本文選題：冠狀動脈慢血流　切入點(diǎn)：炎癥　出處：《鄭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景冠狀動脈慢血流(slow coronary flow,SCF)最初由Tambe等[1]首先發(fā)現(xiàn)并報(bào)道,根據(jù)Mohammad等[2]最新統(tǒng)計(jì)數(shù)據(jù)在行冠狀動脈造影的患者中6.6%存在SCF現(xiàn)象。SCF患者可表現(xiàn)為不明原因的胸部不適、穩(wěn)定型心絞痛、急性冠狀動脈綜合癥、惡性心律失常以及猝死等[3-4],鑒于SCF發(fā)生率增加和臨床表現(xiàn)多樣性其日益受到關(guān)注。盡管關(guān)于SCF的研究已很多,但其具體病理生理機(jī)制仍不明確,所以對于SCF的治療暫無明確指南推薦,僅根據(jù)臨床癥狀給予對應(yīng)治療。綜合目前研究SCF可能的發(fā)生機(jī)制主要為內(nèi)皮功能受損[5-6]、微血管功能失調(diào)[7]、炎癥反應(yīng)[8]以及動脈粥樣硬化早期改變[9]。內(nèi)皮細(xì)胞受損導(dǎo)致血管活性物質(zhì)分泌紊亂,引發(fā)微血管舒縮失調(diào),同時內(nèi)皮細(xì)胞損傷也是血管壁動脈粥樣硬化的關(guān)鍵環(huán)節(jié);微血管是血流阻力的主要來源,微血管病變可致血流阻力增加及大血管充血狀態(tài),這時血細(xì)胞可發(fā)生疊連和聚集,血液粘度增加一方面使血流阻力進(jìn)一步增加,另一方面可致白細(xì)胞向血管壁粘附,導(dǎo)致內(nèi)皮細(xì)胞炎癥狀態(tài),出現(xiàn)內(nèi)皮細(xì)胞損傷,從而誘發(fā)血管壁病理性改變;炎癥反應(yīng)可首先致內(nèi)皮損傷修復(fù)失衡,出現(xiàn)內(nèi)膜增厚及平滑肌增殖等病理性變化,從而發(fā)生血管重構(gòu),血流阻力隨之增加�？梢奡CF是這些因素相互作用的結(jié)果,而非單一因素引起。外周血細(xì)胞包括白細(xì)胞、紅細(xì)胞及血小板,白細(xì)胞是炎癥反應(yīng)的主要參與者,并可釋放多種炎性因子加速炎癥反應(yīng);紅細(xì)胞的免疫粘附作用可致紅細(xì)胞之間以及紅細(xì)胞與血小板之間出現(xiàn)粘附,進(jìn)而導(dǎo)致微血管栓塞、血流阻力增加;血小板除其主要的凝血和止血作用外,尚有保護(hù)血管內(nèi)皮、參與內(nèi)皮修復(fù)、防止動脈粥樣硬化的作用,但血小板的過度激活可致血栓形成,引起血管栓塞�；谏鲜鐾庵苎�(xì)胞功能,并結(jié)合目前有關(guān)研究,推測外周血細(xì)胞某些成分可能在一定程度上參與了SCF的病理生理過程。因此本研究通過對比SCF組與正常組外周血細(xì)胞各項(xiàng)指標(biāo),旨在明確外周血細(xì)胞中各項(xiàng)指標(biāo)與SCF的關(guān)系,以期為臨床診斷提供依據(jù)。目的探討外周血細(xì)胞中的各項(xiàng)指標(biāo)與冠狀動脈慢血流的相關(guān)性方法以鄭州大學(xué)第一附屬醫(yī)院心內(nèi)科經(jīng)冠狀動脈造影檢查證實(shí)狹窄40%的195例患者為研究對象,其中SCF組99例(男性52例,女性47例),正常血流(normal coronary flow,NCF)組96例(男性45例,女性51例),SCF定義為圖像采集速度30幀/s時,造影劑通過至少1支冠狀動脈的幀數(shù)27幀[10],記錄患者基本臨床資料并在入院次日早晨抽取空腹肘靜脈血進(jìn)行血常規(guī)、血脂、血糖、尿酸、尿素及肌酐測定,計(jì)算中性粒細(xì)胞與淋巴細(xì)胞比值(neutrophil to lymphocyte ratio,NLR),采用SPSS17.0統(tǒng)計(jì)軟件對兩組數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.兩組患者基線資料相比無統(tǒng)計(jì)學(xué)差異(P0.05);2.SCF組白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)、紅細(xì)胞分布寬度(red cell distribution width,RDW)、超敏C反應(yīng)蛋白(high sensitivity C-reactive protein,hs-CRP)、平均血小板體積(mean platelet volume,MPV)、尿酸(UA)及NLR均顯著高于NCF組(6.76±1.31 vs.6.32±1.39,P=0.024;4.24±1.12 vs.3.79±1.16,P=0.007;13.47±1.93 vs.12.88±1.90,P=0.034;2.20±0.69 vs.2.01±0.61,P=0.041;9.04±1.11vs.8.55±1.42,P=0.008;287.55±67.46 vs.262.26±80.46,P=0.018;2.45±0.80 vs.2.06±0.70,P0.001),差異有統(tǒng)計(jì)學(xué)意義(P0.05);3.Pearson相關(guān)分析顯示NLR與hs-CRP呈顯著正相關(guān),r=0.871,P0.001;4.二元Logistic回歸分析顯示增高的NLR(OR=1.885,95%CI:1.254-2.835,P=0.002)及MPV(OR=1.381,95%CI:1.085-1.757,P=0.009)可能是發(fā)生SCF的獨(dú)立危險(xiǎn)因素;5.ROC曲線表明NLR(AUC=0.635,敏感性為59.6%,特異性為61.5%)及MPV(AUC=0.612,敏感性為80.8%,特異性為46.9%)對SCF的發(fā)生具有重要預(yù)測價(jià)值。結(jié)論1.白細(xì)胞、中性粒細(xì)胞、hs-CRP及UA參與了SCF的病理生理過程;2.NLR與血清hs-CRP水平正相關(guān),其可作為炎癥狀態(tài)的標(biāo)志物,增高的NLR及hs-CRP提示SCF可能是一種炎癥狀態(tài);3.NLR及MPV可能是發(fā)生SCF的獨(dú)立危險(xiǎn)因素,其可作為臨床無創(chuàng)性預(yù)測SCF的重要指標(biāo)。
[Abstract]:The background of slow coronary flow (slow coronary, flow, SCF) initially by the Tambe [1] first discovered and reported 6.6%, according to the latest statistics Mohammad [2] undergoing coronary angiography in patients with SCF in patients with.SCF showed unexplained chest discomfort, stable angina, acute coronary syndrome, malignant arrhythmia and sudden death of [3-4], whereas SCF increased incidence and clinical manifestations of diversity of its growing concern. Although there have been a lot of research on SCF, but the specific pathophysiological mechanism is still not clear, so for SCF treatment no clear guidelines, only to give the corresponding therapy according to the clinical symptoms. At present a comprehensive study of SCF the mechanism mainly is endothelial dysfunction and microvascular dysfunction of [5-6], [7], [8] and inflammatory reaction in early atherosclerotic changes [9]. endothelial cell damage leads to vasoactive The material secretion disorder, caused by micro vasomotor disorders, and the key link of endothelial cell injury is vascular atherosclerosis; microvascular blood flow resistance is the main source of the micro vascular lesions increased resistance to flow and vascular hyperemia, then blood cells can produce overlapping and aggregation, increased blood viscosity, the blood flow resistance on one hand to further increase, on the other hand can cause white blood cells to vascular endothelial cell adhesion, leading to inflammation, endothelial cell injury, and induce vascular pathological change; the inflammatory response can be induced in the first skin damage repair imbalance, endometrial thickening and proliferation of vascular smooth muscle cells and other pathological changes, resulting in vascular remodeling, blood flow resistance increased SCF. Visible is the interaction result of all these factors, rather than a single factor. Peripheral blood cells including white blood cells, red blood cells and blood platelets, white blood cells Is the main participants of the inflammatory response and the release of various inflammatory factors accelerate inflammation; adhesion between erythrocyte immune adhesion function can cause the red blood cells and red blood cells and platelets, leading to microvascular embolization, blood flow resistance increased; in addition to the platelet coagulation and hemostasis, and protect vascular endothelium, participate in endothelial repair, prevent atherosclerosis, but can cause excessive activation of platelet thrombosis caused by vascular embolization. The peripheral blood cell function based on, combined with the current relevant research, push test some components of peripheral blood cells may participate in the pathophysiological process of SCF to a certain extent. Therefore the research and the normal group compared with the SCF group in peripheral blood cells of the index, the correlation between SCF aims to make clear in the peripheral blood cells, in order to provide the basis for clinical diagnosis. Objective to investigate The method of correlation in the peripheral blood cells index and coronary slow flow in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University underwent coronary angiography and 195 cases of stenosis was confirmed in 40% of the patients as the research object, including 99 cases of SCF group (52 males, 47 females), normal blood flow (normal coronary flow, NCF) 96 patients (45 cases, male 51 cases of female), SCF is defined as the image acquisition speed of 30 frames /s, contrast agent through at least 1 coronary artery. 27 frames [10], record the basic clinical data of patients and blood routine in the hospital the next morning fasting venous blood lipid, blood glucose, uric acid, urea and creatinine determination the calculation, neutrophil to lymphocyte ratio (neutrophil to lymphocyte ratio, NLR), using SPSS17.0 statistical software for statistical analysis of data of the two groups. Results 1. patients of the two groups at baseline compared no significant difference (P0.05); 2.SC F group of white blood cell count, neutrophil count, red cell distribution width (red cell distribution width, RDW), high sensitive C reactive protein (high sensitivity C-reactive protein, hs-CRP), mean platelet volume (mean platelet, volume, MPV), uric acid (UA) and NLR were significantly higher than that of group NCF (6.76 + 1.31 vs.6.32 + 1.39, P=0.024; 4.24 + 1.12 vs.3.79 + 1.16, P=0.007; 13.47 + 1.93 vs.12.88 + 1.90, P=0.034; 2.20 + 0.69 vs.2.01 + 0.61, P=0.041; 9.04 + 1.11vs.8.55 + 1.42, P=0.008; 287.55 + 67.46 vs.262.26 + 80.46, P=0.018; 2.45 + 0.80 vs.2.06 + 0.70, P0.001), the difference was statistically significant (P0.05) 3.Pearson; correlation analysis showed a significant positive correlation between NLR and hs-CRP, r=0.871, P0.001; 4. two yuan Logistic regression analysis showed that the increased NLR (OR=1.885,95%CI:1.254-2.835, P=0.002) and MPV (OR=1.381,95%CI:1.085-1.757, P=0.009) may be an independent risk of SCF Factor; 5.ROC curves show that NLR (AUC=0.635, the sensitivity was 59.6%, specificity was 61.5% (AUC=0.612) and MPV, the sensitivity was 80.8%, specificity 46.9%) is important for the predictive value of SCF. Conclusion: 1. white blood cells, neutrophils, hs-CRP and UA are involved in the pathophysiology of SCF is related to 2.NLR; and the level of serum hs-CRP, which may be used as a marker of inflammation, NLR and increased hs-CRP may indicate that SCF is an inflammatory condition; 3.NLR and MPV may be the independent risk factors of SCF, it can be used as a noninvasive prediction of SCF important index.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4

【共引文獻(xiàn)】

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本文編號：1636975