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目的探讨急性脑梗死患者颈动脉粥样斑块稳定性与单核细胞趋化因子4、膜联蛋白A1水平的关系。方法选择西安交通大学医学院神经内科2008年1月至2010年12月住院的124例急性脑梗死患者,男性73例,女性51例,年龄41～88(60.8±12.9)岁,健康对照组35例,其中男性21例,女性14例,年龄42～79(59.3±12.1)岁。采用彩色多普勒超声仪测量颈动脉内中膜厚度及斑块类型,颅脑CT检查计数颅内分布区的梗死病灶。脑梗死患者分为颈动脉正常组(n=26)、稳定型斑块组(n=38)、不稳定型斑块组(n=60)。用酶联免疫法测定单核细胞趋化因子4,用逆转录-聚合酶链反应(RT-PCR)方法检测膜联蛋白A1基因的mRNA表达水平,免疫组化法测膜联蛋白A1的表达,Western blot检测膜联蛋白A1蛋白质表达水平。对检查结果进行比较。结果①颈动脉正常组、稳定型斑块组、不稳定型斑块组的颈内动脉分布区病灶数、颈动脉内中膜厚度差异显著(F=21.36、24.5,P<0.05);②健康对照组、颈动脉正常组、稳定型斑块组和不稳定型斑块组单核细胞趋化因子4的含量比较差异显著(F=19.8,P<0.05);不稳定型斑块组颈动脉粥样斑块组织膜联蛋白A1的mRNA、蛋白表达水平、蛋白表达率明显少于稳定型斑块组(t=2.19、2.876,χ2=9.23,P<0.05)。结论单核细胞趋化因子4、膜联蛋白A1水平与颈动脉粥样斑块不稳定性密切相关,并参与了急性脑梗死的发生。
Objective To investigate the relationship between the stability of carotid atherosclerotic plaques and the levels of monocyte chemotactic factor 4 and annexin A1 in patients with acute cerebral infarction. Methods A total of 124 patients with acute cerebral infarction hospitalized from January 2008 to December 2010 in Xi’an Jiaotong University School of Medicine were enrolled in this study. There were 73 males and 51 females, ranging in age from 41 to 88 (60.8 ± 12.9) years. The healthy controls 35 Cases, including 21 males and 14 females, aged 42 to 79 (59.3 ± 12.1 years). Color Doppler ultrasound was used to measure the carotid intima-media thickness and plaque type. Brain CT scan was used to count the intracranial lesions. Patients with cerebral infarction were divided into normal carotid artery group (n = 26), stable plaque group (n = 38) and unstable plaque group (n = 60). Monocyte chemotactic factor 4 was detected by enzyme-linked immunosorbent assay (ELISA), mRNA expression of annexin A1 was detected by reverse transcription-polymerase chain reaction (RT-PCR) and annexin A1 expression by immunohistochemistry Western blot was used to detect Annexin A1 protein expression. Check the results for comparison. Results ① There were significant differences in carotid artery distribution and carotid intima-media thickness between normal carotid artery group, stable plaque group and unstable plaque group (F = 21.36, 24.5, P <0.05) The levels of MCP-4 in the control group, the normal carotid artery group, the stable plaque group and the unstable plaque group were significantly different (F = 19.8, P <0.05); unstable plaque group carotid artery Atherosclerotic plaque annexin A1 mRNA, protein expression, protein expression was significantly less than the stable plaque group (t = 2.19,2.876, χ2 = 9.23, P <0.05). Conclusions Monocyte chemotactic factor 4 and annexin A1 are closely related to carotid plaque instability and are involved in the development of acute cerebral infarction.