本文選題：糖尿病腎病 + 血小板形態(tài)��； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的隨著糖尿病腎病患者壽命延長,糖尿病腎病患者并發(fā)心血管疾病比例升高,更多死于心血管疾病,尤其是冠脈疾病,而非腎功能不全及尿毒癥本身。如何在糖尿病腎病人群中早期識別冠脈疾病風(fēng)險(xiǎn)顯得尤為重要。本研究旨在探討糖尿病腎病患者血小板形態(tài)指標(biāo)與急性冠脈綜合征(ACS)發(fā)生及嚴(yán)重程度之間的相關(guān)性,進(jìn)而評估血小板形態(tài)指標(biāo)是否可作為評估急性冠脈綜合征(ACS)發(fā)生、發(fā)展的簡易指標(biāo)。方法納入2011年1月至2015年12月于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院就診的糖尿病腎病患者439例,其中合并急性冠脈綜合癥患者219例為ACS組,未合并急性冠脈綜合癥患者220例為對照組。ACS組中190例患者根據(jù)冠脈造影光盤結(jié)果進(jìn)行SYNTAX評分,并根據(jù)評分結(jié)果分為低評分組(101例)、中評分組(50例)及高評分組(39例)。收集全部入選患者的性別、年齡、是否合并高血壓、是否合并高脂血癥、是否存在吸煙史、紅細(xì)胞計(jì)數(shù)、血紅蛋白、血小板計(jì)數(shù)、尿素、肌酐、尿酸、高密度脂蛋白、低密度脂蛋白、超敏C反應(yīng)蛋白、紅細(xì)胞沉降率等基線資料。入選的患者均在入院后空腹采用真空采血管留取外周靜脈血,并采用全自動(dòng)血細(xì)胞分析儀檢測血小板平均體積(MPV)、血小板分布寬度(PDW)、大血小板比率(P-LCR)等血小板形態(tài)相關(guān)參數(shù)。ACS組患者根據(jù)冠脈造影結(jié)果進(jìn)行Gensini評分。對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析分析血小板形態(tài)指標(biāo)與冠脈病變嚴(yán)重程度相關(guān)性。結(jié)果與對照組相比,ACS組三項(xiàng)血小板形態(tài)指標(biāo)明顯升高(P均0.05)。Logistic回歸分析提示PDW可作為ACS發(fā)生的影響因素(OR 1.399(1.031-1.898),P0.05)。MPV、PDW、P-LCR指標(biāo)隨著冠脈病變支數(shù)增加而增高(P0.05)。線性相關(guān)分析結(jié)果顯示,MPV、PDW、P-LCR均與Gensini評分呈正相關(guān),相關(guān)系數(shù)分別為:0.694、0.697、0.673(P均0.05)。多元線性回歸分析提示血小板形態(tài)指標(biāo)對冠脈Gensini評分存在獨(dú)立影響(標(biāo)準(zhǔn)化回歸系數(shù)為:0.723,P0.01)。SYNTAX評分患者中,高評分組在MPV、PDW、P-LCR均明顯高于中、低評分組[(12.6±0.8)fL比(11.6±0.6)、(10.7±0.8)fL,(17.4±2.4)%比(14.6±1.6)%、(12.8±1.7)%,(45±6)%比(38±5)%、(31±7)%],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析提示血小板形態(tài)指標(biāo)(MPV、PDW及P-LCR,比值比=6.154,95%置信區(qū)間:3.260~11.618,P=0.001)為高SYNTAX評分的危險(xiǎn)因素。Spearman相關(guān)分析顯示MPV(rs=0.723,P0.001)、PDW(rs=0.708,P0.001)、P-LCR(rs=0.727,P0.001)均與冠狀動(dòng)脈SYNTAX評分呈正相關(guān)。多元線性回歸分析結(jié)果提示血小板形態(tài)指標(biāo)、尿素對冠狀動(dòng)脈SYNTAX評分存在獨(dú)立影響,標(biāo)準(zhǔn)化回歸系數(shù)依次為0.799(P0.001)和0.136(P=0.016)。結(jié)論血小板形態(tài)指標(biāo)與冠脈病變程度存在正相關(guān)性,對冠狀動(dòng)脈病變程度可能存在預(yù)測意義,并且可作為糖尿病腎病患者合并發(fā)生急性冠脈綜合征的評估指標(biāo)。
[Abstract]:Objective with the prolongation of life span of diabetic nephropathy, the proportion of diabetic nephropathy complicated with cardiovascular disease increased, and more died of cardiovascular disease, especially coronary artery disease, rather than renal insufficiency and uremia itself.It is very important to identify the risk of coronary artery disease in diabetic nephropathy population.The purpose of this study was to investigate the correlation between platelet morphology and the incidence and severity of acute coronary syndrome (ACS) in patients with diabetic nephropathy, and to evaluate whether platelet morphology can be used as an assessment of the occurrence of acute coronary syndrome (ACS).A simple indicator of developmentMethods from January 2011 to December 2015, 439 patients with diabetic nephropathy were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University, including 219 patients with acute coronary syndrome (ACS) as ACS group.220 patients without acute coronary syndrome (ACS) were divided into low score group (101 cases) and high score group (39 cases) and high score group (39 cases).Gender, age, hypertension, hyperlipidemia, smoking history, red blood cell count, hemoglobin, platelet count, urea, creatinine, uric acid, high density lipoprotein were collected.Baseline data of low density lipoprotein, hypersensitive C reactive protein and erythrocyte sedimentation rate.After admission, all patients were treated with vacuum blood vessels on an empty stomach to collect peripheral venous blood.The mean platelet volume (MPV), platelet distribution width (PDW) and large platelet ratio (P-LCR) were measured by automatic blood cell analyzer (ACS). The patients in ACS group were evaluated with Gensini according to the results of coronary angiography.The correlation between platelet morphology and severity of coronary artery disease was analyzed statistically.Results compared with the control group, compared with the control group, the three indexes of platelet morphology were significantly increased P and 0.05).Logistic regression analysis showed that PDW could be used as an influential factor for the occurrence of ACS (OR 1.399) 1.031-1.898P0.05N. MPVG PDWP- LCR increased with the increase of the number of coronary artery lesion branches.The results of linear correlation analysis showed that there was a positive correlation between the P-LCR and the Gensini score, and the correlation coefficients were respectively 0. 05%, 0. 694 ~ 0. 697 and 0. 673% (P = 0. 05).Multiple linear regression analysis showed that platelet morphology had an independent effect on coronary Gensini score (standardized regression coefficient was 0. 723 P 0. 01%. SYNTAX score). The high score group was significantly higher than that of middle group.浣庤瘎鍒嗙粍[(12.6鹵0.8)fL姣，

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