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目的:研究急性脑梗死(ACI)患者血管内皮功能的变化情况,并分析其与脑梗死类型及颈动脉斑块性质的相关性。方法:选择2014年6月到2015年6月在我院收治的脑梗死患者100例作为研究对象。根据病史及磁共振成像(MRI)诊断结果分为ACI组(n=70)和非急性脑梗死(NACI)组(n=30),对两组患者间的血管内皮细胞功能的相关指标进行比较,同时按照梗死类型以及颈动脉斑块性质不同对ACI组进行分组,探究梗死类型与斑块性质与反应性充血指数(RHI)的相关性。结果:ACI组纤维蛋白原(Fbg)、低密度脂蛋白(LDL)、大内皮素-1(big ET-1)、超敏C反应蛋白(hs-CRP)和内皮细胞生长因子(VEGF)水平均高于NACI组,RHI水平低于NACI组,差异有统计学意义(P<0.05)。不同急性脑梗死TOAST分型中心源性栓塞型(CE)、小血管闭塞或腔隙性梗死型(SAA)、不明原因型(SUE)和大动脉粥样硬化型(LAA)测得RHI水平逐渐上升,hs-CRP水平和big ET-1水平逐渐下降,差异具有统计学意义(P<0.05);比较不同斑块性质发现无斑块组、硬斑块组、软斑块组和混合斑块组的VEGF水平逐渐升高,RHI水平逐渐降低,差异均有统计学意义(P<0.05)。相关性分析显示,RHI与斑块性质、hs-CRP以及big ET-1之间呈现负相关(r=-0.672,-0.402,-0.512,P<0.05)。结论:血管内皮功能与急性脑梗死类型和颈动脉斑块性质有相关性,可作为评估梗死类型和斑块性质的预测指标。
Objective: To study the changes of vascular endothelial function in patients with acute cerebral infarction (ACI) and to analyze its correlation with the type of cerebral infarction and the nature of carotid plaques. Methods: 100 patients with cerebral infarction who were admitted to our hospital from June 2014 to June 2015 were selected as the research object. According to the medical history and magnetic resonance imaging (MRI) diagnosis results, the ACI group (n = 70) and non-acute cerebral infarction group (n = 30) According to the type of infarction and the nature of carotid plaques, ACI group was divided into groups to explore the correlation between infarction type and plaque properties and reactive congestive index (RHI). Results: The levels of fibrinogen (Fbg), low density lipoprotein (LDL), big ET-1, hs-CRP and VEGF in ACI group Were higher than NACI group, RHI level was lower than NACI group, the difference was statistically significant (P <0.05). In the TOAST classification of different acute cerebral infarction, the levels of RHI gradually increased in central embolic (CE), small vessel occlusion or lacunar infarction (SAA), unexplained (SUE) and atherosclerosis (LAA) , hs-CRP levels and big ET-1 levels gradually decreased, the difference was statistically significant (P <0.05); comparison of different plaque properties found no plaque group, hard plaque group, soft plaque group and mixed plaque group VEGF levels gradually increased, RHI levels gradually decreased, the differences were statistically significant (P <0.05). Correlation analysis showed that there was a negative correlation between RHI and plaque quality, hs-CRP and big ET-1 (r = -0.672, -0.402, -0.512, P <0.05). Conclusion: The vascular endothelial function is correlated with the type of acute cerebral infarction and carotid plaque, which can be used as a predictor of infarct type and plaque quality.