本文關(guān)鍵詞：尿酸與急性ST段抬高型心肌梗死患者急診PCI術(shù)后冠脈血流及預(yù)后的相關(guān)性研究　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 尿酸 急性ST段抬高型心肌梗死 急診PCI 臨床預(yù)后

【摘要】：研究背景：流行病學(xué)顯示，尿酸水平升高與心血管疾病相關(guān)，尿酸是普通人群、冠心病患者不良預(yù)后的獨(dú)立預(yù)測因子。研究發(fā)現(xiàn)，尿酸升高與冠脈血流受損相關(guān)。但是目前尚不清楚尿酸是否能預(yù)測急性ST段抬高型心肌梗死（acuteST-elevation myocardial infarction STEMI）患者急診經(jīng)皮冠狀動(dòng)脈介入治療（primary percutaneous coronary intervention PCI）術(shù)后冠脈血流受損、以及尿酸是否與STEMI患者短期和長期預(yù)后獨(dú)立相關(guān)。 研究目的：對(duì)住院期間尿酸水平與STEMI患者急診PCI后冠脈血流以及短期和長期預(yù)后的相關(guān)性進(jìn)行研究。 研究方法：選取2010年01月至2013年6月就診于海淀醫(yī)院、發(fā)病在12h內(nèi)的STEMI并且行急診PCI的患者。根據(jù)實(shí)驗(yàn)室檢測的尿酸結(jié)果將STEMI患者分成兩組：高尿酸組（其中男性420umol/l,女性360umol/l），其中男性24例（77.4%）、女性7例（22.6%）；正常尿酸組（其中男性≤420umol/l,女性≤360umol/l），其中男性82例（75.9%）、女性26例（24.1%）。所有患者PCI術(shù)后收入CCU進(jìn)一步治療。入院后采集所有患者的一般情況、實(shí)驗(yàn)室檢查結(jié)果、經(jīng)胸超聲心臟彩超及冠狀動(dòng)脈造影結(jié)果，記錄患者住院期間死亡和主要不良心血管情況�；颊叱鲈�6個(gè)月后進(jìn)行隨訪，收集患者PCI術(shù)后6個(gè)月的死亡和主要不良心血管情況。多變量分析住院期間尿酸水平與STEMI患者急診PCI術(shù)后冠脈血流受損相關(guān)性、以及尿酸水平與STEMI患者住院期間和PCI術(shù)后6個(gè)月死亡和主要不良心血管事件的相關(guān)性。 研究結(jié)果： 本研究共納入139名行急診PCI的STEMI患者，其中男性106例（76.3%），女性33例（23.7%）。高尿酸組31例(22.3％)，正常尿酸組108例(77.7％)。 高尿酸組高血壓發(fā)病率(54.8％vs32.4％，PO.05)、陳舊心肌梗死發(fā)病率(19.4％vs8.3％，PO.05)、多支血管病變發(fā)病率（61.3％vs37.0％，PO.05)顯著高于正常尿酸組；入院后高尿酸組與正常尿酸組心功能KillipⅠ級(jí)(54.8％vs73.1％，P=0.06)、KillipⅡ級(jí)(12.9％vs18.5％，P=0.47)無統(tǒng)計(jì)學(xué)差異，但是高尿酸組KillipⅢ級(jí)（16.1％vs3.7％，PO.05)、KillipⅣ級(jí)（16.1％vs4.6％，PO.05)顯著高于正常尿酸組。經(jīng)胸超聲心動(dòng)圖顯示，高尿酸組患者的左室射血分?jǐn)?shù)（LVEF）顯著低于正常尿酸組（49±15％vs54±11％，PO.05)。冠脈造影檢查顯示，高尿酸組和低尿酸組無復(fù)流（TIMI血流0、1、2級(jí)）發(fā)生率也存在統(tǒng)計(jì)學(xué)差異（29.0％vs10.2％，PO.05)。高尿酸組患者住院期間主要不良心血管事件顯著高于正常尿酸組（25.8％vs7.4％，PO.05)；兩組6個(gè)月主要不良心血管事件也存在統(tǒng)計(jì)學(xué)差異（25.2％vs23.1％，PO.05)。多變量分析表明，在校正了影響因素后，住院期間尿酸水平是STEMI患者急診PCI術(shù)后冠脈血流受損、住院期間不良心血管事件的獨(dú)立危險(xiǎn)因素（分別0R=1.0995%CI1.02-1.18, PO.05；0R=1.0995%CI1.02-1.12, PO.05）。 研究結(jié)論： 住院期間尿酸水平與STEMI患者急診PCI術(shù)后冠脈血流受損獨(dú)立相關(guān)。此外，尿酸是STEMI患者急診PCI術(shù)后短期主要不良心血管事件的獨(dú)立危險(xiǎn)因素。因此我們的研究證實(shí)，，作為一項(xiàng)簡便、快捷、低廉、可靠的檢查手段，尿酸不但能預(yù)測STEMI患者急診PCI術(shù)后冠脈血流受損，還是評(píng)估STEMI患者危險(xiǎn)分層有效的標(biāo)記物。
[Abstract]:Background: epidemiologic studies suggest that elevated levels of uric acid, uric acid is associated with cardiovascular disease, the general population, independent predictors of poor prognosis of patients with coronary heart disease. The study found that uric acid is associated with impaired coronary flow. But it is unclear whether uric acid can predict acute ST elevation myocardial infarction (acuteST-elevation myocardial infarction STEMI) patients after emergency percutaneous coronary intervention (primary percutaneous coronary intervention PCI) impaired coronary blood flow after operation, and whether uric acid independently associated with STEMI in patients with short-term and long-term prognosis.
Objective: To study the relationship between the level of uric acid during hospitalization and the coronary blood flow after emergency PCI and the short-term and long-term prognosis in patients with STEMI.
Methods: from 2010 to June 2013 in Haidian Hospital from 01 months, the incidence of 12h in the STEMI and emergency PCI patients. According to the results of laboratory tests and uric acid STEMI patients were divided into two groups: high uric acid group (male 420umol/l, female 360umol/l), among which 24 cases were male (77.4%), 7 females (22.6%); normal uric acid group (male = 420umol/l, female 360umol/l), among which 82 cases were male (75.9%), 26 cases were female (24.1%). All the patients with PCI after CCU treatment. Further income generally collected after admission in all patients, results of laboratory examination, transthoracic echocardiography and coronary angiography records of hospitalized patients, adverse cardiovascular death and major. During the follow-up of patients 6 months after discharge, death and major adverse cardiovascular conditions for 6 months were collected after PCI. Multivariate analysis of uric acid during hospitalization The correlation between level and coronary artery blood flow impairment after emergency PCI operation in STEMI patients, and the correlation between uric acid level and death and major adverse cardiovascular events in STEMI patients during hospitalization and 6 months after PCI were also analyzed.
The results of the study:
A total of 139 STEMI patients undergoing emergency PCI were enrolled in this study, including 106 men (76.3%), 33 women (23.7%), 31 patients (22.3%) in hyperuricemia group, and 108 patients (77.7%) in normal uric acid group.
High uric acid group the incidence of hypertension (54.8%vs32.4%, PO.05), old myocardial infarction incidence rate (19.4%vs8.3%, PO.05), multivessel disease incidence rate (61.3%vs37.0%, PO.05) was significantly higher than that in normal uric acid group; after admission, high uric acid group and normal uric acid group Killip heart function grade (54.8%vs73.1%, P=0.06), Killip (grade II 12.9%vs18.5%, P=0.47) had no significant difference, but the high uric acid group of Killip III (16.1%vs3.7%, PO.05), Killip grade (16.1%vs4.6%, PO.05) was significantly higher than that in normal uric acid group. Transthoracic echocardiography showed high uric acid group of patients with left ventricular ejection fraction (LVEF) was significantly lower than the normal uric acid group (49 + 15%vs54 + 11%, PO.05). Coronary angiography showed high uric acid group and low uric acid group of no reflow (TIMI flow 0,1,2) incidence rate there were significant difference (29.0%vs10.2%, PO.05). The main high uric acid group of patients during hospitalization To adverse cardiovascular events was significantly higher than that in normal uric acid group (25.8%vs7.4%, PO.05); the two group of 6 months of major adverse cardiovascular events there were significant difference (25.2%vs23.1%, PO.05). Multivariate analysis showed that in the correction factors, during the period of hospitalization is uric acid impaired coronary blood flow in patients with STEMI after emergency PCI, independent risk period the factors of adverse cardiovascular events in hospital (respectively 0R=1.0995%CI1.02-1.18, PO.05; 0R=1.0995%CI1.02-1.12, PO.05).
The conclusions are as follows:
During hospitalization, uric acid and emergency patients after PCI STEMI impaired coronary flow independently. In addition, uric acid is the independent risk factors of short-term major adverse cardiovascular events in STEMI patients after emergency PCI. Therefore our research confirms that as a simple, fast, inexpensive, reliable inspection method, not only can predict the uric acid in patients with STEMI after emergency PCI impaired coronary flow, or assess the risk stratification of STEMI patients and effective marker.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R542.22

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