本文選題：急性冠脈綜合征　切入點(diǎn)：動(dòng)脈粥樣硬化　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:檢測(cè)抗α1腎上腺素受體自身抗體(Autoantibodies againstα1 adrenegic receptors,α1 AA)在急性冠脈綜合征(Acute Coronary Syndrome,ACS)患者及正常人外周血中的表達(dá),并比較冠心病與正常受試者之間、不同嚴(yán)重程度冠心病患者之間的差別,探討α1 AA在冠心病患者中可能存在的作用。方法:分別收集在大連醫(yī)科大學(xué)附屬第二醫(yī)院心內(nèi)科病房住院經(jīng)冠脈CTA或冠脈造影(CAG)明確冠脈無嚴(yán)重狹窄(狹窄50%管腔直徑)的15名受試者為對(duì)照(Control)組,選取原發(fā)性高血壓患者14例為高血壓(HTN)組,不穩(wěn)定性心絞痛(UA)組18例,不穩(wěn)定性心絞痛合并高血壓(HTN+UA)組22例,急性心肌梗死(21例),急性心肌梗死合并高血壓(HTN+AMI)組14例;其中針對(duì)急性心肌梗死患者,以發(fā)病6小時(shí)、12小時(shí)、24小時(shí)、48小時(shí)、72小時(shí)、1周為時(shí)間點(diǎn)采集患者肘正中靜脈血,其他受試者均采集清晨空腹靜脈血,并分離得到血漿,用酶聯(lián)免疫吸附試驗(yàn)(ELISA)檢測(cè)血漿中α1 AA的水平,比較各分組之間的差異,并分析它在急性心肌梗死患者血漿中不同時(shí)間點(diǎn)的表達(dá)情況;分析α1 AA與GRACE評(píng)分、SYNTAX評(píng)分及冠心病相關(guān)臨床檢驗(yàn)指標(biāo)的關(guān)系,多個(gè)樣本均數(shù)組間比較采用one way ANOVA,雙變量服從正態(tài)分布進(jìn)行Pearson相關(guān)分析,危險(xiǎn)因素分析采用多因素Logistic回歸分析。結(jié)果:1.正常對(duì)照組中亦有α1 AA表達(dá),但水平較低;2.高血壓組患者的血清中α1 AA水平較正常對(duì)照組高,具有統(tǒng)計(jì)學(xué)意義;3.同正常對(duì)照組比較,不穩(wěn)定性心絞痛組未見明顯差異,急性心肌梗死組α1 AA水平明顯降低,P0.05;4.同高血壓組相比,不穩(wěn)定性心絞痛合并高血壓組未見差異,急性心肌梗死合并高血壓組的α1 AA表達(dá)明顯降低,P0.05;5.不穩(wěn)定性心絞痛組較急性心肌梗死組血清中α1 AA表達(dá)明顯高,P0.05;;不穩(wěn)定性心絞痛合并高血壓組較心肌梗死合并高血壓組的α1 AA水平明顯高,P0.05;6.合并高血壓的不穩(wěn)定性心絞痛組較不合并高血壓一組表達(dá)更高,P0.05;合并高血壓的急性心肌梗死組較不合并高血壓一組表達(dá)增高,但不存在明顯差異,P0.05;7.急性心肌梗死發(fā)病起始的12h、72h以及1w時(shí)血清中α1 AA水平較6h減低,12h、72h以及1w的水平不存在顯著差異,P0.05;8.ACS患者的α1 AA表達(dá)水平同GRACE評(píng)分相關(guān)分析顯示二者呈負(fù)性相關(guān)(R= 0.516,P0.01)。9.急性心肌梗死患者的α1 AA的回歸系數(shù)是0.038,P0.01,95.0%置信區(qū)間是1.017 1.061;白細(xì)胞數(shù)(WBC)的回歸系數(shù)是 0.587,P0.01,95.0%置信區(qū)間是0.392 0.788。結(jié)論:α1 AA在急性心肌梗死患者血清中表達(dá)減低,且同疾病嚴(yán)重程度呈負(fù)性相關(guān)。
[Abstract]:Objective: to detect the expression of autoantibodies against 偽 1-adrenoceptor against 偽 1 adrenegic receptors (偽 1-AAA) in peripheral blood of patients with acute Coronary syndromes and normal controls, and to compare the expression between coronary heart disease and normal subjects. Differences between patients with different severity of coronary heart disease, To explore the possible role of 偽 1 / AA in coronary heart disease (CHD). Methods: 50% coronary artery stenosis (50% stenosis) was confirmed by CTA or CAG in the cardiology ward of the second affiliated Hospital of Dalian Medical University. The control group consisted of 15 subjects with cavity diameter. Fourteen patients with essential hypertension were selected as essential hypertension group, 18 patients with unstable angina pectoris (UAA), 22 patients with unstable angina pectoris with hypertension (HTN UAA), 21 patients with acute myocardial infarction (AMI) and 14 patients with acute myocardial infarction (AMI). For the patients with acute myocardial infarction, the median elbow vein blood was collected at the point of 6 hours, 12 hours, 24 hours and 48 hours and 72 hours and 1 week. The other subjects collected fasting venous blood in the morning and separated the plasma. Elisa was used to detect the level of 偽 _ 1 AA in plasma, to compare the difference among different groups, and to analyze its expression at different time points in patients with acute myocardial infarction (AMI). To analyze the relationship between 偽 1 AA and GRACE score and clinical test indexes related to coronary heart disease, one way ANOVA was used for comparison among the multiple sample mean groups, and the Pearson correlation analysis was carried out from normal distribution. Multivariate Logistic regression analysis was used to analyze the risk factors. Results: 1. The expression of 偽 1 AA was also found in the normal control group, but the level was lower than that in the normal control group. The serum level of 偽 1 AA in the hypertension group was higher than that in the normal control group. There was no significant difference between unstable angina pectoris group and normal control group, but the level of 偽 1 and AA in acute myocardial infarction group was significantly lower than that in hypertension group. There was no significant difference between unstable angina pectoris group and hypertension group. The expression of 偽 _ 1 偽 _ 1 in patients with acute myocardial infarction and hypertension was significantly lower than that in patients with unstable angina pectoris than that in patients with acute myocardial infarction (AMI), and the expression of 偽 _ 1 偽 _ 1 in patients with unstable angina pectoris with hypertension was significantly higher than that in patients with unstable angina pectoris complicated with hypertension. The level of 偽 _ 1 偽 _ 1 in blood pressure group was significantly higher than that in hypertension group (P 0.05). The expression of 偽 _ 1 AA in unstable angina pectoris group with hypertension was higher than that in non-hypertension group, and the expression of 偽 _ 1 AA in acute myocardial infarction group with hypertension was higher than that in non-hypertension group. However, there was no significant difference between P0.05 and 77.The level of 偽 _ 1 AA in the serum of patients with acute myocardial infarction at the onset of acute myocardial infarction at 12h, 72h and 1w was significantly lower than that at 6h, 12h, 72h and 1w respectively. There was no significant difference in the expression of 偽 _ 1 偽 _ 1 in patients with acute myocardial infarction at 12h, 72h and 1w. The correlation analysis between 偽 _ 1-AA expression and GRACE score in patients with acute myocardial infarction showed that. There was a negative correlation between the two. The regression coefficient of 偽 _ 1AA was 0.038 渭 P _ (0.01) ~ 95.0% confidence interval was 1.017 ~ 1.061, the regression coefficient of white blood cell count was 1.017 ~ 1.061, and the regression coefficient of WBC was 0.392 0.788. Conclusion: the expression of 偽 _ 1AA in the serum of patients with acute myocardial infarction is lower than that of WBC _ (0.587g) P0.01P _ (0.95)% confidence interval is 0.392 0.788.Conclusion: the expression of 偽 _ (1) AA in serum of patients with acute myocardial infarction is lower than that of patients with acute myocardial infarction. There was a negative correlation with the severity of the disease.
【學(xué)位授予單位】：大連醫(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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