本文選題：冠心病 + HDL　； 參考：《鄭州大學》2017年碩士論文

【摘要】：目的探討冠心病(coronary heart disease,CHD)患者高密度脂蛋白(high-density lipoprotein,HDL)、血尿酸(uric acid,UA)與血管內(nèi)皮功能的關系及三者與冠脈病變程度的相關性。方法選取2014年4月至2015年10月在河南省人民醫(yī)院心內(nèi)科就診的疑似CHD患者243人,所有患者均進行冠脈造影,其中冠脈造影陽性者146例為冠心病組,冠脈造影陰性者97例為非冠心病組,以上患者均用Endo-PAT2000儀器進行血管內(nèi)皮功能檢查,經(jīng)計算機校正得出RHI(反應性充血指數(shù)reactive hyperemia index)。比較2組一般資料、血脂水平、肝功能、腎功能、UA及RHI間的差異;依RHI正常與否運用二分類Logistic回歸分析血管內(nèi)皮功能即RHI的影響因素;運用Pearson相關分析探討了冠心病組HDL、UA與RHI之間的關系;再將冠心病組患者依冠狀動脈病變程度分為單支病變組(37例)、雙支病變組(48例)與三支病變組(61例)3個亞組,運用方差分析分別比較各亞組間HDL、UA及RHI的差異。結果1.冠心病組HDL、血管內(nèi)皮功能評估指數(shù)-RHI低于非冠心病組,差異有統(tǒng)計學意義[(0.99±0.21)mmol/L比(1.08±0.24)mmol/L、(1.6±0.3)比(1.8±0.5)](P0.05)。但冠心病組UA水平高于非冠心病組,差異有統(tǒng)計學意義[(325.07±79.87)umol/l比(321.52±85.50)umol/l](P0.01)。2.兩組總體人群中RHI與UA水平相關(比值比=0.802,P=0.045)。非冠心病組患者中RHI與高血壓相關(比值比=0.979,P=0.005)。冠心病組患者中,RHI與HDL、UA的相關性有統(tǒng)計學意義(比值比分別為5.132、0.901,P值分別為0.043、0.004),且HDL與RHI呈明顯線性正相關(r=0.470,P0.001),UA水平與RHI呈線性負相關(r=-0.202,P=0.014)。3.冠心病組患者中單支病變組、雙支病變組及三支病變組HDL水平分別為(1.16±0.35)、(1.01±0.25)、(1.02±0.20),組間差異有統(tǒng)計學意義(P=0.014),其中單支病變組與雙支病變組、單支病變組與三支病變組HDL差異有統(tǒng)計學意義(P0.05)。4.冠心病組患者中單支病變組、雙支病變組及三支病變組UA水平分別為[(248.84±57.73)、(331.81±56.63)、(360.97±76.70)],組間差異有統(tǒng)計學意義(P0.01),兩兩比較各組UA水平差異仍有統(tǒng)計學意義(P0.05)。5.冠心病組患者中單支病變組、雙支病變組及三支病變組RHI水平分別為[(1.52±0.23)、(1.44±0.19)、(1.40±0.19)],組間差異有統(tǒng)計學意義(P=0.025),其中單支病變組與三支病變組RHI差異有統(tǒng)計學意義(P=0.007)。結論1.在冠心病患者中HDL為血管內(nèi)皮功能正常的保護因素,且HDL與血管內(nèi)皮功能呈線性正相關;而UA為血管內(nèi)皮功能正常的危險因素,且UA水平與血管內(nèi)皮功能呈負相關。提示提高HDL與降低UA可能會對血管內(nèi)皮功能有改善作用。2.隨著冠脈病變程度的加重,RHI逐漸下降,而UA逐漸升高。提示UA、血管內(nèi)皮功能與冠脈病變程度相關,它們可以預測冠狀動脈病變程度。
[Abstract]:Objective to investigate the relationship between high density lipoprotein (HDL) and vascular endothelial function in patients with coronary heart disease (heart) and the relationship between these three factors and the severity of coronary artery disease.Methods A total of 243 suspected CHD patients from April 2014 to October 2015 in Henan Provincial people's Hospital were selected. All the patients underwent coronary angiography. Among them, 146 cases were positive for coronary artery disease.97 patients with negative coronary arteriography were non-coronary heart disease group. All the patients were examined with Endo-PAT2000 instrument for vascular endothelial function. The RHI (reactive hyperemia index reactive hyperemia index) was obtained by computer correction.The differences of blood lipid level, liver function, renal function, UA and RHI were compared between the two groups, and the influencing factors of vascular endothelial function (RHI) were analyzed by two-classification Logistic regression analysis according to whether RHI was normal or not.Pearson correlation analysis was used to study the relationship between RHI and RHI in coronary heart disease group. According to the degree of coronary artery disease, the patients in coronary heart disease group were divided into three subgroups: single vessel lesion group (37 cases), double vessel lesion group (48 cases) and three vessel disease group (61 cases).Analysis of variance was used to compare the differences of HDLLA UA and RHI among subgroups.Result 1.The vascular endothelial function assessment index (RHI) in coronary heart disease group was lower than that in non-coronary heart disease group, and the difference was statistically significant [0.99 鹵0.24 mmol / L 1.08 鹵0.24 mmol / L = 1.6 鹵0.3 vs 1.8 鹵0.5].However, the level of UA in coronary heart disease group was higher than that in non-coronary heart disease group, and the difference was statistically significant [325.07 鹵79.87)umol/l vs 321.52 鹵85.50)umol/l] P 0.01g 路2.There was a correlation between RHI and UA levels in the two groups (the ratio was 0.802, P < 0.045).RHI was associated with hypertension in patients with non coronary heart disease (ratio: 0.979g P < 0.005).In coronary heart disease group, the correlation between HDL and HDLU UA was statistically significant (the ratio ratio was 5.132 鹵0.901g / r = 0.043 鹵0.004, P = 0.043 鹵0.004, respectively), and there was a significant linear positive correlation between HDL and RHI. There was a linear negative correlation between RHI and RHI (r = -0.202, P = 0.014, n = 3).The HDL levels of single vessel disease group, double vessel lesion group and three vessel lesion group were 1.16 鹵0.35, 1.01 鹵0.25, 1.02 鹵0.20, respectively. There was significant difference in HDL between single vessel lesion group and double vessel lesion group, single vessel lesion group and three vessel lesion group.The levels of UA in single vessel group, double vessel lesion group and three vessel lesion group were respectively [248.84 鹵57.73andil] (331.81 鹵56.63) (360.97 鹵76.70). There was significant difference between the two groups (P 0.01), and there was still significant difference in UA level between two groups (P 0.05).The RHI levels of single vessel disease group, double vessel lesion group and three vessel lesion group were 1.52 鹵0.23 鹵0.19 鹵1.40 鹵0.19 respectively, and there was significant difference in RHI between the single vessel lesion group and the three vessel lesion group (P 0.007).Conclusion 1.In patients with coronary heart disease, HDL was the protective factor of normal vascular endothelial function, and HDL was positively correlated with vascular endothelial function, while UA was the risk factor of normal vascular endothelial function, and the level of UA was negatively correlated with vascular endothelial function.It is suggested that increasing HDL and decreasing UA may improve vascular endothelial function. 2. 2.With the severity of coronary artery lesion, RHI decreased and UA gradually increased.The results suggest that the vascular endothelial function is related to the severity of coronary artery lesion, and they can predict the severity of coronary artery lesion.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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