本文選題：NLRP3及其相關(guān)因子　切入點(diǎn)：非ST段抬高型ACS(NSTE-ACS)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的分析非ST段抬高型急性冠狀動(dòng)脈綜合征(non-ST seggment elevation acute coronary syndrome,NSTE-ACS)患者 NLRP3 及其相關(guān)因子IL-1 β、IL-18水平與全球急性冠狀動(dòng)脈事件注冊(cè)(Global Registry ofAcute Coronary Events,GRACE)評(píng)分及危險(xiǎn)分層的相關(guān)性,探討NLRP3及其相關(guān)因子IL-1 β、IL-18水平是否可以對(duì)NSTE-ACS患者危險(xiǎn)分層及住院期間發(fā)生MACE進(jìn)行預(yù)測(cè)。方法選取2015年3月至2016年3月在柳州市工人醫(yī)院心血管內(nèi)科一病區(qū)住院的患者141例,由具有冠狀動(dòng)脈造影資質(zhì)的專(zhuān)業(yè)醫(yī)生對(duì)患者進(jìn)行冠狀動(dòng)脈造影檢查。其中,非ST段抬高型急性冠脈綜合征患者90例,穩(wěn)定性心絞痛患者(AP)24例,冠狀動(dòng)脈造影結(jié)果無(wú)異常者作為對(duì)照組27例。根據(jù)NSTE-ACS患者臨床分型分為:不穩(wěn)定性心絞痛(UA)組、非ST段抬高型心肌梗死(NSTEMI)組。按GRACE評(píng)分結(jié)果對(duì)NSTE-ACS患者分組:高危組(≥140分)、中危組(109-139分)、低危組(≤108分者)。對(duì)患者的年齡、性別、心率、血壓、吸煙史、高血壓病史、糖尿病史等基礎(chǔ)性材料進(jìn)行詳細(xì)記錄。采用酶聯(lián)免疫吸附法(Enzyme Linkde Immunosorbent Assay,ELISA)測(cè)定所有患者外周血NLRP3、IL-1β、IL-18水平,記錄NSTE-ACS患者住院期間MACE的發(fā)生情況。對(duì)各組間一般資料、外周血NLRP3及其相關(guān)因子IL-1 β、IL-18水平進(jìn)行差異性比較。然后再對(duì)外周血NLRP3及IL-1 β、IL-18進(jìn)行相關(guān)性分析。最后通過(guò)ROC曲線(xiàn)求出各個(gè)指標(biāo)的曲線(xiàn)下面積及最佳截?cái)帱c(diǎn)。分析NLRP3及其相關(guān)因子IL-1β、IL-18水平對(duì)NSTE-ACS患者危險(xiǎn)分層及住院期間發(fā)生MACE的預(yù)測(cè)價(jià)值。結(jié)果(1)經(jīng)比較,患者的臨床基礎(chǔ)資料如年齡、性別、高血壓病、糖尿病患病率、血脂、心率、肌酐、用藥情況等組間比較無(wú)統(tǒng)計(jì)學(xué)意義。(2)①NSTEMI組、UA組、AP組NLRP3及IL-1β水平顯著高于對(duì)照組(P0.05)。②NSTEMI 組 NLRP3、IL-1 β 水平顯著高于 UA 組和 AP 組(P0.05)。③NSTEMI組IL-18水平顯著高于UA組和對(duì)照組(P0.05);UA組、AP組、對(duì)照組組間IL-18水平無(wú)明顯差別(P0.05)。(3)①高危組、中危組、低危組NLRP3、IL-1β、hsCRP水平及白細(xì)胞計(jì)數(shù)顯著高于對(duì)照組(P0.05)。②高危組、中危組NLRP3、IL-1β、hsCRP水平及白細(xì)胞計(jì)數(shù)顯著高于低危組(P0.05)。③高危組NLRP3、IL-1β、hsCRP水平及白細(xì)胞計(jì)數(shù)顯著高于中危組(P0.05)。④高危組IL-18水平顯著高于中危組、低危組、對(duì)照組(P0.05)。⑤中危組、低危組、對(duì)照組組間IL-18水平無(wú)明顯差別(P0.05)。⑥高危組NLRP3、IL-1β、IL-18水平顯著高于中危、低危及對(duì)照組,提示NLRP3、IL-1β、IL-18水平有助于高�；颊叩淖R(shí)別。(4)相關(guān)性分析結(jié)果顯示,NLRP3及IL-1 β、IL-18水平與GRACE評(píng)分的相關(guān)系數(shù)分別為 0.599,0.590,0.281,P0.05,提示 NLRP3 及 IL-1β、IL-18 水平與GRACE評(píng)分呈良好的相關(guān)性。(5)ROC曲線(xiàn)求得NLRP3及其相關(guān)因子IL-1 β、IL-18對(duì)NSTE-ACS患者住院期間發(fā)生MACE的曲線(xiàn)下面積分別為0.921、0.762、0.692。最佳截?cái)帱c(diǎn)分別為 133.77pg/mL、7.83ng/mL、15.07ng/mL。結(jié)論相比較于IL-Iβ及IL-18,外周血NLRP3水平的檢測(cè)與GRACE評(píng)分對(duì)NSTE-ACS患者危險(xiǎn)分層及住院期間發(fā)生MACE的預(yù)測(cè)有比較好價(jià)值,外周血NLRP3有可能成為NSTE-ACS患者預(yù)后判斷的重要血清標(biāo)記物。
[Abstract]:Objective to analyze the non ST elevation acute coronary syndrome (non-ST seggment elevation acute coronary syndrome, NSTE-ACS) in patients with NLRP3 and its related factors of IL-1 beta, IL-18 level and the global registry of acute coronary events (Global Registry ofAcute Coronary Events, GRACE) correlation score and risk stratification, discuss NLRP3 and its related factors of IL-1 beta, IL-18 whether the level of risk stratification of NSTE-ACS patients during hospitalization and incidence of MACE were predicted. Methods 141 cases from March 2015 to March 2016 in a hospital of Liuzhou Worker's Hospital Department of Cardiology disease patients, for patients with coronary artery angiography with coronary angiography by qualified professional doctor. Among them, non ST elevation acute coronary syndrome in 90 cases patients, patients with stable angina pectoris (AP) in 24 cases, no abnormal results of coronary angiography as control Group of 27 cases. According to the clinical NSTE-ACS patients were divided into unstable angina pectoris (UA) group, non ST elevation myocardial infarction (NSTEMI) group according to the GRACE score of NSTE-ACS patients were divided into two groups: high risk group (more than 140), medium risk group (109-139), low risk group (less than or equal to 108). The patient's age, gender, heart rate, blood pressure, smoking history, hypertension history, diabetes history and other basic materials were recorded. Using enzyme-linked immunosorbent assay (Enzyme Linkde Immunosorbent Assay, ELISA) were measured in all patients with peripheral blood NLRP3, IL-1 beta, IL-18 level, NSTE-ACS records of hospitalized patients during MACE. The general data between groups, peripheral blood NLRP3 and related cytokine of IL-1, IL-18 levels were compared. Then the peripheral blood NLRP3 and IL-1 beta, IL-18 correlation analysis. Finally, through the ROC curve area under the curve of each index and the best section 鏂偣.鍒嗘瀽NLRP3鍙?qiáng)鍏剁浉鍏冲洜瀛怚L-1尾,IL-18姘村鉤瀵筃STE-ACS鎮(zhèn)ｈ，

本文編號(hào)：1594031