本文選題：冠心病　切入點：脂蛋白磷脂酶A2　出處：《南京醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討脂蛋白相關磷脂酶A2與經(jīng)典風險因子在預測冠心病(CHD)中的協(xié)同作用,并且證實Lp-PLA2用于預測冠心病冠狀動脈狹窄病變的診斷價值。方法:在2011年3月至2014年7月31期間,納入新疆伊犁哈薩克自治州友誼醫(yī)院住院治療的來自11個不同名族的911名疑似冠心病患者,以冠脈造影檢查確診或排出冠心病,根據(jù)檢查結果采用Gensini評分體系評估冠心病患者病情嚴重程度。通過免疫比濁法測定所有研究對象血漿當中Lp-PLA2濃度。符合正態(tài)分布的數(shù)據(jù)以平均數(shù)士標準差表示,使用方差分析進行多組間差異檢驗。偏態(tài)數(shù)據(jù)以中位數(shù)和四分位數(shù)表示,使用Kruskal—WallisH檢驗(K-W檢驗)進行多組間差異檢驗。Spearman相關檢驗用于評估兩個定量變量之間的關系。使用多元邏輯回歸分析血漿Lp-PLA2濃度與冠心病嚴重程度之間關系,交互作用模型分析血漿Lp-PLA2與傳統(tǒng)疾病危險因素的相互作用。結果:各民族人群血漿Lp-PLA2水平存在統(tǒng)計學差異(p＜0.05),其中漢族人群最低(182.25(117.63-259.03)),維吾爾族人群最高(229.56(163.11-294.58))。Spearman相關分析表明Lp-PLA2與冠心病的嚴重程度呈正相關(r= 0.176,p =0.000)。進行二元邏輯回歸分析Lp-PLA2與其他危險因素的關系。多因素邏輯回歸分析顯示Lp-PLA2水平與冠心病發(fā)生顯著相關(OR,1.882;95%CI,1.369-2.587,p = 0.000)。Lp-PLA2 受試者工作特征曲線下面積為 0.589(95%CI,0.549-0.629,p = 0.000)。還發(fā)現(xiàn)Lp-PLA2和其他危險因素之間的協(xié)同作用:年齡(SI=20.95,SIM= 2.89,4P=0.64),性別(SI= 1.15,SIM= 0.67,= 0.10),SBP(SI = SIM=1.56,AP = 0.45),HDL-C(SI=1.22,SIM=0.92,AP = 0.13),LDL-C(SI=3.47,SIM=2.00,AP = 0.62),FBG(SI=2.27,SIM= 1.37,AP =0.47)。冠心病發(fā)生歸因于Lp-PLA2和年齡相互作用的比例高達64%。結論:人血漿中Lp-PLA2水平與冠心病的嚴重程度呈正相關,Lp-PLA2與傳統(tǒng)疾病危險因素在預測冠心病方面有明顯的正相關作用。因此,Lp-PLA2可作為預測冠心病的獨立影響因素。
[Abstract]:Objective: to investigate the synergistic effect of lipoprotein associated phospholipase A 2 and classical risk factor in predicting coronary artery disease (CAD) and to confirm the diagnostic value of Lp-PLA2 in predicting coronary artery stenosis.Methods: from March 2011 to July 31, 2014, 911 patients with suspected coronary heart disease (CHD) who were admitted to the Friendship Hospital of Yili Kazak Autonomous Prefecture, Xinjiang, were diagnosed or excluded by coronary angiography.The severity of coronary heart disease was evaluated by Gensini scoring system.Lp-PLA2 levels in plasma were measured by immunoturbidimetric method.The data in accordance with the normal distribution are expressed as the mean standard deviation and the analysis of variance is used to test the differences between groups.The skewed data were expressed as median and quartile, using Kruskal-WallisH test / K-W test. Spearman correlation test was used to evaluate the relationship between the two quantitative variables.Multivariate logistic regression analysis was used to analyze the relationship between plasma Lp-PLA2 concentration and severity of coronary heart disease (CHD). The interaction between plasma Lp-PLA2 and traditional disease risk factors was analyzed by an interactive model.The relationship between Lp-PLA2 and other risk factors was analyzed by binary logistic regression analysis.Multivariate logistic regression analysis showed that the level of Lp-PLA2 was significantly correlated with the occurrence of coronary heart disease (CHD). The area under the operating characteristic curve of 0.000).Lp-PLA2 subjects was 0.549-0.629 (p = 0.000).榪樺彂鐜癓p-PLA2鍜屽叾浠栧嵄闄╁洜绱犱箣闂寸殑鍗忓悓浣滅敤:騫撮緞(SI=20.95,SIM= 2.89,4P=0.64),鎬у埆(SI= 1.15,SIM= 0.67,= 0.10),SBP(SI = SIM=1.56,AP = 0.45),HDL-C(SI=1.22,SIM=0.92,AP = 0.13),LDL-C(SI=3.47,SIM=2.00,AP = 0.62),FBG(SI=2.27,SIM= 1.37,AP =0.47).Coronary heart disease is attributed to the interaction of Lp-PLA2 and age as high as 64%.Conclusion: the level of Lp-PLA2 in human plasma is positively correlated with the severity of coronary heart disease. Lp-PLA2 has a positive correlation with traditional disease risk factors in predicting coronary heart disease.Therefore, Lp-PLA2 may be an independent predictor of coronary heart disease.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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