本文選題：慢性血栓栓塞性肺動脈高壓 + 組織因子　； 參考：《福建醫(yī)科大學》2015年碩士論文

【摘要】：目的:檢測纖維蛋白原(Fg)、D-二聚體、C-反應蛋白(CRP)、腫瘤壞死因子-α(TNF-α)、單核趨化蛋白-1(MCP-1)、組織因子(TF)和單核細胞TF(TF m RNA)在慢性血栓栓塞性肺動脈高壓(CTEPH)患者的表達情況,了解CTEPH的血凝狀態(tài),CRP、TNF-α、MCP-1與CTEPH疾病嚴重程度及其與TF之間的關系,探討單核細胞組織因子和炎性因子在CTEPH發(fā)生發(fā)展中的可能作用。方法:入選2013年6月至2014年10月于福建醫(yī)科大學附屬第一醫(yī)院診為CTEPH的患者10例、急性肺栓塞(PTE)患者20例,排除CTEPH的肺動脈高壓(PH)患者15例,選取20例在本院體檢中心體檢健康者作為對照組,選用凝固法檢測血中Fg的含量,免疫比濁法檢測血中D-二聚體和CRP含量,用酶聯(lián)免疫吸附分析(ELISA)法分別檢測血漿中TNF-α、MCP-1、TF抗原含量,發(fā)色底物法測定血漿中TF活性,Percoll密度梯度離心法分離外周血單核細胞,選用逆轉錄-聚合酶鏈反應(RT-PCR法)檢測單核細胞TF m RNA表達,將各項檢測指標進行相關性分析。結果:(1)CTEPH患者血漿Fg(4.404±0.563)、D-二聚體水平(1.075±1.507)較正常人(2.668±0.425,0.181±0.076)高,其中Fg水平升高差異有統(tǒng)計學意義(P=0.00010.01),D-二聚體升高無統(tǒng)計學意義(P=0.3900.05)。CTEPH組患者肺動脈平均壓79.7±21.193mm Hg,與血漿Fg水平呈正相關(r=0.843,P=0.002㩳0.05),與血漿D-二聚體水平無相關性(r=-0.082,P=0.8210.05)。(2)CTEPH患者血漿CRP含量(26.440±5.175)較正常人(2.417±1.707)高,差異有統(tǒng)計學意義(P=0.00010.01),其中CTEPH患者肺動脈平均壓與CRP水平呈正相關(r=0.922,P=0.001㩳0.05);CTEPH患者血漿TNF-α(32.340±4.525)、MCP-1水平(45.487±16.522)均高于對照組(12.116±7.404,22.267±8.594),差異有統(tǒng)計學意義(P=0.0001㩳0.01,P=0.008㩳0.01);其中CTEPH患者肺動脈平均壓與MCP-1水平呈正相關(r=0.661,P=0.037㩳0.05),與TNF-α水平無關(r=0.487,P=0.1540.05)。(3)CTEPH患者血漿TF活性(24.350±6.103)和TF抗原(45.677±12.061)含量均高于對照組(20.236±3.293,27.924±3.333),其中TF抗原含量升高差異有統(tǒng)計學意義(P=0.0060.01),TF活性升高差異無統(tǒng)計學意義(P=0.3180.05)。CTEPH患者血中單核細胞TF m RNA(0.332±0.019)表達高于對照組(0.248±0.007),差異有統(tǒng)計學意義(P=0.0001㩳0.01),與血漿TF抗原含量相關性分析顯示二者呈正相關(r=0.826,P=0.003㩳0.01)。CTEPH患者血漿TF抗原含量與CRP(r=0.733,P=0.016㩳0.05)、TNF-α(r=0.662,P=0.037㩳0.05)、MCP-1(r=0.696,P=0.025㩳0.05)之間相關性分析均提示它們之間存在相關性。結論:CTEPH患者血中單核細胞TF m RNA表達高于對照組,與血漿TF抗原含量呈顯著正相關,提示CTEPH血源性組織因子可能主要來自于單核細胞;CTEPH患者血漿TF抗原含量與炎性因子CRP、TNF-α、MCP-1的高表達具有良好的相關性,提示TF、CRP、TNF-α和MCP-1可能在CTEPH的炎癥-凝血-血栓循環(huán)中發(fā)揮具有重要作用。
[Abstract]:Objective: to detect the expression of fibrinogen (Fg), D- two polymer, C- reactive protein (CRP), tumor necrosis factor alpha (TNF- alpha), mononuclear chemotactic protein -1 (MCP-1), tissue factor (TF) and mononuclear TF (TF m RNA) in chronic thromboembolic pulmonary hypertension. Degree and its relationship with TF to explore the possible role of monocyte tissue factor and inflammatory factor in the development of CTEPH. Methods: from June 2013 to October 2014, 10 patients who were diagnosed as CTEPH in the First Affiliated Hospital of Fujian Medical University, 20 cases of acute pulmonary embolism (PTE), and 15 cases of pulmonary arterial hypertension (PH) of CTEPH were excluded. 20 cases of healthy people in the physical examination center of our hospital were selected as the control group. The content of Fg in blood was detected by coagulation method. The content of D- two polymer and CRP in blood was detected by immunization turbidimetry. The content of TNF- alpha, MCP-1, TF antigen in plasma was detected by enzyme linked immunosorbent assay (ELISA). The activity of TF in plasma was measured by chromogenic substrate method and the Percoll density gradient was measured. Centrifugation was used to separate peripheral blood mononuclear cells. The expression of TF m RNA in mononuclear cells was detected by reverse transcription polymerase chain reaction (RT-PCR). The results were as follows: (1) the plasma Fg (4.404 + 0.563) of CTEPH patients and the level of D- two polymer (1.075 + 1.507) were higher than those of normal people (2.668 + 0.425,0.181 + 0.076), and the level of Fg increased The difference was statistically significant (P=0.00010.01). The increase of D- two polymer was not statistically significant (P=0.3900.05) in group.CTEPH, the average pressure of pulmonary artery was 79.7 + 21.193mm Hg, and there was a positive correlation with the plasma Fg level (r=0.843, P=0.002? 0.05), and no correlation with the level of plasma D- two polymer (r= -0.082,). (2) the plasma concentration (26.440 + 5.175) was more positive. The difference was statistically significant (P=0.00010.01). The average pressure of pulmonary artery in CTEPH patients was positively correlated with CRP (r=0.922, P=0.001? 0.05); the plasma TNF- alpha (32.340 + 4.525) and MCP-1 level (45.487 + 16.522) in CTEPH patients were higher than those in the group (12.116 + 7.404,22.267 + 8.594), and the difference was statistically significant (P=0.0001? 0.01, P). =0.008? 0.01); the average pressure of pulmonary artery in CTEPH patients was positively correlated with the level of MCP-1 (r=0.661, P=0.037? 0.05), not related to the level of TNF- alpha (r=0.487, P=0.1540.05). (3) the plasma TF activity (24.350 + 6.103) and TF antigen (45.677 + 12.061) in patients with CTEPH were higher than those of the control group (20.236 + 3.293,27.924 3.333). Statistical significance (P=0.0060.01), the increase of TF activity was not statistically significant (P=0.3180.05), the expression of TF m RNA (0.332 + 0.019) in the blood of.CTEPH patients was higher than that of the control group (0.248 + 0.007), the difference was statistically significant (P=0.0001? 0.01), and the correlation analysis with the plasma TF antigen content showed that the two was positively correlated (r=0.826, P=0.003? 0.01).CTEPH. The correlation analysis between the plasma TF antigen content and CRP (r=0.733, P=0.016? 0.05), TNF- alpha (r=0.662, P=0.037? 0.05), MCP-1 (r=0.696, P=0.025? 0.05) all indicated their correlation. Conclusion: the expression of the mononuclear cell TF in the blood of CTEPH patients is higher than that of the control group, which is significantly correlated with the plasma antigen content, suggesting the origin of blood origin. The tissue factor may mainly come from monocyte; the plasma TF antigen content of CTEPH patients has good correlation with the high expression of inflammatory factors CRP, TNF- alpha and MCP-1, suggesting that TF, CRP, TNF- alpha and MCP-1 may play an important role in the inflammation coagulation thrombus cycle of CTEPH.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R544.1

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