【摘要】：目的： 探討女性缺血性心臟病的臨床特點；研究女性缺血性心臟病患者冠脈阻塞程度及伴發(fā)抑郁狀態(tài)對血漿Ghrelin水平的影響，從而進一步指導女性缺血性心臟病的診斷和治療。 方法： 收集2011年5月至2012年4月期間在我院住院的有缺血性心臟病癥狀的女性患者基本資料和住院期間各項檢查結(jié)果，共計504例；采集2012年7月至2012年12月期間于我院住院的有缺血性心臟病癥狀、擬行冠脈造影檢查的女性患者空腹狀態(tài)時的肘靜脈血，酶聯(lián)免疫法測定血漿Ghrelin水平，并于抽血當天（入院第二天）對患者進行醫(yī)院焦慮抑郁量表（HADS）問卷。 結(jié)果： ①阻塞性冠脈病變組較非阻塞性冠脈病變患者相比，胸痛癥狀明顯增多（31.63%vs.22.48%）；非阻塞性冠脈病變組與阻塞性冠脈病變組相比，心慌癥狀明顯增多（21.71%vs.15.34%）。但兩組患者最多見的癥狀都表現(xiàn)為胸悶。 ②與非阻塞性冠脈病變組相比，阻塞性冠脈病變組患者年齡明顯偏大（60.69歲vs.63歲），絕經(jīng)時間更長（11.21年vs.13.34年），收縮壓和舒張壓明顯升高（129.51mmHg vs.135.38mmHg，77.97mmHg vs.81.21mmHg），左室射血分數(shù)明顯降低（67.04%vs.64.76%），外周血中性粒細胞明顯增多（55.67%vs.63.75%），血紅蛋白明顯降低（123.31g/l vs.120.70g/l），血尿酸明顯增高（284.95umol/l vs.305.98umol/l），膽固醇明顯升高（4.47mmol/l vs.5.02mmol/l），甘油三酯明顯升高（1.82mmol/l vs.2.50mmol/l），，低密度脂蛋白明顯升高（2.37mmol/l vs.3.01mmol/l），血漿纖維蛋白原明顯升高（2.90g/l vs.3.46g/l），空腹血糖明顯升高（5.17mmol/l vs.5.76mmol/l），高血壓史（56.2%vs.77.1%）、卒中史（9.6%vs.16.7%）、糖尿病史（23.3%vs.34.5%）、吸煙史（2.1%vs.6.8%）、冠心病家族史（21.8%vs.37.4%）、合并外周動脈粥樣硬化（71.45%vs.83.1%）、合并甲狀腺功能減退癥（11.8%vs.16.5%）、胸片示心影變大（54.35%vs.62.6%）發(fā)生率更高，上述指標的差異均具有統(tǒng)計學意義（P0.05）。 ③對比阻塞性冠脈病變組及非阻塞性冠脈病變組，抑郁的發(fā)生率無統(tǒng)計學差異（P0.05）；與非阻塞性冠脈病變組相比，阻塞性冠脈病變組血漿Ghrelin水平顯著降低（10.14ng/ml vs.8.81ng/ml, P0.05），差異有統(tǒng)計學意義；已發(fā)生阻塞性冠脈病變的女性患者，對比抑郁組和非抑郁組，合并抑郁癥的患者血漿Ghrelin水平明顯降低（9.11ng/ml vs.7.52ng/ml, P0.05），差異有統(tǒng)計學意義。 結(jié)論： ①女性缺血性心臟病患者冠脈病變嚴重程度對患者臨床癥狀有一定的影響。 ②女性缺血性心臟病冠脈病變嚴重程度由多種因素共同決定，包括患者年齡、絕經(jīng)時間、入院時血壓和心臟收縮功能、外周血中性粒細胞和血紅蛋白水平、血尿酸、膽固醇、甘油三酯、低密度脂蛋白、血漿纖維蛋白原水平、空腹血糖以及是否具有高血壓史、卒中史、糖尿病史、吸煙史、冠心病家族史、甲狀腺功能減退、外周動脈粥樣硬化及胸片示心影是否變大。 ③女性缺血性心臟病患者發(fā)生抑郁與否與冠脈病變嚴重程度無關(guān)；女性缺血性心臟病患者冠脈發(fā)生阻塞性病變時血漿Ghrelin水平明顯降低，合并抑郁時血漿Ghrelin水平進一步降低。
[Abstract]:Purpose: To study the clinical characteristics of women with ischemic heart disease, and to study the effect of the degree of coronary obstruction and the status of depression on the level of plasma Ghrelin in women with ischemic heart disease, so as to further guide the diagnosis and treatment of ischemic heart disease in women. Treatment. Methods: From May 2011 to April 2012, we collected the basic data of the female patients with the symptoms of the ischemic heart disease in our hospital and the results of all the examinations during the hospitalization, with a total of 504 cases, and collected in our hospital from July 2012 to December 2012. The plasma Ghrelin level was determined by the enzyme-linked immunosorbent assay in the fasting state of women with ischemic heart disease, and the plasma Ghrelin level was determined by the enzyme-linked immunosorbent assay, and the patient was subjected to a hospital anxiety and depression scale on the day of the blood draw (the second day of admission). (HA Results: The symptoms of chest pain increased significantly (31. 63% vs. 22. 48%) compared with those with non-obstructive coronary artery disease (31. 63% vs. 22. 48%).. 71% vs. 15.34%), both groups The most common symptoms in the patients were chest distress. The age of patients with obstructive coronary lesions was significantly higher (60. 69 years vs. 63 years) compared with the non-obstructive coronary artery disease group, with a significant increase in systolic and diastolic blood pressure (129.51mmHg vs. 133.38 mmHg, 77. 97mmHg vs. 81.21mmHg), and a significant decrease in the left ventricular ejection fraction. (67. 04% vs. 64. 76%), the number of peripheral blood neutrophils (55. 67% vs. 63. 75%), the significant decrease in hemoglobin (123.31g/ l vs. 120. 70g/ l), the significant increase in blood uric acid (284. 95uml/ l vs. 305. 98uml/ l), a marked increase in cholesterol (4.47mmol/ l vs. 5.02mmol/ l), a marked increase in triglyceride (1.82 mmol/ l vs. 2. 50mmol/ l), and a marked increase in low-density lipoprotein (2.37mmo The plasma fibrinogen was significantly higher (2.90g/ l vs. 3.46g/ l), and the plasma fibrinogen increased significantly (5.17mmol/ l vs. 5.76mmol/ l), the history of hypertension (56. 2% vs. 77.1%), the history of stroke (90.6% vs. 16.7%), the history of stroke (2.1% vs. 63.8%), the family history of coronary heart disease (21.8% vs. 37.4%), and the combined peripheral atherosclerosis. (71.45% vs. 83.1%), combined with hypothyroidism (11. 8% vs. 16. 5%), chest X-ray showed a higher incidence (54. 35% vs. 62.6%) and the above-mentioned index There was no significant difference in the incidence of plasma Ghrelin in the patients with obstructive coronary artery disease (P0.05). The plasma Ghrelin level in the patients with obstructive coronary artery disease was significantly lower (10.14ng/ ml vs. 8. 81n) compared with the non-obstructive coronary artery disease group (P <0.05). There was a significant difference in the plasma Ghrelin level in patients with obstructive coronary artery disease, compared with the depressive and non-depressed groups (9.11 ng/ ml vs. 7. 52n). g/m 1, P0.05), and the difference was of statistical significance. The severity of the coronary artery disease in patients with heart disease has a certain effect on the clinical symptoms of the patient. The severity of the coronary artery disease in the patients with heart disease is determined by a number of factors, including the age of the patient, the time of menopause, the blood pressure and the systolic function of the heart at the time of admission, and the neutral particles in the peripheral blood. cell and hemoglobin levels, blood uric acid, cholesterol, triglycerides, low density lipoproteins, plasma fibrinogen levels, fasting blood glucose, and whether there is a history of hypertension, stroke history, history of diabetes, smoking history, coronary heart disease, The history of family, hypothyroidism, peripheral atherosclerosis and chest X-ray showed that the heart and shadow of the patients with ischemic heart disease were not related to the severity of the coronary artery disease, and the plasma Ghr in patients with ischemic heart disease in the patients with obstructive pulmonary disease
【學位授予單位】：華中科技大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R541.4;R749.4

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