本文關鍵詞： C-反應蛋白 預后 動脈粥樣硬化型 腦梗死 C-反應蛋白 基因多態(tài)性 基因 預后 大動脈粥樣硬化型 腦梗死　出處：《南方醫(yī)科大學》2017年博士論文　論文類型：學位論文

【摘要】：C-反應蛋白(C-reactive protein,CRP)水平及其基因多態(tài)性可能影響腦梗死預后。但關于CRP水平及基因多態(tài)性與大動脈粥樣硬化型(Large-artery atherosclerosis,LAA)腦梗死預后的關系尚不明了。本課題旨在探討CRP水平及其基因多態(tài)性與LAA腦梗死預后的相關性。第一章CRP血清水平與大動脈粥樣硬化型腦梗死預后的相關研究目的:探討LAA腦梗死急性期CRP血清水平與患者長期神經(jīng)功能缺失狀態(tài)及主要血管復發(fā)事件的相關性。方法:以南京卒中登記系統(tǒng)為基礎,前瞻性登記2012年1月至2014年6月首次發(fā)作的LAA腦梗死患者。收集患者一般臨床資料及發(fā)病2周內(nèi)靜脈血。對所有納入研究的患者進行為期1年的隨訪,記錄患者1年mRS評分及主要血管復發(fā)事件。分別采用多元Logistic回歸分析和Cox比例風險模型對患者1年神經(jīng)功能缺失狀態(tài)及主要血管復發(fā)事件進行分析。結果:本研究共收集符合納入標準患者625例(男性458例)。經(jīng)過1年隨訪,共63例患者發(fā)生主要血管復發(fā)事件。相比CPR≤2.40mg/l組患者,CPR2.40 mg/l組患者1年神經(jīng)功能恢復狀態(tài)明顯較差(P = 0.007)。Log CRP水平越高,患者1年神經(jīng)功能恢復狀態(tài)越差(P= 0.002)。按性別進行分層,在男性組和女性組中CRP水平均為1年神經(jīng)功能恢復狀態(tài)獨立預測指標。相比CPR≤2.40 mg/l組患者,CPR2.40 mg/l組患者1年主要血管復發(fā)事件較多(P = 0.036),校正可能混雜因素后,兩組主要血管復發(fā)事件無顯著統(tǒng)計學差異(P = 0.110)。結論:LAA腦梗死發(fā)病2周內(nèi)CRP血清水平可預測患者1年神經(jīng)功能恢復狀態(tài),但不能預測患者1年主要血管復發(fā)事件的發(fā)生。第二章CRP基因多態(tài)性與大動脈粥樣硬化型腦梗死預后的相關性目的:探討中國漢族人群中CRP基因多態(tài)性與LAA腦梗死患者發(fā)病3個月的神經(jīng)功能恢復狀態(tài)的相關性。方法:以南京卒中登記系統(tǒng)為基礎,前瞻性登記2013年8月至2015年10月首次發(fā)作的LAA腦梗死患者。根據(jù)GWAS研究報道,篩選出5個與亞洲人群CRP 血清水平相關的 CRP 基因位點(rs876537,rs2794520,rs3093059,rs7553007及rs11265260)進行基因分型。記錄患者3個月mRS評分。結果:共690例患者(男性507例)納入研究。CRP基因rs3093059(顯性模型:OR = 2.49;95%CI 1.55-4.00;隱性模型:OR = 3.67;95%CI 1.22-11.03)和rs11265260(顯性模型:OR = 2.51;95%CI 1.56-4.02;隱性模型:OR = 4.70;95%CI1.63-13.56)與患者3個月預后不良顯著相關。相比CACAC單倍體,單倍體 TCCCC(OR = 2.54;95%CI 1.14-5.68)和 TACAC(OR = 2.40;95%CI,1.24-4.64)增加患者3個月預后不良風險。結論:在中國漢族人群中,CRP基因rs3093059和rs11265260基因多態(tài)性與LAA腦梗死患者3個月神經(jīng)功能恢復狀態(tài)相關。
[Abstract]:C-reactive protein. The level of CRP and its gene polymorphism may affect the prognosis of cerebral infarction. Large-artery atherosclerosis. LAA). The relationship between the prognosis of cerebral infarction and the level of CRP, its gene polymorphisms and the prognosis of cerebral infarction in LAA is not clear. Chapter 1: the serum level of CRP and the prognosis of atherosclerotic cerebral infarction. The objectives of the study are as follows:. To investigate the correlation between the serum level of CRP in acute phase of cerebral infarction (LAA) and the long-term neurological deficit and recurrent events in patients with acute cerebral infarction. Methods: based on the Nanjing Stroke Registration system. Prospective registration of patients with LAA cerebral infarction from January 2012 to June 2014. General clinical data were collected and venous blood was collected within 2 weeks of onset. All patients included in the study were included in the study for a period of one year. Follow up. The 1-year mRS score and major vessel recurrence events were recorded. Multivariate Logistic regression analysis and Cox proportional risk model were used to evaluate the 1-year neurological deficit and major vascular recurrence in patients. Results:. A total of 625 patients who met the inclusion criteria were collected in this study (. Male 458 cases were followed up for 1 year. A total of 63 patients had major vascular recurrence events, compared with CPR 鈮，

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