本文選題：纖維蛋白原　切入點：中性粒細胞-淋巴細胞比值　出處：《廣西中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:急性冠脈綜合征(ACS)是冠心病急性發(fā)病的臨床類型。近年來許多研究已經(jīng)證實了炎癥在冠狀動脈粥樣硬化病變的發(fā)生和進展具有主要致病作用,且糖尿病患者持續(xù)高血糖狀態(tài)又可顯著增加血管內(nèi)皮細胞的氧化應(yīng)激和炎癥反應(yīng),兩者共同促進冠狀動脈粥樣硬化斑塊的進展和破裂。血清纖維蛋白原(Fib)和中性粒細胞-淋巴細胞比值(NLR)不僅作為一種炎癥標志物,也是心血管事件發(fā)生的預(yù)測因素。因此,本研究旨在探討:1.外周血Fib、NLR與急性冠脈綜合征的相關(guān)性,以及與冠脈病變嚴重程度的關(guān)聯(lián)。2.外周血Fib、NLR與ACS合并糖尿病的關(guān)系,以及與冠脈病變嚴重程度的關(guān)聯(lián)。3.血清Fib和NLR對急性冠脈綜合征的預(yù)測價值。方法:1.本次研究收集2015年10月至2016年10月該時間段入院并行冠脈造影檢查的230例ACS患者(其中合并糖尿病92例,不合并糖尿病138例)。同時選取疑診為“急性冠脈綜合征”但住院期間行冠脈造影術(shù)檢查證實無明顯冠脈狹窄的患者為對照組(58例)。并詳細記錄每例患者入院后的一般臨床資料(年齡、性別、吸煙史、高血壓史等)及相關(guān)實驗室血清指標(血常規(guī)、纖維蛋白原、血脂、血糖等),并計算出中性粒細胞與淋巴細胞比值(NLR),分析血清Fib水平、NLR與ACS組和對照組間的關(guān)聯(lián)以及ACS合并糖尿病與不合并糖尿病血清Fib、NLR之間的差異;2.將230例ACS患者根據(jù)冠狀動脈造影結(jié)果進行冠脈病變SYNTAX評分,并按評分結(jié)果分為低危組(68例)、中危組(79例)及高危組(83例),分析血清Fib、NLR與冠脈病變SYNTAX評分組間的相關(guān)性,并比較ACS合并糖尿病組和非糖尿病ACS組不同SYNTAX評分組間血清Fib、NLR的差異;3.根據(jù)冠脈造影結(jié)果將230例ACS患者分為單支病變組(86例)、雙支病變組(77例)及多支病變組(67例),分析血清Fib、NLR與冠脈病變支數(shù)間的相關(guān)性,并比較ACS合并糖尿病組和非糖尿病ACS組不同冠脈病變支數(shù)間血清Fib、NLR的差異。本次研究所有數(shù)據(jù)均應(yīng)用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析。結(jié)果:1.ACS組中血清Fib水平、NLR明顯高于對照組,且ACS組中合并糖尿病患者血清Fib水平、NLR高于非糖尿病ACS患者。2.高危組中血清Fib水平和NLR明顯高于中危組和低危組,中危組又高于低危組;同時對ACS合并糖尿病組和非糖尿病ACS組不同冠脈病變SYNTAX評分組間血清Fib水平及NLR分別進行比較,也均存在統(tǒng)計學(xué)差異(P0.05)。3.多支病變組中血清Fib和NLR明顯高于雙支病變組和單支病變組,雙支病變組中血清Fib水平高于單支病變組,但NLR在雙支病變組和單支病變組中差異無統(tǒng)計學(xué)意義(P0.05);同時對ACS合并糖尿病組和非糖尿病ACS組不同冠脈病變支數(shù)間血清Fib水平及NLR分別進行比較,也均存在統(tǒng)計學(xué)差異(P0.05)。4.相關(guān)性分析提示Fib及NLR與冠脈病變SYNTAX評分呈正相關(guān)性。5.多元線性逐步回歸分析提示Fib和NLR是ACS患者冠脈病變嚴重程度的獨立預(yù)測因子。6.血清Fib和NLR的ROC曲線分析提示對ACS的發(fā)生具有一定的預(yù)測價值。結(jié)論:1.ACS患者發(fā)病時血清Fib水平及NLR均顯著升高,其中又以ACS合并糖尿病患者升高最顯著,提示血清Fib及NLR與ACS及糖尿病的發(fā)生、發(fā)展密切相關(guān)。2.血清Fib水平及NLR與ACS患者冠脈病變SYNTAX嚴重程度及冠脈病變數(shù)量密切相關(guān),可作為ACS患者冠脈病變嚴重程度的獨立預(yù)測因子。3.血清Fib水平及NLR對ACS的早期診斷具有一定的臨床價值。
[Abstract]:Objective: acute coronary syndrome (ACS) is a clinical type of coronary heart disease with acute onset. In recent years, many studies have confirmed that inflammation has a main pathogenic role in the occurrence and progression of coronary atherosclerosis, oxidative stress and inflammatory reaction in patients with diabetes mellitus and persistent hyperglycemia and increased vascular endothelial cells, both of them promote progress and rupture of coronary atherosclerotic plaque. Serum fibrinogen (Fib) and neutrophil to lymphocyte ratio (NLR) is not only a marker of inflammation, also predictive of cardiovascular events. Therefore, this study aims to investigate: 1. peripheral blood Fib, NLR associated with acute coronary syndrome, and association.2. the severity of coronary artery disease with peripheral blood Fib, the relationship between NLR and ACS patients with diabetes mellitus, and the severity of coronary artery disease with serum Fib and NLR of.3. Association The predictive value of acute coronary syndrome. Methods: 230 cases of 1. ACS patients in this study were collected from October 2015 to October 2016, the time of admission parallel coronary angiography (including 92 cases with diabetes, 138 cases without diabetes). At the same time as the "sign" selection of suspected acute coronary syndrome during hospitalization for coronary angiography examination no significant coronary artery stenosis patients as control group (58 cases). The clinical data and detailed records of each patient after admission (age, gender, smoking history, history of hypertension and related laboratory index) serum (blood, fibrinogen, blood lipid, blood sugar, etc.) and calculate the neutrophil to lymphocyte the ratio (NLR), analysis of the serum level of Fib, NLR and correlation between ACS group and control group and ACS patients with diabetes mellitus and diabetic serum Fib, the difference between NLR 2.; 230 cases of ACS patients were made according to the coronary artery The shadow SYNTAX coronary artery score according to the scoring results and divided into low risk group (68 cases), moderate risk group (79 cases) and high risk group (83 cases), SYNTAX correlation analysis of serum Fib, NLR and coronary artery lesion scores between groups, and compared ACS with diabetes group and non diabetes ACS group SYNTAX scores between the serum levels of Fib, NLR difference; 3. according to the results of coronary angiography in 230 patients with ACS were divided into single vessel group (86 cases), double vessel lesion group (77 cases) and multivessel disease group (67 cases), correlation analysis of serum Fib, NLR and coronary artery lesions between the branches, and compared ACS with diabetes group and non diabetes ACS group different coronary lesions between serum Fib, NLR difference. This research all data are used SPSS17.0 statistical software for statistical analysis. Results: the level of serum Fib in 1.ACS group, NLR was significantly higher than the control group, and ACS group with diabetes patients serum Fib level that is higher than NLR Non diabetic patients with ACS.2. high-risk group serum levels of Fib and NLR were significantly higher than those in the risk group and the low risk group, medium risk group was higher than that of low risk group; at the same time of ACS with serum Fib levels and NLR scores between the diabetic group and non-diabetic group ACS different SYNTAX coronary lesions were compared, and there were statistically significant differences (P0.05).3. multi vessel disease group serum Fib and NLR were significantly higher than that of double branch lesions group and single vessel disease group, double vessel group in the serum level of Fib was higher than that of single branch lesion group, but there was no significant NLR in double vessel group and single vessel disease group (P0.05); while the difference with ACS NLR and serum Fib levels in diabetic group and non-diabetic group ACS different coronary lesions were also compared, there were statistically significant differences (P0.05) and Fib.4. correlation analysis showed that NLR and SYNTAX score of coronary artery lesion of.5. was positively correlated to the multivariate linear stepwise regression Analysis showed that the Fib and NLR is ROC curve in patients with ACS the severity of coronary artery disease were independent predictors of.6. serum Fib and NLR analysis showed that the is of certain value in predicting the occurrence of ACS. Conclusion: 1.ACS patients with serum level of Fib and NLR were significantly increased, especially in ACS patients with diabetes increased significantly. The results showed that the serum Fib and NLR and ACS and the incidence of diabetes is closely related to the development of.2., the number of levels of serum Fib and NLR and SYNTAX ACS in patients with coronary lesion severity and coronary artery lesions are closely related, can be used as independent pre ACS patients with the severity of coronary artery disease measuring factor.3. serum levels of Fib and NLR has certain clinical value in early diagnosis of ACS.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

【參考文獻】

相關(guān)期刊論文 前3條

1 ;急性ST段抬高型心肌梗死診斷和治療指南[J];中華心血管病雜志;2015年05期

2 劉力生;;中國高血壓防治指南2010[J];中華高血壓雜志;2011年08期

3 中國心臟調(diào)查組;胡大一;潘長玉;;中國住院冠心病患者糖代謝異常研究——中國心臟調(diào)查[J];中華內(nèi)分泌代謝雜志;2006年01期

，

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