本文選題：不穩(wěn)定型斑塊 + Gensini評分　； 參考：《河北北方學院》2015年碩士論文

【摘要】：冠狀動脈動脈粥樣硬化斑塊的形成,發(fā)展和破裂過程中炎癥反應起著重要作用。目前發(fā)現(xiàn)大量的炎癥標志物與斑塊穩(wěn)定性相關。其中,白介素-6受體(interleukin 6 receptor,IL-6R)和白介素-6(interleukin 6,IL-6)結合形成復合物,通過心肌細胞豐富的gpl30信號轉導受體發(fā)揮作用,是動脈粥樣硬化重要的炎性標記物。金屬肽酶含血小板反應蛋白基元-1(adisintegrin and metalloprotease with thrombospongding type 1 motifs,ADAMTS-1)主要通過上調血管平滑肌細胞的增殖、遷移、凋亡,激活不同的細胞表面分子,參與細胞外基質的降解與重組過程,在冠狀動脈粥樣斑塊的初始、發(fā)展及破裂過程發(fā)揮重要作用。超敏C反應蛋白(high sensitive C reactive protein,hs-CRP)是急性炎癥期IL-6、腫瘤壞死因子(tumor necrosis factor,TNF)及其他細胞因子等刺激肝臟形成的一種急性反應蛋白,是冠心病的獨立危險因素。本研究通過觀察冠心病血清ADAMTS-1、IL-6R及hs-CRP水平,結合冠脈造影結果Gensini評分、斑塊Ambrose分類,探討ADAMTS-1、IL-6R、hs-CRP與不穩(wěn)定型斑塊關系;通過觀察急性冠脈綜合癥(acute coronary syndromes,ACS)患者經皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)術前與術后IL-6R及ADAMTS-1水平,探討PCI術對不穩(wěn)定型斑塊炎癥標記物IL-6R及ADAMTS-1的影響。本研究連續(xù)選取我院2013年3月至2013年12月住院24h內完成冠狀動脈造影(coronary angiography,CAG)患者328例。診斷為冠心病(coronary heart disease,CHD)272例,包括急性心肌梗死(acute myocardial infarction,AMI)105例、不穩(wěn)定型心絞痛(unstable angina,UA)126例、穩(wěn)定型心絞痛(stable angina,SA)41例;冠狀動脈無狹窄患者56例為對照組。ACS包括AMI及UA。AMI患者中39例行急診PCI;42例UA患者行PCI術。所有研究對象入院即刻采靜脈血,行PCI術ACS患者于PCI術后12h后再次采靜脈血,采用酶聯(lián)免疫吸附(enzyme linked immunosorbent assay,ELISA)法測定血清IL-6R、ADAMTS-1水平,采用日立7170A型全自動生化分析儀測定hs-CRP,總膽固醇(total cholesterol,TC),甘油三脂(triglycerides,TG)、低密度脂蛋白膽固醇(low density lipoprotein-cholesterol,LDL-C)水平。對冠心病患者CAG結果行Gensini評分,采用Ambrose分類評價斑塊性質。實驗結果表明:AMI組、UA組血清IL-6R、ADAMTS-1水平顯著高于SA組、對照組(P0.05);AMI組hs-CRP水平顯著高于UA組、SA組、對照組(P0.05);Ambrose分類復雜病變組IL-6R、ADAMTS-1、hs-CRP水平顯著高于簡單病變組、對照組(P0.05),簡單病變組ADAMTS-1水平顯著高于對照組(P0.05);采用Pearson相關檢驗CHD組IL-6R水平與ADAMTS-1水平呈顯著正相關(r=0.70,P0.05),IL-6R、ADAMTS-1、hs-CRP水平與Gensini評分無相關性(P0.05);多支病變組、雙支病變組及單支病變組各組間IL-6R及ADAMTS-1水平差異無統(tǒng)計學意義(P0.05);PCI術后12h PCI AMI組、PCI UA組IL-6R、ADAMTS-1水平均較入院時升高,差異有統(tǒng)計學意義(P0.05)。綜上所述IL-6R、ADAMTS-1及hs-CRP與不穩(wěn)定型斑塊具有相關性,與冠狀動脈的狹窄程度及病變的范圍無關;ACS患者PCI術后IL-6R、ADAMTS-1水平升高,IL-6R、ADAMTS-1可以預測斑塊的不穩(wěn)定性。
[Abstract]:Inflammation plays an important role in the formation, development and rupture of coronary atherosclerotic plaques. A large number of inflammatory markers are found to be associated with plaque stability. Among them, the interleukin -6 receptor (interleukin 6 receptor, IL-6R) and interleukin -6 (interleukin 6, IL-6) are combined to form complexes and are rich in cardiac myocytes. Gpl30 signal transduction receptor plays an important role in atherosclerosis. Metal peptidase contains platelet reactive protein -1 (adisintegrin and metalloprotease with thrombospongding type 1 motifs, ADAMTS-1), mainly by up regulating the proliferation, migration, and apoptosis of vascular smooth muscle cells, activating different cell surface fractions. The process of degradation and reorganization of the extracellular matrix plays an important role in the initial, development and rupture processes of coronary atherosclerotic plaques. The hypersensitive C reactive protein (high sensitive C reactive protein, hs-CRP) is an acute inflammatory stage IL-6, and the tumor necrosis factor (tumor necrosis factor, TNF) and other cytokines stimulate the formation of the liver. An acute reactive protein, an independent risk factor for coronary heart disease, is an independent risk factor for coronary heart disease. By observing the serum ADAMTS-1, IL-6R, and hs-CRP levels of coronary heart disease, combined with the Gensini score of coronary angiography and Ambrose classification of plaque, the relationship between ADAMTS-1, IL-6R, hs-CRP and unstable plaque was explored, and the acute coronary syndrome (acute coronary syndromes) was observed. ACS) the effect of PCI operation on the inflammatory markers IL-6R and ADAMTS-1 of unstable plaque before and after percutaneous coronary intervention (percutaneous coronary intervention, PCI), and IL-6R and ADAMTS-1 levels. This study selected our hospital from March 2013 to December 2013 to complete the coronary angiography (coronary). Aphy, CAG) 328 patients were diagnosed as coronary heart disease (coronary heart disease, CHD), including 105 cases of acute myocardial infarction (acute myocardial infarction, AMI), 126 cases of unstable angina pectoris (unstable angina), 41 cases of stable angina pectoris, 56 cases of coronary artery stenosis and 56 cases of coronary artery stenosis. In 39 cases, 39 cases were treated with emergency PCI, 42 cases of UA patients were performed PCI operation. All the subjects were admitted to the hospital immediately to collect venous blood. The PCI operation ACS patients recovered the venous blood after PCI after 12h, and used the enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA) method to determine the serum levels. CRP, total cholesterol (total cholesterol, TC), glycerol three fat (triglycerides, TG), low density lipoprotein cholesterol (low density lipoprotein-cholesterol, LDL-C). In group A and control group (P0.05), the level of hs-CRP in group AMI was significantly higher than that in group UA, group SA and control group (P0.05); the level of IL-6R, ADAMTS-1, hs-CRP in Ambrose classification complex group was significantly higher than that in the simple lesion group, and the control group (P0.05) was significantly higher than that in the control group. There was significant positive correlation (r=0.70, P0.05), IL-6R, ADAMTS-1, hs-CRP level had no correlation with Gensini score (P0.05), and there was no significant difference in IL-6R and ADAMTS-1 levels between the multi branch lesions group and the single branch lesion group (P0.05). Learning significance (P0.05). In summary, IL-6R, ADAMTS-1 and hs-CRP are associated with unstable plaques, not related to the degree of coronary stenosis and the extent of the lesion; IL-6R, ADAMTS-1 levels in ACS patients are elevated, IL-6R, and ADAMTS-1 can predict plaque instability after PCI.
【學位授予單位】：河北北方學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R541.4

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