基质金属蛋白酶-3基因多态与颈动脉斑块稳定性的关系

目的 探讨基质金属蛋白酶-3(matrix metalloproteinase-3,MMP-3)血清水平及启动子基因5A/6A多态与颈动脉斑块稳定性的关系.方法 280例急性脑梗死患者根据颈动脉超声结果 分为颈动脉易损斑块组(124例)和颈动脉稳定斑块组(156例).采用ELISA法测定两组患者的血清MMP-3水平,同时采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法分析MMP-3启动子基因5A/6A多态性.结果 易损斑块组发病48 h内的血清MMP-3水平为(23.8±8.3)ng/μl,而稳定斑块组为(20.0±10.0)ng/μl(t=3.39,P=0.00).易损斑块组5A/6A+5A/5A基因型频率为39.5%,稳定斑块组为25.6%,两者比较差异有统计学意义(χ2=6.13,P:0.01,DR=1.90,95%CI,1.14～3.15),5A等位基因频率在易损斑块组为20.6%,稳定斑块组为12.8%,两者比较差异也有统计学意义(χ2=6.09,P=0.01,DR=1.76,95%CI 1.12～2.77).结论 MMP-3血清水平及启动子基因5A/6A多态性可能与中国汉族人群颈动脉易损斑块发生的倾向性有关,5A等位基因可能是颈动脉易损斑块的遗传易患标志之一.     

趋化因子受体CX3CR1基因多态与中国北方人群脑梗死的关系

目的探索趋化因子受体CX3CR1基因单核苷酸多态(SNPs)与中国北方人群脑梗死发病的关系。方法不同类型的脑梗死患者563例及健康对照563例,周围静脉全血提取单个核细胞基因组DNA并行PCR分段扩增CX3CR1基因。抽取其中各200例进行CX3CR1基因测序,明确脑梗死组和对照组的SNP情况。两组剩下的各363例针对查到的SNP位点设计引物,将包含SNP位点的局部片段进行PCR及基因测序以检测SNP情况。结果发现研究人群有rs3732379(C→T)、rs3732378(G→A)、rs1050592(T→C)3个SNP位点。其中脑梗死组rs3732379位点T碱基及TT、TC基因型,rs3732378位点A碱基及AA、GA型,rs1050592位点C碱基及CC、TC型的频率均明显高于对照组。rs3732379、rs3732378、rs1050592间有显著的连锁不平衡,形成3种单倍型(按前述3个SNP的三座位碱基顺序,分别为T-A-C、T-G-C、C-G-T)及6种基因型。单倍型分析显示:单倍型T-A-C的频率与脑梗死的发病相关(OR=5.24,P=0.002)。结论在中国北方人群中,携带rs3732379位点T碱基及TT、TC型,rs3732378位点A碱基及AA、GA型,rs1050592位点C碱基及CC、TC型与脑梗死的发病相关,携带单倍型T-A-C是脑梗死发病的危险因素。     

单胺氧化酶B基因多态与早发帕金森病的相关性

目的 探讨单胺氧化酶B(MAO-B)基因型和等位基因与早发帕金森病(early-onset Parkinson's disease,EOPD)的关系.方法 采取聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法,研究65例EOPD患者(<50岁)、60例晚发PD(late-onset Parkinson's disease,LOPD)患者(≥60岁)和66名健康对照者(<50岁)的基因型频率和等位基因频率的分布差异.结果 EOPD组的AA基因型频率(49/65,75.4%)高于健康对照组(34/66,51.5%),差异有统计学意义(x2=8.075,P=0.018);LOPD组分别与EOPD组、健康对照组的从基因型频率比较,差异无统计学意义;男性EOPD组分别与男性健康对照组、男性LOPD组,女性EOPD组分别与女性健康对照组、女性LOPD组的AA基因型频率比较,差异无统计学意义;男性LOPD组与男性健康对照组、女性LOPD组与女性健康对照组的AA基因型频率比较,差异无统计学意义.EOPD组的A等位基因频率(107/130,82.3%)高于健康对照组(87/132,65.9%),差异有统计学意义(X2=9.165,P=0.002);LOPD组分别与EOPD组、健康对照组的A等位基因频率比较,差异无统计学意义;男性EOPD组的A等位基因频率(60/70,85.7%)高于男性健康对照组(51/72,70.8%),差异有统计学意义(x2=4.606,P=0.032);女性EOPD组的A等位基因频率(47/60,78.3%)高于女性健康对照组(36/60,60.0%),差异有统计学意义(x2=4.728,P=0.030);男性LOPD组分别与男性EOPD组、男性健康对照组,女性LOPD组分别与女性EOPD组、女性健康对照组的A等位基因频率比较,差异均无统计学意义.结论 MAO-B的从基因型频率增高是EOPD组发病的危险因素;MAO-B的A等位基因频率增高是EOPD组、男性EOPD组及女性EOPD组发病的危险因素.     

单胺氧化酶B基因多态与早发帕金森病的相关性

Objective To investigate the association between polymorphisms in monoamine oxidase B (MAO-B)and early-onset Parkinson's disease(EOPD).Methods Polymerase chsin reactionrestriction fragment length polymorphism was used to identify the genotypes of polymorphisms in MAO-B in 65 patients in EOPD group(early-onset age<50 years),60 in late-onset Parkinson's disease(LOPD) group(late-onset age≥160 years)and 66 healthy controls(<50 years).Results The frequency of AA genotype was higher in EOPD groups(49/65,75.4%)than in healthy controls(34/66,51.5%),and the difference between them was statistically significant(x2=8.075,P=0.018).The frequency of AA genotype between EOPD group and LOPD group,between LOPD group and healthy controls had no statistical significance.The frequency of AA genotype between male in EOPD group and male healthy controls,between female in EOPD group and female healthy controls had no statistical significance.The frequencies of AA genotype between male in EOPD group and LOPD group,between female in EOPD group and in LOPD group had no statistical significance.The frequency of AA genotype between male in LOPD group and in healthy controls,between female in LOPD group and female healthy controls had no statistical significance.The frequency of A alleles was higher in EOPD group(107/130,82.3%)than in healthy controls(87/132,65.9%)and the difierence between them was statistical significant(x2=9.165,P=0.002).The frequency of A allele between EOPD group and LOPD group,between LOPD group and healthy controls had no statistical significance. The frequency of A allele was higher in male EOPD group (60/70,85.7%) than in male healthy controls(51/72,70. 8% ), the difference between them was statistically significant (X2 =4. 606, P=0. 032) ;the frequency of A alleles was higher in female in EOPD group (47/60,78. 3% ) than in female healthy controls(36/60,60. 0% ), the difference between them was statistical significance( x2 =4. 728, P = 0. 030). The frequency of A alleles between male EOPD group and male LOPD group, between female EOPD group and female LOPD group had no statistical significance. The frequency of A allele between male LOPD group and male healthy controls, between female LOPD group and female healthy controls had no statistical significance. Conclusions The AA genotype of MAO-B is the risk factor of EOPD. The A allele of MAO-B is a risk factor of EOPD group for both male and female.     

单胺氧化酶B基因多态与早发帕金森病的相关性

Objective To investigate the association between polymorphisms in monoamine oxidase B (MAO-B)and early-onset Parkinson's disease(EOPD).Methods Polymerase chsin reactionrestriction fragment length polymorphism was used to identify the genotypes of polymorphisms in MAO-B in 65 patients in EOPD group(early-onset age<50 years),60 in late-onset Parkinson's disease(LOPD) group(late-onset age≥160 years)and 66 healthy controls(<50 years).Results The frequency of AA genotype was higher in EOPD groups(49/65,75.4%)than in healthy controls(34/66,51.5%),and the difference between them was statistically significant(x2=8.075,P=0.018).The frequency of AA genotype between EOPD group and LOPD group,between LOPD group and healthy controls had no statistical significance.The frequency of AA genotype between male in EOPD group and male healthy controls,between female in EOPD group and female healthy controls had no statistical significance.The frequencies of AA genotype between male in EOPD group and LOPD group,between female in EOPD group and in LOPD group had no statistical significance.The frequency of AA genotype between male in LOPD group and in healthy controls,between female in LOPD group and female healthy controls had no statistical significance.The frequency of A alleles was higher in EOPD group(107/130,82.3%)than in healthy controls(87/132,65.9%)and the difierence between them was statistical significant(x2=9.165,P=0.002).The frequency of A allele between EOPD group and LOPD group,between LOPD group and healthy controls had no statistical significance. The frequency of A allele was higher in male EOPD group (60/70,85.7%) than in male healthy controls(51/72,70. 8% ), the difference between them was statistically significant (X2 =4. 606, P=0. 032) ;the frequency of A alleles was higher in female in EOPD group (47/60,78. 3% ) than in female healthy controls(36/60,60. 0% ), the difference between them was statistical significance( x2 =4. 728, P = 0. 030). The frequency of A alleles between male EOPD group and male LOPD group, between female EOPD group and female LOPD group had no statistical significance. The frequency of A allele between male LOPD group and male healthy controls, between female LOPD group and female healthy controls had no statistical significance. Conclusions The AA genotype of MAO-B is the risk factor of EOPD. The A allele of MAO-B is a risk factor of EOPD group for both male and female.     

基质金属蛋白酶—3基因多态性与颈动脉狭窄的相关性

目的探讨基质金属蛋白酶-3(Matrix metalloproteinase-3,MMP-3)启动子-1612 5A/6A基因多态性与颈动脉狭窄的关系,同时检测血清MMP-3水平及与颈动脉狭窄的相关机制。方法采用聚合酶链反应-限制性酶切片段长度多态性(PCR-RFLP)方法分析421例颈动脉狭窄患者和171例对照组MMP-3启动子-1612 5A/6A基因多态性,同时用酶联免疫吸附法(Enzyme LinkedImmunoSorbent Assay,ELISA)测定两组研究对象的血清MMP-3水平。结果颈动脉狭窄组6A/6A基因型频率与对照组相比差异有统计学意义(OR=2.55,95%CI1.07～6.07,P=0.026),同时6A等位基因频率在颈动脉狭窄组明显高于对照组(OR=1.58,95%CI1.08～2.33,p=0.014)。颈动脉狭窄组的MMP—3血浆浓度与对照组相比明显增高(19±9vs 16±7μg/L,P0.01)。MMP-3基因6A/6A纯合子和血浆MMP-3浓度明显相关(P0.01)。结论 MMP-3启动子-16125A/6A基因多态性与颈动脉狭窄有关,6A等位基因可能是颈动脉狭窄的遗传易感标志,这可能与MMP-3血浆浓度增加有关。     

新生大鼠海马神经干细胞表达趋化因子受体CX3CR1的体外研究

目的 探讨体外培养神经干细胞是否表达趋化因子受体CX3CR1.方法 采用无血清方法分离、培养新生大鼠海马神经干细胞,细胞免疫荧光方法检测神经干细胞标志巢蛋白(nestin)表达及干细胞多向分化为神经元及胶质细胞的能力,后通过细胞免疫荧光及RT-PCR方法检测神经干细胞表达趋化因子受体CX3CR1的情况.结果 体外培养新生大鼠海马神经干细胞呈nestin阳性.可分化为神经丝蛋白200(NF200)阳性的神经元、胶质纤维酸性蛋白(GFAP)阳性的星形胶质细胞及2',3'-环核苷酸-3'-磷酸二酯酶(CNP)阳性的少突胶质细胞,细胞免疫荧光及RT-PCR证实神经干细胞表达趋化因子受体CX3CR1.结论 新生大鼠海马神经干细胞表达趋化因子受体CX3CR1.为进一步研究其体内外迁移提供理论依据.     

缺血性脑血管病患者趋化因子受体CX3CR1基因T280M多态性的研究

目的探讨缺血性脑血管病(ICVD)患者趋化因子受体CX3CR1基因T280M的多态性及其频率。方法采用聚合酶链反应和限制性片段长度多态性方法检测165例ICVD患者(脑梗死85例,腔隙性脑梗死40例,短暂性脑缺血发作40例)与150名健康对照者(正常对照组)CX3CR1基因T280M的多态性,比较两组及ICVD亚组的基因频率。结果正常对照组CX3CR1基因T280M只有TT和TM基因型,ICVD组有TT、TM和MM3种基因型,两组间基因型的差异有统计学意义(P<0.05);ICVD组M等位基因频率(8.7%)明显高于正常对照组(2.3%)(P<0.01);不同ICVD亚组之间基因型及M等位基因频率的差异无统计学意义(均P>0.05)。结论ICVD患者趋化因子受体CX3CR1基因T280M有MM基因型,并且M等位基因的频率明显增高,提示CX3CR1基因T280M多态性可能与ICVD有关。     

基质金属蛋白酶-7血清水平及其基因-181A/G多态性对颈动脉斑块稳定性的影响

目的 探讨基质金属蛋白酶-7(matrix metalloproteinase-7,MMP-7)血清水平及其基因启动子区-181 A/G多态性对颈动脉斑块稳定性的影响.方法 503例患有颈动脉粥样硬化性疾病的患者根据B型超声检查结果分为颈动脉易损斑块组(118例)和稳定斑块组(385例).采用ELISA法检测两组患者血清MMP-7水平,同时运用聚合酶链反应-限制性片段长度多态性方法(PCR-RFLP)分析两组患者MMP-7基因启动子-181A/G多态性.结果 易损斑块组血清MMP-7水平为(19.31 ± 8.10)μg/L,而稳定斑块组为(14.98±4.97)μg/L,两者相比差异有统计学意义(t=5.49,P=0.00).MMP-7基因启动子-181位点AG+GG基因型及G等位基因总体分布在易损斑块组和稳定斑块组间比较差异有统计学意义(OR=1.81,P=0.025和OR=1.71,P=0.029).易损斑块组内AG+GG基因型患者血清MMP-7水平较从基因型者高(t=2.62,P=0.01),而稳定斑块组内AG+GG基因型和AA基因型间MMP-7血清水平相比差异无统计学意义(t=6.51,P=0.52).结论 血清MMP-7水平可能成为颈动脉易损斑块检测的一个生物学指标.MMP-7基因启动子区-181A/G多态性可能影响MMP-7蛋白的表达,从而与颈动脉易损斑块的遗传易患性密切相关.

Abstract：

Objective To explore the influence of plasma matrix metalloproteinase-7 ( MMP-7 ) levels and genetic polymorphism of MMP-7 - 181 A/G on the stability of carotid plaque.Method According to carotid ultrasound examination, 503 patients with carotid atherosclerotic lesions were consecutively recruited and divided into vulnerable plaque group (n = 118) and stable plaque group (n = 385).Plasma MMP-7 levels were measured by enzyme-linked immunosorbent assay (ELISA), and MMP-7 -181 A/G genotypes were determined by polymerase chain reaction-restiction fragment length polymorphism (PCR-RFLP).Results Plasma MMP-7 levels in carotid vulnerable plaque group were significantly enhanced as compared to stable plaque group (t =5.49, P =0.00).The frequency of MMP-7 -181G allele in vulnerable plaque group was significantly higher than that in stable plaque group (11.4% vs 7.0% ,χ2 = 4.78, P= 0.029).Compared to AA genotype, the genotypes with - 181G allele (AG + GG) significantly increased susceptibility to carotid vulnerable plaque ( χ2 = 5.01, OR = 1.81, P = 0.025 ) .When further analyzing the relationship between genotype and plasma MMP-7 levels, no significant differences of plasma MMP-7 levels were observed between AA genotype and AG + GG genotype in stable plaque group.However, in vulnerable plaque group, plasma MMP-7 levels of AG + GG genotype were significantly higher than that of AA genotype( t = 2.62, P = 0.01).Conclusion The present findings suggest that plasma MMP-7 level may be a biomarker for carotid vulnerable plaque.Genetic polymorphism of - 181 A/G in MMP-7 promoter may affect the expression of MMP-7, and seems to be implicated in susceptibility to carotid vulnerable plaque.     

基质金属蛋白酶-7血清水平及其基因-181A/G多态性对颈动脉斑块稳定性的影响

Objective To explore the influence of plasma matrix metalloproteinase-7 ( MMP-7 ) levels and genetic polymorphism of MMP-7 - 181 A/G on the stability of carotid plaque.Method According to carotid ultrasound examination, 503 patients with carotid atherosclerotic lesions were consecutively recruited and divided into vulnerable plaque group (n = 118) and stable plaque group (n = 385).Plasma MMP-7 levels were measured by enzyme-linked immunosorbent assay (ELISA), and MMP-7 -181 A/G genotypes were determined by polymerase chain reaction-restiction fragment length polymorphism (PCR-RFLP).Results Plasma MMP-7 levels in carotid vulnerable plaque group were significantly enhanced as compared to stable plaque group (t =5.49, P =0.00).The frequency of MMP-7 -181G allele in vulnerable plaque group was significantly higher than that in stable plaque group (11.4% vs 7.0% ,χ2 = 4.78, P= 0.029).Compared to AA genotype, the genotypes with - 181G allele (AG + GG) significantly increased susceptibility to carotid vulnerable plaque ( χ2 = 5.01, OR = 1.81, P = 0.025 ) .When further analyzing the relationship between genotype and plasma MMP-7 levels, no significant differences of plasma MMP-7 levels were observed between AA genotype and AG + GG genotype in stable plaque group.However, in vulnerable plaque group, plasma MMP-7 levels of AG + GG genotype were significantly higher than that of AA genotype( t = 2.62, P = 0.01).Conclusion The present findings suggest that plasma MMP-7 level may be a biomarker for carotid vulnerable plaque.Genetic polymorphism of - 181 A/G in MMP-7 promoter may affect the expression of MMP-7, and seems to be implicated in susceptibility to carotid vulnerable plaque.     

颈动脉狭窄闭塞性病变后交通支开放与椎动脉起始段狭窄的关系

目的探讨颈动脉狭窄闭塞性病变(≥70%)患者后交通支开放与否与椎动脉起始段狭窄的关系。方法对160例经血管造影证实颈动脉动脉狭窄(≥70%)并行外科治疗(内膜剥脱术、颈动脉支架术)的患者分为后交通支开放组与后交通支未开放组,术前及术后均采用彩色多普勒血流成像(CDFI)检测双侧颈动脉及椎动脉,分别比较两组患者双侧椎动脉起始段狭窄的发生率。结果后交通支开放组椎动脉起始段局部流速术前(后交通支开放)明显高于术后(后交通支关闭)。后交通支关闭前后椎动脉起始段峰值流速(PSV)与舒张末流速(EDV)分别为100.76±74.84cm/s、81.54±54.29 cm/s(P=0.000);后交通支开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占45.6%(73/160),后交通支未开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占28.1%(45/160),两者之间存在显著差异(P=0.002)。结论颈动脉狭窄闭塞性病变后交通支开放患者,椎动脉起始段狭窄的发生率显著升高。     

缺血性眼病与颈动脉狭窄的相关研究

目的 探讨颈动脉狭窄的病因及缺血性眼病的发生与颈动脉狭窄的关系.方法 经颅多普勒超声(TCD)及数字减影血管造影(DSA)检查明确有颈动脉狭窄患者300例,男性246例,女性54例,年龄31～78岁,单侧126例,双侧174例.利用统计学方法对颈动脉狭窄发病的相关因素、狭窄程度及颈动脉狭窄与其所导致的缺血性眼病的关系进行分析.结果 颈动脉狭窄的主要发病因素是动脉粥样硬化;颈动脉狭窄的发病与年龄、性别、高血压、高血脂、高同型半胱氨酸血症等因素相关;颈动脉狭窄患者中37.3%出现了眼部症状,包括一过性黑矇、复视、视力下降、甚至失明,一过性黑矇是最常见的眼部症状(占37.5%),其原因与颈动脉狭窄导致视网膜中央(分支)动脉阻塞、静脉淤滞性视网膜病变、新生血管性青光眼等有关;眼部症状的出现与狭窄的程度、部位有关.结论 颈动脉狭窄造成的眼部供血下降可以导致多种缺血性眼病,眼部症状的出现与颈动脉狭窄的程度及部位有密切关系.同时也为今后的预防、治疗提供了重要的依据.     

支架血管成形术治疗颈动脉狭窄的临床研究

目的探讨支架辅助血管成形术(CAS)治疗颈动脉狭窄的临床意义及其安全性。方法回顾性分析已经行支架辅助血管成形术的32例患者的临床资料,重点对手术方法、并发症、疗效进行总结。结果所有患者均有不同程度的反复短暂性脑缺血发作或不同部位的脑梗死,均经DSA证实有颈内动脉狭窄。所有病人都顺利完成支架植入,术前的平均狭窄率(NASCET方法计算)为(78．5±8．6)％,治疗以后的平均狭窄率为(17．2±8．3)％,两者相比差异有显著性意义(P<0．05);有5例患者出现术后低血压、心动过缓,有2例出现术后高灌注综合征,无一例发生脑梗此。术后随访6-12月,无颈动脉支架植入后的冉狭窄的发生,未见脑梗死及短暂性脑缺血发作。结论支架辅助血管成形术是治疗颈动脉狭窄有效、安全的方法。     

无症状性ICA患者行颈动脉支架置入术对认知功能的影响

目的 探讨颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响。方法 以本院2012年2月～2014年2月治疗的96例行颈动脉支架置入术的无症状性颈动脉高度狭窄患者为研究组,以同期90例行常规内科治疗的无症状性颈动脉高度狭窄患者为对照组,分别在治疗前3 d和治疗后3个月采用连线测验(TMTa、TMTb)、简易智能量表(MMSE)、阿尔茨海默病评估量表认知部分(ADAS-Cog)评估患者的认知功能。结果 研究组患者治疗前3 d颈动脉狭窄为(79.51±6.02)%,治疗后3个月残余狭窄为(13.52±6.01)%,治疗后3个月狭窄程度较治疗前3 d有明显改善(P<0.05); 治疗后研究组狭窄程度显著低于对照组(P<0.05)。与治疗前3 d相比,研究组治疗后3个月患者的MMSE评分明显增加(P<0.05),TMTa、TMTb和ADAS-Cog评分均明显降低(P<0.05); 治疗3个月研究组各指标均显著优于对照组(P<0.05)。结论 颈动脉高度狭窄可能造成患者认知功能损伤,即使是无症状的此类患者,行颈动脉支架置入术对患者的认知功能也具有一定的改善作用,并且可降低颈动脉狭窄程度。     

颈动脉内膜剥脱术治疗中重度颈动脉狭窄的临床研究

目的以颈动脉支架置入术(CAS)为对照,分析颈动脉内膜剥脱术(CEA)在治疗中重度颈动脉狭窄的临床价值。方法将100例颈动脉狭窄患者按手术方法不同分为观察组(CEA)和对照组(CAS),记录2组围术期手术相关并发症;记录手术用时、住院时间、治疗费用;随访12个月,记录2组包括死亡在内的不良反应发生率及改良Rankin评分情况。结果观察组与对照组在围术期手术相关并发症、住院时间、术后6个月不良反应发生率及改良Rankin评分比较均无明显差异(P均0.05)。但观察组治疗经费低于对照组(P0.05)。结论颈动脉支架置入术治疗中重度颈动脉狭窄效果良好,术后近期和远期疗效及治疗安全性与颈动脉内膜剥脱术相当,但颈动脉内膜剥离术费用成本较低,并发症少。     

应用64排螺旋CT检测缺血性脑血管病与颈动脉斑块和狭窄的关系

目的探讨缺血性脑血管病与颈动脉斑块以及狭窄的关系。方法以2008年12月~2009年11月在苏大附二院神经内科住院的143例缺血性脑血管病患者为实验组;以同期67例无缺血性脑血管病患者为对照组,所有患者均行64排螺旋CT血管造影,检测其双侧颈动脉(颈总动脉、颈内动脉颅外段、颈内动脉颅内段)斑块类型以及狭窄程度。结果 143例缺血性脑血管病患者中,仅有14例(9.8%)患者未检测出明显斑块,斑块发生率为90.2%,各段颈动脉斑块检出率均明显高于非缺血性脑血管病患者。18.2%缺血性脑血管病患者存在轻度颈动脉狭窄,23.1%患者存在中度颈动脉狭窄,18.9%患者存在重度颈动脉狭窄,颈动脉完全闭塞的患者占8.4%,缺血性脑血管病患者颈动脉狭窄检出率(68.6%)明显大于非缺血性脑血管病患者(29.9%),两者差异具有显著统计学意义。结论颈动脉斑块的形成和颈动脉狭窄是造成缺血性脑血管病的主要原因。颈内动脉的狭窄比颈总动脉常见,且在颈内动脉颅内段,斑块以硬斑块为主,在颈总动脉中,尽管狭窄较颈内动脉相对少,但是斑块类型以软斑块为主,由此可推断在国人,造成缺血性脑血管病的主要原因为颈总动脉不稳定斑块的脱落和颈内动脉本身狭窄所致。     

颈动脉狭窄与急性脑卒中并发脑心综合征的相关性研究

目的 探讨颈动脉狭窄与急性脑卒中并发脑心综合征的相关性。方法 选取2015年6月-2018年6月本院收治的急性脑卒中患者100例作为脑卒中组,依据是否并发脑心综合征分为单纯组(n=64例)和脑心组(n=36例),同期体检中心健康人员50例作为健康组,检测所有人员颈动脉狭窄、左心功能[左心室内径(LAD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)],分析颈动脉狭窄与急性脑卒中并发脑心综合征的相关性。结果 脑卒中组颈动脉狭窄程度、斑块发生率为(28.12±6.54)%、56.00%。脑卒中组LAD、LVEDD明显高于健康组,脑卒中组LVEF明显低于健康组(P<0.05); 脑心组颈动脉狭窄程度、斑块发生率、LAD、LVEDD明显高于单纯组,脑心组LVEF明显低于单纯组(P<0.05); 重度脑卒中患者的LAD、LVEDD明显高于轻度脑卒中患者,重度脑卒中患者的LVEF明显低于轻度脑卒中患者(P<0.05); Pearson相关性分析显示,颈动脉狭窄程度与LAD、LVEDD呈正相关(r=0.615,0.623,P<0.05),但与LVEF呈负相关(r=-0.618,P<0.05)。结论 颈动脉狭窄与急性脑卒中并发脑心综合征有关,检测颈动脉狭窄程度可作为评估急性脑卒中并发脑心综合征的重要参考指标。     

Comparison of ultrasonic and histopathological features of carotid artery stenosis

Abstract

Besides the degree of carotid artery stenosis, the composition of the plaque may help to predict the thromboembolic risk. Low echogenicity on ultrasound and hemorrhage into the atheroma demonstrated histopathologically have been shown to be associated with a higher risk of embolism. Twenty-nine consecutive patients with carotid artery stenosis and scheduled for carotid endarterectomy were investigated preoperatively by B-mode ultrasound. Post-operatively the endarterectomy specimens were examined histopathologically. Neither atheroma with hemorrhage nor atheroma without hemorrhage were significantly associated with echolucent ultrasound presentation. Out of the 10 lesions echolucent and homogeneous on ultrasound, six corresponded to atheroma with hemorrhage, two corresponded to atheroma with hemorrhage plus thrombus, two corresponded to fibrous plaque plus thrombus, and one corresponded to pure thrombus. Out of the 4 lesions heterogeneous and predominantly echolucent, one corresponded to atheroma without hemorrhage plus thrombus, one corresponded to atheroma with hemorrhage, one corresponded to atheroma with hemorrhage plus thrombus, one corresponded to atheroma with hemorrhage plus fibrous plaque. Seven out of the 18 atheromas with hemorrhage did not present as purely or predominantly echolucent lesions, six of them were even homogeneouslyechogenic. Plaque surface could not reliably be predicted by ultrasound. In our study, there was no significant correlation between ultrasound and histology of the lesion. [Neural Res 1997; 19: 380-384]     

复合手术技术治疗复杂颈动脉狭窄和闭塞性疾病简

目的分析复合手术技术在复杂颈动脉狭窄或闭塞性疾病中的应用,探讨其临床意义。方法回顾分析12例因颈动脉闭塞和颈动脉串联性病变施行复合手术患者之临床资料,初步分析手术安全性和有效性。结果8例颈动脉闭塞患者,7例实现血管再通;4例颈动脉串联性病变患者,均实现血管再通。术后无一例发生脑卒中或死亡。结论采用复合手术技术治疗颈动脉闭塞和串联性病变疗效安全可靠,值得在临床推荐开展。     

血清基质金属蛋白酶-10水平与中老年颈动脉狭窄的相关性分析

目的 探讨中老年颈动脉狭窄患者血清基质金属蛋白酶-10(MMP-10)的变化情况及其与主要危险因素、伴随症状、狭窄程度、狭窄部位和斑块性质之间的关系。方法 选择2014年3月～2016年2月在本院治疗的106例老年颈动脉狭窄患者作为病例组,随机选择同期在本院体检的80例无颈动脉狭窄的老年健康体检者作为对照组; 收集所有研究对象颈动脉超声检查及其他临床资料,并采集血清检测患者血清MMP-10水平。结果 病例组患者血清MMP-10水平显著高于对照组(p<0.01)。按照危险因素分组后发现吸烟组血清MMP-10水平高于非吸烟组(p<0.05); 糖尿病组MMP-10水平高于无糖尿病组(p<0.05)。病例组患者分组后发现症状性颈动脉狭窄患者血清MMP-10水平显著高于无症状组(p<0.05); 双侧颈动脉狭窄患者血清MMP-10水平显著高于单侧组(p<0.01); 不稳定性颈动脉粥样斑块患者血清MMP-10水平显著高于稳定性斑块组(p<0.05),且血清MMP-10水平随着狭窄程度升高而增加(p<0.01)。结论 中老年颈动脉狭窄患者血清MMP-10水平高于对照组,吸烟和糖尿病可增加血清MMP-10水平; 对于合并脑缺血症状、双侧颈动脉狭窄、不稳定性斑块及重度狭窄中老年患者MMP-10血清水平升高。