動脈瘤性蛛網(wǎng)膜下腔出血患者腦脊液中可溶性血小板源性生長因子受體β與腦血管痙攣的相關性研究
發(fā)布時間:2018-03-01 01:34
本文關鍵詞: 蛛網(wǎng)膜下腔出血 腦血管痙攣 血小板源性生長因子 腦脊液 出處:《南方醫(yī)科大學》2017年碩士論文 論文類型:學位論文
【摘要】:研究背景:蛛網(wǎng)膜下腔出血(subarachnoid hemorrhage,SAH)是高致殘率和致死率的疾病,腦血管痙攣(cerebral vasospasm,CVS)是其主要的并發(fā)癥。有關CVS發(fā)生的確切機制目前尚不清楚。因此有必要對CVS進行進一步研究。血小板源性生長因子(PDGF)是生長因子超家族中的一員,與之結合的受體有PDGFR-a和-β兩個亞型。通常情況下,單體狀態(tài)下的PDGF和PDGFR并無生物學活性。PDGFR各亞型之間結構和功能相似,均有一個胞外域、跨膜域和一個胞內的酪氨酸激酶結構域,對跨膜信號進行轉導,對小血管的形成和傷口的修復具有著重要的調節(jié)作用。根據(jù)既往臨床及基礎研究提示sPDGFR可能會參與SAH后血管痙攣的發(fā)生。方法:本次研究包括2015年11月至2016年4月因動脈瘤性蛛網(wǎng)膜下腔出血入住我院神經(jīng)外科的患者。所有患者于SAH后1-3d、4-6d、7-9d行腰椎穿刺術留取腦脊液3ml,或者從留有腦室外引流管或者腰椎穿刺引流管處留取3ml腦脊液。對照組于接受椎管內麻醉前留取腦脊液1ml。所有腦脊液sPDGFR的濃度均有酶聯(lián)免疫吸附試驗(ELISA)測得。記錄患者年齡、性別、發(fā)病時間等一般資料,患者的臨床資料(Hunt-Hess分級、Fisher分級、世界神經(jīng)外科(WFNS)評分)以及患者影像學資料。結果:本研究共納入32例SAH患者,其中女性20例,男性12例。5例正常人腦脊液作為對照;颊叩钠骄挲g55.7± 12.3歲。SAH后1-3d,患者腦脊液中sPDGFRβ的平均濃度886.93 pg/ml。正常對照組的腦脊液中sPDGFRβ平均濃度484.04 pg/ml。SAH患者腦脊液中平均sPDGFRβ濃度高于正常對照組,差異有統(tǒng)計學意義(p=0.0012)。SAH后患者腦脊液樣本(1-3天,4-6天,and 7-9天)中,sPDGFR β的濃度隨時間的變化,直到7-9天達到高(886.93±242.86 pg/ml vs 1229.07±513.69 pg/ml vs 1338.13±468.30 pg/ml,p0.001)。ROC曲線分析后發(fā)現(xiàn)1-3dsPDGFR β濃度對腦血管痙攣有一定的預測能力。曲線下面積(AUC)是0.680(p=0.082)。sPGFR β濃度的診斷閾值是975.38 pg/ml。將患者分為兩組-血管痙攣組和非血管痙攣組,發(fā)現(xiàn)發(fā)生腦血管痙攣患者腦脊液中sPDGFRβ濃度明顯高于非血管痙攣組,差異有統(tǒng)計學意義(973.46±239.23pg/ml vs 788.85±213.99pg/ml,p=0.029),sPDGFRβ濃度與血管痙攣有明顯的相關性(Chi-square=5.542,p=0.019,r=0.416,p=0.018)。SAH 后1-3d腦脊液中高sPDGFRβ濃度是血管痙攣發(fā)生的獨立危險因素(p=0.001,OR=19.22,95%CI:3.27-113.03),除此之外,年齡(p0.001,OR=0.024,95%CI:0.004-0.157)和 WFNS分級IV-V(p=0.061,OR=5.196,95%CI:1-29.16)也是CVS發(fā)生的獨立危險因素。腦脊液中高sPDGFRβ濃度不是SAH患者6個月預后不良的獨立危險因素。結論:SAH后腦脊液中sPDGFR β濃度明顯升高,1-3d腦脊液中高sPDGFR β濃度與SAH后腦血管痙攣的發(fā)生明顯相關,且是腦血管痙攣發(fā)生的獨立危險因素。因此,早期檢測腦脊液中sPDGFRβ濃度對腦血管痙攣的診斷具有潛在臨床參考價值。
[Abstract]:Background: subarachnoid hemorrhage (SAH) is a disease with high disability rate and mortality. Cerebral vasospasmCVS is a major complication of cerebral vasospasm. The exact mechanism of CVS is not clear. Therefore, it is necessary to further study CVS. PDGF is a member of the superfamily of growth factors. The binding receptors are PDGFR-a and 尾 subtypes. In general, PDGF and PDGFR in monomer state have no biological activity. The structure and function of each subtype of PDGFR are similar, and each of them has an extracellular domain. Transmembrane domain and an intracellular tyrosine kinase domain transduction of transmembrane signal. SPDGFR may be involved in the development of vasospasm after SAH according to previous clinical and basic studies. Methods: this study includes November 2015 to 2016. Patients admitted to neurosurgery department for aneurysm subarachnoid hemorrhage. All patients received lumbar puncture at 1-3 d 4-6 d after SAH for 3 ml of cerebrospinal fluid, or 3 ml of brain from left ventricular drainage tube or lumbar puncture drainage tube. Spinal fluid. Cerebrospinal fluid (CSF) 1 ml was retained in the control group before being anesthetized into the spinal canal. The concentration of sPDGFR in all cerebrospinal fluid was measured by enzyme linked immunosorbent assay (Elisa). Sex, onset time and other general data, clinical data of patients with Hunt-Hess grade and Fisher grade, World Neurosurgery WFS score) and imaging data of patients. Results: 32 patients with SAH were included in this study, 20 of whom were women. The average age of patients was 55.7 鹵12.3 years. The average concentration of sPDGFR 尾 in CSF was 886.93 PG / ml. The average concentration of sPDGFR 尾 in CSF of normal controls was 484.04 pg/ml.SAH. The concentration was higher than that in the control group. There was a significant difference in the concentration of sPDGFR 尾 with time in cerebrospinal fluid (CSF) samples of patients with SAH (1-3 days, 4-6 days and 7-9 days). By 7 to 9 days after reaching a high level of 886.93 鹵242.86 pg/ml vs 1229.07 鹵513.69 pg/ml vs 1338.13 鹵468.30 PG / ml P 0.001U, ROC curve analysis showed that the concentration of 1-3dsPDGFR 尾 could predict cerebral vasospasm to some extent, and the area under the curve was 0.680p0.082n.sPGFR 尾 concentration, the diagnostic threshold was 975.38 PG / ml. Spastic group and non-vasospasm group, It was found that the concentration of sPDGFR 尾 in cerebrospinal fluid of patients with cerebral vasospasm was significantly higher than that of non-vasospasm group. The difference was statistically significant (973.46 鹵239.23 PG / ml vs 788.85 鹵213.99pg / ml / ml / ml / ml respectively) and there was a significant correlation between the concentration of sPDGFR 尾 and vasospasm. In addition, the high concentration of sPDGFR 尾 in cerebrospinal fluid was an independent risk factor for the development of vasospasm. In addition, high sPDGFR 尾 concentration in cerebrospinal fluid was found to be an independent risk factor for the development of vasospasm. Age (p 0.001) and WFNS grade IV-V: 0.061) are also independent risk factors for the occurrence of CVS. High sPDGFR 尾 concentration in cerebrospinal fluid is not an independent risk factor for poor prognosis in patients with SAH at 6 months. Conclusion the concentration of sPDGFR 尾 in cerebrospinal fluid is significantly higher than that in cerebrospinal fluid for 1 to 3 days after CVS. The moderate and high concentration of sPDGFR 尾 was significantly correlated with the occurrence of cerebral vasospasm after SAH. Therefore, early detection of sPDGFR 尾 concentration in cerebrospinal fluid has potential clinical reference value in the diagnosis of cerebral vasospasm.
【學位授予單位】:南方醫(yī)科大學
【學位級別】:碩士
【學位授予年份】:2017
【分類號】:R743.35
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