指数,既往病史(高血压、冠心病、脑血管疾病史),并作胸片、心电图、血常规、血生化等检查,并行头颅MRI平扫及多导睡眠仪监测。共选择30例睡眠呼吸暂停综合征(SAS)患者,其中包括16例SAS伴脑血管病(CVD)患者及14例不伴脑血管病患者,并随机选择15例无脑血管病及未达睡眠呼吸暂停综合征诊断标准的单纯鼾症者为对照组。血栓调节蛋白(TM)采用酶联免疫吸附实验检测(TM ELISA)。D 二聚体测定采用胶乳增强的免疫比浊法。结果:与对照组相比,SAS组(包括伴或不伴CVD)患者年龄、性别、体重指数差异均无统计学意义(P0.05)。与对照组相比,SAS组(包括伴或不伴CVD)患者TM水平明显升高[(0.3814±0.08 ng/ml)vs(0.2801±0.07 ng/ml)],D-二聚体水平也明显升高[(786.40±423.50 ng/ml)vs(124.10±24.46 ng/ml)],差异均有统计学意义(P值分别为0.46和0.013)。脑血管病在睡眠呼吸暂停综合征中发病率高达53.3%(16/30)。与不伴CVD组相比,伴CVD组TM水平有升高[(0.3612±0.09 ng/ml)vs(0.3910±0.08 ng/ml)],但差异无统计学意义(P=0.665);D-二聚体水平明显升高[(282.90±31.92 ng/ml)vs(1118.40±301.50 ng/ml)],差异有统计学意义(P=0.045)。Pearson相关性分析结果示TM与睡眠期呼吸紊乱指数(AHI)及氧减指数(ODI)两参数间相关性无意义;D-二聚体与两参数间亦未见相关性(P0.05)。结论:SAS有较高的脑血管发病率;SAS患者均存在明确的内皮细胞功能及凝血-纤溶系统的受损,与脑血管疾病发生有相同的病理基础,因此我们认为血管内皮细胞功能的损害及其继发的功能紊乱是SAS并发CVD的机制之一。
[Abstract]:Objective: to investigate the changes of vascular endothelial cell function and coagulation-fibrinolytic system function in patients with sleep apnea syndrome. Methods: all the patients were selected from the Department of Neurology Department of Peking University Shenzhen Hospital from February 2008 to February 2009. Body mass index (BMI), past history (hypertension, coronary heart disease, cerebrovascular disease), chest radiography, electrocardiogram, blood routine, blood biochemistry and so on were calculated. Brain MRI scan and polysomnography were performed. 30 patients with sleep apnea syndrome (SAS) were selected. There were 16 cases of SAS with cerebrovascular disease and 14 cases without cerebrovascular disease. Fifteen patients without cerebrovascular disease or without sleep apnea syndrome were randomly selected as control group. Thrombomodulin (TMN) was detected by enzyme-linked immunosorbent assay (Elisa). ELISA).D dimer was determined by latex enhanced immunoturbidimetry. Results: there was no significant difference in age, sex and body mass index (BMI) between SAS group and control group (including or without CVD.Compared with control group), there was no significant difference in age, sex and body mass index (BMI) between SAS group and control group (P 0.05). TM levels in SAS patients (including or without CVDs) were significantly increased [0.3814 卤0.08 ng/ml)vs(0.2801 卤0.07 ng / ml] the level of D-dimer also increased significantly. [786.40 卤423.50 ng/ml)vs(124.10 卤24.46 ng / ml]. The incidence of cerebrovascular disease in sleep apnea syndrome was as high as 53.3% / 30%. Compared with the group without CVD, the difference was statistically significant (P = 0.46 and 0.013) respectively. TM level increased in CVD group. [0. 3612 卤0. 09 ng/ml)vs(0.3910 卤0. 08 ng / ml], but the difference was not statistically significant (P < 0. 665). D- dimer level increased significantly. [282.90 卤31.92 ng/ml)vs(1118.40 卤301.50 ng / ml]. The results of correlation analysis showed that TM was associated with respiratory disorder index (AHII) and oxygen reduction index (ODI) during sleep. The correlation between the two parameters is meaningless; There was also no correlation between D-dimer and the two parameters (P 0. 05). Conclusion the incidence of cerebrovascular disease is higher in the patients with SAS than in the controls. All patients with SAS had clear endothelial cell function and impaired coagulation and fibrinolysis system, which had the same pathological basis as the occurrence of cerebrovascular disease. Therefore, we suggest that the impairment of vascular endothelial cell function and its secondary dysfunction may be one of the mechanisms of SAS complicated with CVD.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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