本文選題：胱抑素C + 房顫�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究血清Cys-C水平與慢性心房顫動(dòng)及其臨床分型的相關(guān)性。方法:連續(xù)入選2013年9月至2016年11月在吉林大學(xué)白求恩第一醫(yī)院就診的患者278例為研究對(duì)象,將其分為房顫組182例,無房顫對(duì)照組96例。其中房顫組根據(jù)歐洲房顫管理指南、北美起搏和電生理學(xué)會(huì)的心律失常工作組聯(lián)合組織對(duì)房顫的分類,分為陣發(fā)性房顫(paroxysmal Af)組、持續(xù)性房顫(pesistent Af)組、永久性房顫(permanent Af)組。結(jié)果:(1)房顫組胱抑素C水平明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.001);不同房顫類型患者的Cys-C水平比較:永久性房顫組高于持續(xù)性房顫組,持續(xù)性房顫組高于陣發(fā)性房顫組,差異均有統(tǒng)計(jì)學(xué)意義(p0.001)。(2)胱抑素C水平與其他指標(biāo)的相關(guān)性分析結(jié)果:在房顫組中胱抑素C水平與白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比、CRP水平、同型半胱氨酸水平、左心房內(nèi)徑呈線性正相關(guān),相關(guān)系數(shù)分別為(r=0.211,p=0.004)、(r=0.184,p=0.013)、(r=0.269,p0.001)、(r=0.424,p0.001)、(r=0.269,p0.001);與年齡、中性粒細(xì)胞絕對(duì)值、鈣離子濃度和左心室內(nèi)徑間無相關(guān)性(p0.05)。(3)房顫組左心室內(nèi)徑、左心房內(nèi)徑、中性粒細(xì)胞百分比、低密度脂蛋白膽固醇、C反應(yīng)蛋白、同型半胱氨酸水平均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05);左室射血分?jǐn)?shù)小于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.001)。(4)不同房顫類型組間的左室射血分?jǐn)?shù)、左心房內(nèi)徑、中性粒細(xì)胞百分比、低密度脂蛋白膽固醇、C反應(yīng)蛋白、同型半胱氨酸水平間的差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)于中性粒細(xì)胞百分比,永久性房顫(Permanent Af)組高于陣發(fā)性房顫組(paroxysmal Af),差異有統(tǒng)計(jì)學(xué)意(p0.05)。對(duì)于低密度脂蛋白膽固醇,永久性房顫(Permanent Af)組高于陣發(fā)性房顫(paroxysmal Af)組和持續(xù)性房顫(persistent Af)組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)于左室射血分?jǐn)?shù),永久性房顫(Permanent Af)組低于陣發(fā)性房顫(paroxysmal Af)組和持續(xù)性房顫(persistent Af)組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。在左心房內(nèi)徑、C反應(yīng)蛋白、同型半胱氨酸水平上永久性房顫(Permanent Af)組高于持續(xù)性房顫(persistent Af)組,持續(xù)性房顫(persistent Af)組高于陣發(fā)性房顫(paroxysmal Af)組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。(5)房顫危險(xiǎn)因素的多元logistic回歸分析:結(jié)果顯示C反應(yīng)蛋白、同型半胱氨酸、胱抑素C水平、左心室內(nèi)徑大小、左心房內(nèi)徑大小為影響房顫的危險(xiǎn)因素。結(jié)論:1、血清胱抑素C水平在房顫組明顯高于對(duì)照組,在不同房顫臨床分型之間有差異,其水平隨房顫持續(xù)時(shí)間的增加而增加。2、血清胱抑素C水平與炎性標(biāo)志物CRP、白細(xì)胞、中性粒細(xì)胞百分比水平呈正相關(guān),表明血清胱抑素C與機(jī)體的慢性炎癥有關(guān),參與房顫的發(fā)生、維持和復(fù)發(fā)。3、Logistic分析結(jié)果提示在校正了其他因素影響,血清胱抑素C水平升高可以作為房顫的獨(dú)立預(yù)測(cè)因子。
[Abstract]:Objective: to study the correlation between serum Cys-C level and chronic atrial fibrillation.Methods: two hundred and eighty-eight consecutive patients from September 2013 to November 2016 in Bai Qiuen first Hospital of Jilin University were selected and divided into two groups: the atrial fibrillation group (n = 182) and the control group (n = 96).The atrial fibrillation group was divided into three groups according to the European atrial fibrillation management guidelines, the atrial fibrillation group organized by the pacing and electrophysiological association of North America, the paroxysmal Afgroup, the persistent atrial fibrillation persistent Afar group and the permanent atrial fibrillation permanent Af. group.Results the level of cystatin C in the atrial fibrillation group was significantly higher than that in the control group, the difference was statistically significant (p 0.001). The Cys-C level of the patients with different types of atrial fibrillation was higher than that of the persistent atrial fibrillation group, and that of the persistent atrial fibrillation group was higher than that of the paroxysmal atrial fibrillation group.The correlation between the level of cystatin C and other indexes: in atrial fibrillation group, the level of cystatin C and white blood cell count, percentage of neutrophils and CRP, homocysteine level were analyzed.The levels of low density lipoprotein cholesterol C reactive protein and homocysteine were significantly higher than those of the control group (P 0.05), and the left ventricular ejection fraction (LVEF) was lower than that of the control group (P 0.001), and the left ventricular ejection fraction (LVEF) of different atrial fibrillation groups was significantly lower than that of the control group (P < 0.05).There were significant differences in left atrial diameter, percentage of neutrophils, low density lipoprotein cholesterol C-reactive protein and homocysteine levels.The percentage of neutrophils in permanent atrial fibrillation patients was higher than that in paroxysmal Afs patients with paroxysmal atrial fibrillation (P 0.05).For low density lipoprotein cholesterol, there was a significant difference between permanent AF and paroxysmal Afs and persistent AF persistent Af.For left ventricular ejection fraction (LVEF), the difference was statistically significant in permanent AF Af1 group, paroxysmal AF group and persistent AF persistent Af1 group (P 0.05).At the level of homocysteine, permanent atrial fibrillation (permanent) was higher than persistent atrial fibrillation (persistent), persistent atrial fibrillation (persistent) was higher than paroxysmal Afar (P < 0.05).Multivariate logistic regression analysis showed that C-reactive protein, homocysteine, cystatin C, left ventricular diameter and left atrial diameter were the risk factors of atrial fibrillation.Conclusion: the serum cystatin C level in the AF group was significantly higher than that in the control group, and there was a difference between the clinical types of AF and the clinical type of AF. The serum cystatin C level and the inflammatory marker CRP, leukocyte were increased with the increase of AF duration, and the serum cystatin C level was significantly higher in the AF group than that in the control group.The percentage of neutrophils was positively correlated, indicating that serum cystatin C was associated with chronic inflammation, and was involved in the occurrence, maintenance and recurrence of atrial fibrillation.Elevated serum cystatin C level may be an independent predictor of atrial fibrillation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75

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