本文選題：纖維蛋白原　切入點(diǎn)：慢性腎臟病　出處：《蚌埠醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過檢測(cè)慢性腎臟病(chronic kidney disease,CKD)患者血清中纖維蛋白原(fibrinogen,,FIB)水平證明CKD患者存在高FIB狀態(tài),以及CKD患者中因動(dòng)脈粥樣硬化(atherosclerosis,AS)致心血管疾病(cardiovascular disease,CVD)的發(fā)病率較高,兩者間存在關(guān)聯(lián)。在對(duì)心血管事件常規(guī)治療措施之外,對(duì)干預(yù)FIB水平是否可以降低CVD事件的發(fā)生發(fā)展,并進(jìn)一步改善CKD預(yù)后的研究提供理論基礎(chǔ)。方法:搜集蚌埠醫(yī)學(xué)院第一附屬醫(yī)院腎內(nèi)科2016年01月-2016年10月原發(fā)性中晚期慢性腎臟病患者90例,按照CKD分期標(biāo)準(zhǔn)分組,CKD3期、CKD4期以及CKD5期各為1組,共3組。記錄并隨訪姓名、年齡、性別、吸煙史、原發(fā)病及心血管病史等,同時(shí)選擇同期健康體檢者30例作為對(duì)照組。收集患者資料及相關(guān)生化指標(biāo),采用酶聯(lián)免疫吸附法測(cè)定所有入組者纖維蛋白原。入選患者采用彩色多普勒超聲檢測(cè)頸動(dòng)脈內(nèi)中膜厚度(IMT)。應(yīng)用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.CKD3-5期患者血清FIB及D-二聚體水平:CKD3-5期患者FIB及D-二聚體水平都高于對(duì)照組(P0.05),且隨著e GFR下降有上升趨勢(shì)。2.CKD3-5期患者頸動(dòng)脈彩超結(jié)果:CKD3-5期患者的頸動(dòng)脈IMT厚度、頸動(dòng)脈IMT增厚率及斑塊發(fā)生率與健康對(duì)照組相比均有升高(P0.05)。3.CKD3-5期患者動(dòng)脈粥樣硬化與血清FIB、D-二聚體水平的關(guān)系:根據(jù)頸動(dòng)脈彩超檢查結(jié)果將CKD患者分為頸動(dòng)脈正常組、IMT增厚無斑塊組及斑塊形成組。斑塊形成組的血清FIB水平與頸動(dòng)脈正常組比IMT增厚無斑塊組顯著增高(P0.05),IMT增厚無斑塊組的血清FIB水平高于正常組(P0.05)。斑塊形成組的血清D-二聚體水平高于正常組(P0.05)。4.CKD3-5期患者FIB水平與IMT、e GFR直線相關(guān)分析:血清FIB水平、D-二聚體水平均與IMT呈正相關(guān)(r=0.724、0.486,P.05),與e GFR呈負(fù)相關(guān)(r=-0.483、-0.451,P.05)。頸動(dòng)脈IMT與e GFR水平呈負(fù)相關(guān)(r=-0.566,P.05)。血清FIB水平與D-二聚體水平呈正相關(guān)(r=0.539,P0.05)。5.多重線性邏輯回歸顯示:血清FIB(β=7.094,P0.05)、D-二聚體(β=15.118,P0.05)、TG(β=0.002,P0.05)、LDL(β=3.472,P0.05)水平是CKD3-5期患者頸動(dòng)脈IMT增厚的危險(xiǎn)因素。結(jié)論:1.CKD3-5期患者頸動(dòng)脈粥樣硬化發(fā)生率與正常人相比明顯升高;2.CKD3-5期患者FIB水平顯著升高,D-二聚體水平升高。3.FIB水平、D-二聚體水平的增高與CKD3-5期患者發(fā)生動(dòng)脈粥樣硬化相關(guān)。
[Abstract]:Objective: to detect the level of fibrinogen fibrinogenin (kidney) in the serum of patients with chronic renal disease (kidney) and to prove that there is a high level of FIB in patients with CKD and a higher incidence of cardiovascular disease caused by atherosclerosis in patients with CKD. There is a correlation between the two. In addition to routine treatment of cardiovascular events, whether intervention in FIB level can reduce the occurrence and development of CVD events, Methods: from January 2016 to October 2016, 90 patients with primary and advanced chronic kidney disease in the Department of Nephrology, the first affiliated Hospital of Bengbu Medical College, were collected. According to the standard of CKD staging, the patients were divided into three groups respectively: CKD3, CKD4 and CKD5. Their names, age, sex, smoking history, primary disease and cardiovascular history were recorded and followed up. At the same time, 30 healthy persons were selected as control group. The data of patients and related biochemical indexes were collected. The fibrinogen was measured by enzyme-linked immunosorbent assay (Elisa). The carotid intima media thickness (IMTT) was detected by color Doppler ultrasound. SPSS18.0 software was used for statistical analysis. Results 1. The serum FIB and D- dimer levels in patients with CKD3-5 were significantly higher than those in the control group (P 0.05), and with the decrease of e GFR, there was an increasing trend of carotid artery color Doppler ultrasound in patients with phase 3-5 of CKD3.The results of color Doppler ultrasound showed that the levels of FIB and D- dimer in patients with phase 3-5 were higher than those in the control group (P < 0.05). IMT thickness of carotid artery in patients with stage 3 to 5, Carotid IMT thickening rate and plaque incidence were higher than those of healthy control group. 3. The relationship between atherosclerosis and serum FIBD- dimer level in patients with CKD3-5: according to the results of carotid color Doppler ultrasound, the patients with CKD were divided into normal carotid artery. The level of serum FIB in plaque formation group was significantly higher than that in normal carotid artery group compared with IMT thickening without plaque group. The level of serum FIB in plaque free plaque group was significantly higher than that in normal plaque group. The level of serum D- dimer was higher than that of normal group (P0.05n. 4. CKD3-5). There was a linear correlation analysis between FIB level and IMTX GFR. The serum FIB level was positively correlated with IMT (r 0.724 0. 486p. 05), and negatively correlated with e GFR (P 0. 483- 0. 451p05). There was a negative correlation between IMT and e GFR in carotid artery. Serum FIB level was positively correlated with D- dimer level. Multiplex linear regression analysis showed that serum FIB level was a risk factor for carotid artery IMT thickening in patients with CKD3-5. Conclusion: serum FIB-15.118P0.05TGis (尾 0.002P0.05P0.05) is a risk factor for carotid artery IMT thickening in patients with CKD3-5. Conclusion\\\;\\\; 1. The FIB level of CKD3-5 patients was significantly higher than that of normal controls. 3. The increase of D-dimer level was associated with atherosclerosis in patients with CKD3-5 stage.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692;R543.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 唐冰瑤;李紹梅;;慢性腎臟病患者動(dòng)脈粥樣硬化危險(xiǎn)因素的研究進(jìn)展[J];中國(guó)動(dòng)脈硬化雜志;2016年01期

2 王玉潔;胡承剛;甘林望;呂俊;曹靈;;慢性腎臟病患者各期凝血功能變化及相關(guān)影響因素分析[J];現(xiàn)代醫(yī)藥衛(wèi)生;2015年24期

3 劉振寶;趙迎春;潘曉春;李旗;張瑜;高丹宇;王麗麗;葛士騮;;腦梗死患者腎小球?yàn)V過率與頸動(dòng)脈粥樣硬化的相關(guān)性研究[J];中華老年心腦血管病雜志;2014年11期

4 袁敏杰;魏盟;;慢性腎臟病與冠狀動(dòng)脈和主動(dòng)脈粥樣硬化的關(guān)系[J];國(guó)際心血管病雜志;2013年04期

5 劉一凡;向代軍;唐紅衛(wèi);張洪瑞;吳小利;謝尹晶;李綿洋;王成彬;李登清;;慢性腎臟病患者血栓彈力圖、凝血參數(shù)等指標(biāo)的分析及臨床意義[J];解放軍醫(yī)學(xué)院學(xué)報(bào);2013年07期

6 陳e，

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