【作者】 薛静；

【导师】 姚智；

【作者基本信息】 天津医科大学 ， 免疫学， 2007， 硕士

【摘要】 [目的]探讨血浆蛋白Z(Protein Z，PZ)水平与急性缺血性脑卒中(Acute ischemic stroke，AIS)及其病因学亚型的关系。[方法]随机选择天津市环湖医院2005年1月至9月确诊为AIS的患者42例和健康对照组42例，AIS患者均于急性期(发病后1至7日内)取静脉血(对照组空腹取静脉血)以酶联免疫吸附法(ELISA)测定血浆PZ浓度，同时平行测定血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及血清C反应蛋白(CRP)、糖(GLU)、甘油三酯(TG)、总胆固醇(TC)等指标。根据核磁共振(MRI)结果将AIS病例分为两组：大动脉卒中组和小动脉及腔隙性卒中组。[结果] AIS患者急性期血浆PZ水平高于对照组(1.66 versus 1.34 mg／L，P＜0.01)，有显著的统计学差异；AIS初发组较复发组PZ水平虽有增高趋势(1.75 versus 1.55 mg／L，P＞0.05)，但无统计学差异；AIS组及对照组血浆PZ水平均无性别差异(P＞0.05)；在AIS组，年龄与血浆PZ水平存在负相关(r=-0.463，P＜0.01)；大动脉性卒中组较小动脉及腔隙性卒中组血浆PZ水平升高(1.86 versus 1.44 mg／L，P＜0.05)，有统计学差异；AIS组血清CRP水平高于对照组(7.56 versus 2.89 mg／L，P＜0.01)，有显著的统计学差异；AIS组血清TG水平高于对照组(2.16 vetsus 1.16 mmol／L，P＜0.01)，有显著的统计学差异；AIS组血GLU水平较对照组升高(7.32 versus 5.32 mmol／L，P＜0.05)，有统计学差异；AIS组FIB水平高于对照组(3.08 versus 2.77 g／L，P＜0.05)，有统计学差异；AIS组血浆PT、APTT及血清TC水平与对照组比较均无统计学差异。[结论] AIS患者急性期血浆PZ水平明显升高，特别是由大动脉梗塞引起的卒中，提示血浆PZ水平升高可能与缺血性脑卒中尤其是青年脑缺血发病危险性有关。更多还原

【Abstract】 [Objective] To discuss the relation between plasma protein Z level,acute ischemic stroke and etiologic subtypes of ischemic stroke.[Methods] We conducted a case-control study of 42 hospital cases ofacute ischemic stroke and 42 randomly selected controls. Plasma proteinZ concentrations were measured within 7 days after acute ischemicstroke(limosis in controls)with ELISA assay. Plasma PT, APTT, FIB andserum OLUCOSE, TG, TC, CRP were measured simultaneity. Using establishedMRI criteria, we classified cases of acute ischemic stroke by twoetiologic subtype: stroke due to large-artery thromboembolism andstroke due to small-artery thromboembolism and lacuna stroke.[Results] Plasma levels of protein Z measured within 7 days of acuteischemic stroke were significantly higher in cases than incontrols(1.66 versus 1.34 mg/L, P＜0.01), there was a remarkablestatistical significance; ilthrough protein Z levels were higher incases of first-ever acute ischemic stroke than recur ischemicstroke, there were no statistical significance (1.75 versus 1.55 mg/L,P＞0.05); There were no sexual differences in cases or in controls(P＞0.05). In cases of acute ischemic stroke, there was a negativecorrelation between age and protein Z levels (r=-0.463, P＜0.01); Compared with stroke due to small-artery thromboembolism andlacuna, plasma levels of protein Z were higher in stroke due to large-artery thromboembolism (1.86 versus 1.44 mg/L, P＜0.05).Serum levels of C-reactive protein were significantly higher in casesthan in controls(7.56 versus2.89 mg/L, P＜0.01), there was a remarkablestatistical significance; Serum levels of TG were significantly higherin cases than in controls(2.16 versus 1.16mmol/L, P＜0.01), there wasa remarkable statistical significance; Serum levels of GLUCOSE werehigher in cases than in controls(7.32 versus 5.32mmol/L, P＜0.05), therewas a statistical significance; Plasma levels of Fibrinogen werehigher in cases than in controls(3.08 versus 2.77g/L, P＜0.05), therewas a statistical significance; There were no statisticalsignificance of plasma PT, APTT and serum TC in cases or in controls.[Conclusions] Plasma levels of protein Z measured within 7 days ofacute ischemic stroke were significantly higher, especially in strokedue to large-artery atherothrombosis. Elevated Plasma levels of proteinZ concentrations might be associated with an increased risk of ischemicstroke especially cerebral ischemia in young.更多还原