發(fā)布時(shí)間：2018-01-17 21:10

  本文關(guān)鍵詞：Lp-PLA2及常見心血管危險(xiǎn)因素與單支臨界冠狀動(dòng)脈病變斑塊性質(zhì)的相關(guān)性　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 冠心病 脂蛋白相關(guān)磷脂酶A2 血管內(nèi)超聲 斑塊性質(zhì)

【摘要】：目的:研究單支臨界冠狀動(dòng)脈病變最重處斑塊成分構(gòu)成與傳統(tǒng)心血管危險(xiǎn)因素及脂蛋白相關(guān)磷脂酶A2(Lipoprotein-associated phospholipase A2,Lp-PLA2)之間的關(guān)系,同時(shí)分析冠脈病變的斑塊性質(zhì)及其影響因素在穩(wěn)定型心絞痛和急性冠脈綜合征患者之間的區(qū)別,對(duì)臨床冠心病患者冠脈病變斑塊性質(zhì)的估計(jì)及治療方向提供參考。方法:采用回顧性研究分析方法,共納入192例經(jīng)冠脈造影顯示單支冠脈臨界狹窄病變患者,分為穩(wěn)定性心絞痛患者(Stable angina pectoris,SAP)104例和急性冠脈綜合征患者(Acute coronary syndrome,ACS)88例,收集常見心血管危險(xiǎn)因素及LP-PLA2等基線數(shù)據(jù)并比較兩組差異。使用i MAP-IVUS對(duì)臨界冠狀動(dòng)脈粥樣硬化斑塊進(jìn)行分析,將長(zhǎng)軸圖像按照1mm間距進(jìn)行分割形成橫截面,尋找病變狹窄最重處并測(cè)定最小管腔面積(minimum lumen area,MLA),手動(dòng)描繪外彈力膜界面和管腔界面,測(cè)定病變最重處4種不同性質(zhì)的斑塊構(gòu)成面積,即纖維斑塊面積(Fibrous plaque area,FPA)、纖維脂肪面積(Fibro-fatty area,FFA)、壞死斑塊面積(Necrotic core area,NCA)及鈣化斑塊面積(Dense calcium area,DCA),測(cè)定外彈力膜面積(Cross-sectional areas of vascular external elastic membrane,EEMCSA)、斑塊面積(Cross-sectional areas of plaque and media,PMCSA)以及計(jì)算斑塊負(fù)荷(plaque burden,PB)等指標(biāo)并比較兩組差異,采用單因素及多元線性回歸分析各指標(biāo)的相關(guān)預(yù)測(cè)因子。使用二分類Logistic回歸分析冠心病患者發(fā)生急性冠脈綜合征的預(yù)測(cè)因素,使用ROC曲線評(píng)估相關(guān)連續(xù)變量的預(yù)測(cè)價(jià)值并計(jì)算各自的臨界值及對(duì)應(yīng)的診斷靈敏度及特異度。結(jié)果:(1)與SAP組比較,ACS組有更多的糖尿病和吸煙患者,更高的Lp-PLA2血漿濃度和低密度脂蛋白膽固醇(Low-density lipoprotein cholesterol,LDL-C)以及較低的高密度脂蛋白膽固醇(High-density lipoprotein cholesterol,HDL-C),P值均小于0.05。(2)與SAP組比較,ACS組的病變血管有更高的EEMCSA、PMCSA、PB、纖維斑塊面積(Fibrous plaque area,FPA)和壞死斑塊面積(Necrotic core area,NCA),P值均小于0.01。(3)單因素回歸分析中,PB及FPA的危險(xiǎn)預(yù)測(cè)因素包括糖化血紅蛋白(Glycated haemoglobin,GHb A1C)、甘油三酯(Triglycerides,TG)、總膽固醇(Total cholesterol,TC)、LDL-C和Lp-PLA2,服用他汀藥物史及HDL-C是其共同保護(hù)因素。NCA的危險(xiǎn)預(yù)測(cè)因素包括高血壓、年齡、GHb A1C、TC、LDL-C和Lp-PLA2,HDL-C是其保護(hù)因素。FFA及DCA未見明顯相關(guān)預(yù)測(cè)因素。亞組分析SAP與ACS兩組各自斑塊性質(zhì)及斑塊負(fù)荷相關(guān)預(yù)測(cè)因素的結(jié)果不盡相同,詳見后述。(4)多元回歸分析中,在調(diào)整其他危險(xiǎn)因素后,GHb A1C與Lp-PLA2仍是PB、FPA及NCA的共同危險(xiǎn)因素,HDL-C是PB和FPA的共同保護(hù)因素,LDL-C是FP的危險(xiǎn)因素,服用他汀史是PB的保護(hù)因素,高血壓是NCA的危險(xiǎn)因素。(5)二分類Logistic回歸分析顯示男性、糖尿病、Lp-PLA2、LDL-C和NCA是急性冠脈綜合征發(fā)生的危險(xiǎn)預(yù)測(cè)因素,ROC曲線顯示Lp-PLA2及NCA具有較高的預(yù)測(cè)價(jià)值。結(jié)論:GHb A1C與Lp-PLA2是單支冠脈臨界病變最重處PB、FPA及NCA的共同獨(dú)立危險(xiǎn)預(yù)測(cè)因素;膽固醇水平、高血壓及服用他汀史對(duì)病變斑塊性質(zhì)的預(yù)測(cè)有一定預(yù)測(cè)價(jià)值;LP-PLA2以及NCA對(duì)單支冠脈臨界病變患者急性冠脈綜合征的發(fā)生有較高的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: To study the single most critical coronary artery plaques composition associated with traditional cardiovascular risk factors and lipoprotein associated phospholipase A2 (Lipoprotein-associated phospholipase A2, Lp-PLA2) and the relationship between factors of plaque of coronary artery disease and its effect on stable angina and acute coronary syndrome difference between patients, to provide reference the estimation and treatment of coronary artery disease in patients with coronary heart disease clinical direction plaque. Methods: by retrospective analysis, a total of 192 patients with single coronary artery by coronary angiography showed critical stenosis lesions were divided into stable angina pectoris (Stable angina, pectoris, SAP) and 104 cases of patients with acute coronary syndrome (Acute coronary syndrome ACS, 88 cases), collect the most common cardiovascular risk factors and LP-PLA2 baseline data and compared the differences between the two groups. The I of MAP-IVUS Pro Circle of coronary atherosclerotic plaque were analyzed, the long axis images with 1mm spacing segmentation formation cross section, find the most serious stenosis and determined the minimal lumen area (minimum lumen, area, MLA), depicting the manual external elastic membrane interface and lumen interface, determination of the changes of 4 kinds of plaque formation area, namely fiber the plaque area (Fibrous plaque area, FPA), fiber (Fibro-fatty area, FFA fat area), necrosis (Necrotic core area, plaque area and plaque area (NCA) Dense calcium area calcification, DCA), the determination of the external elastic membrane area (Cross-sectional areas of vascular external elastic membrane EEMCSA areas (Cross-sectional), plaque area of plaque and media, PMCSA) and the calculation load (plaque burden, PB plaque index) and compared the differences between the two groups, the regression analysis of each index by using single factor and multivariate linear Close the prediction factors. Regression analysis to predict the factors of acute coronary syndrome occurred in two patients with coronary heart disease using Logistic classification, prediction value using ROC curve to evaluate the correlation of continuous variables and to calculate the critical value and the corresponding diagnostic sensitivity and specificity. Results: (1) compared with SAP group, ACS group had more patients with diabetes and smoking the higher the plasma concentration of Lp-PLA2 and low density lipoprotein cholesterol (Low-density lipoprotein, cholesterol, LDL-C) and low high density lipoprotein cholesterol (High-density lipoprotein, cholesterol, HDL-C), P values were less than 0.05. (2) compared with SAP group, ACS group of vascular lesions have higher EEMCSA, PMCSA. PB (Fibrous plaque area fiber plaque area, plaque area (FPA) and Necrotic core area necrosis, NCA), P values were less than 0.01. (3) single factor regression analysis, the risk of PB and FPA predictors of saccharification Hemoglobin (Glycated haemoglobin, GHb A1C (Triglycerides), triglyceride, total cholesterol (TG), Total cholesterol, TC), LDL-C and Lp-PLA2, statins and HDL-C history is the common protective factors of.NCA in predicting the risk factors including hypertension, age, GHb, A1C, TC, LDL-C and Lp-PLA2, HDL-C is a protective factor..FFA and DCA have no obvious correlation to predict the factors. A subgroup analysis of the SAP and ACS two respectively, plaque and plaque load prediction factors were not the same, see (4). After the regression analysis, after adjusting for other risk factors, GHb A1C and Lp-PLA2 is PB, FPA and NCA of the common risk HDL-C is a common factor, protection of PB and FPA, LDL-C is a risk factor for FP, statins history is a protective factor for PB, hypertension is the risk factor of NCA. (5) two classification Logistic regression analysis showed that male, diabetes, Lp-PLA2, LDL-C and NCA Is the risk factors predicting the incidence of acute coronary syndrome, ROC curve showed that the predictive value of Lp-PLA2 and NCA have high. Conclusion: GHb A1C and Lp-PLA2 is a single coronary artery lesion is the most critical weight at PB, FPA and the independent risk factors to predict common NCA; cholesterol level, hypertension and taking statins history to predict plaque lesions have certain predictive value; LP-PLA2 and NCA of single acute coronary syndrome patients with critical coronary lesions have a higher predictive value.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4

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