本文選題：Gensini評(píng)分　切入點(diǎn)：亞臨床甲減　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:近年來(lái),冠狀動(dòng)脈性心臟病(coronary heart disease CHD)發(fā)病人數(shù)和死亡人數(shù)在我國(guó)快速上升,逐步成為我國(guó)成年人主要死亡原因之一。冠心病的危險(xiǎn)因素很多,已經(jīng)明確的包括有性別、血壓升高、年齡、血脂代謝異常、抽煙、DM和IGT、腹型肥胖以及家族史等。但是許多新的冠心病危險(xiǎn)因素近年來(lái)逐漸被發(fā)現(xiàn),如已有相關(guān)研究發(fā)現(xiàn)CHD的發(fā)病可能與亞臨床甲減(SH)存在關(guān)聯(lián),其機(jī)制很有可能是通過(guò)干擾血脂代謝、影響血小板平均體積(MPV),最終導(dǎo)致冠脈動(dòng)脈硬化,促使CHD的發(fā)生。目的:探討SH與CHD的關(guān)系。方法:選擇2012年7月1日—2014年7月1日在山西醫(yī)科大學(xué)第一醫(yī)院心內(nèi)科住院患者共280例,均在住院期間行冠狀動(dòng)脈造影術(shù)檢查后診斷為冠心病。其中CHD合并SH(實(shí)驗(yàn)組)138例,未合并SH(對(duì)照組)142例。分別檢測(cè)各組血脂水平,包括:甘油三酯(TG),總膽固醇(TC),高密度脂蛋白(HDL),低密度脂蛋白膽固醇(LDL)及MPV,計(jì)算出每位患者的Gensini總積分;進(jìn)一步將實(shí)驗(yàn)組又分為三個(gè)亞組,即:一支病變組、兩支病變組以及三支病變組,分別檢測(cè)出各組的血清游離甲狀腺素(FT4),游離三碘甲腺原氨酸(FT3),促甲狀腺激素(TSH),TC,TG,HDL-C,LDL-C,MPV,計(jì)算出各組的冠狀動(dòng)脈Gensini總積分,記錄基本臨床資料。結(jié)果:在控制性別、糖尿病、吸煙、高血壓等其它因素后得出:(1)組間Gensini總積分相對(duì)比:實(shí)驗(yàn)組冠狀動(dòng)脈Gensini總積分高于對(duì)照組,具有統(tǒng)計(jì)學(xué)差異(P0.05);(2)亞組內(nèi)TSH比較:實(shí)驗(yàn)組內(nèi)三支病變亞組及雙支病變亞組TSH高于單支病變亞組,具有統(tǒng)計(jì)學(xué)差異(P0.05);(3)MPV比較:實(shí)驗(yàn)組明顯高于對(duì)照組,兩者具有統(tǒng)計(jì)學(xué)差異(P0.05);實(shí)驗(yàn)組內(nèi)多支病變組與單支病變組相比,后者低于前者,且具有統(tǒng)計(jì)學(xué)差異(P0.05),實(shí)驗(yàn)組內(nèi)TSH值和MPV值呈正相關(guān),相關(guān)系數(shù)r=0.478;(4)血脂比較:實(shí)驗(yàn)組LDL-C,TC,TG水平高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組內(nèi)三支病變組、雙支病變組與單支病變組相比,前者高于后者,且具有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:SH是冠心病的危險(xiǎn)因素之一,可能通過(guò)影響血脂代謝及MPV水平增加CHD患病風(fēng)險(xiǎn)。
[Abstract]:Background: in recent years, the incidence and death rate of coronary heart disease have increased rapidly in China, and have gradually become one of the leading causes of death among adults in China. There are many risk factors for coronary heart disease. Sex, elevated blood pressure, age, dyslipidemia, smoking, diabetes mellitus and IGT, abdominal obesity, and family history have been identified, but many new risk factors for coronary heart disease have been identified in recent years. If relevant studies have found that the pathogenesis of CHD may be associated with subclinical hypothyroidism, its mechanism is likely to interfere with the metabolism of blood lipids, affect the mean volume of platelets, and eventually lead to coronary arteriosclerosis. Objective: to investigate the relationship between SH and CHD. Methods: from July 1st 2012 to July 1st 2014, 280 patients in Department of Cardiology, the first Hospital of Shanxi Medical University, were selected. All patients were diagnosed as coronary artery disease after coronary angiography, including 138 cases of CHD combined with SH2 and 142 cases of control group. The total Gensini scores of each patient were calculated, and the experimental group was further divided into three subgroups: one lesion group. The serum free thyroxine FT4, free triiodothyronine (FT3) and thyrotropin (TSH) were detected in two vessel group and three vessel group, respectively. The total Gensini score of coronary artery was calculated. Results: after controlling for sex, diabetes, smoking, hypertension and other factors, the total Gensini score was compared between the two groups: the total Gensini score of coronary artery in the experimental group was higher than that in the control group. Comparison of TSH in the subgroup: the TSH of the experimental group was higher than that of the single vessel group, and the TSH of the experimental group was significantly higher than that of the control group. There was a statistical difference between the two groups (P 0.05), and the latter was lower than that in the single vessel group (P 0.05). The TSH and MPV values in the experimental group were positively correlated with those in the control group. Correlation coefficient (r = 0.478 / 4): the level of TG in the experimental group was higher than that in the control group, the difference was statistically significant (P 0.05), the former was higher than the latter in the three vessel lesion group, the double vessel lesion group and the single vessel lesion group, the former was higher than that in the single vessel lesion group, the former was higher than that in the single vessel lesion group. ConclusionSh is one of the risk factors of coronary heart disease, which may increase the risk of CHD by affecting lipid metabolism and MPV level.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4;R581.2

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本文編號(hào)：1621641