本文選題：頸動(dòng)脈斑塊 + Crouse積分�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究頸動(dòng)脈斑塊和血同型半胱氨酸水平二者聯(lián)合對(duì)于冠心病是否有預(yù)測(cè)價(jià)值以及頸動(dòng)脈斑塊Crouse積分、血漿同型半胱氨酸水平的高低與冠脈病變的嚴(yán)重程度之間的相關(guān)性。方法:收集山西醫(yī)科大學(xué)第一醫(yī)院心內(nèi)科2015年7月至2016年8月擬診為冠心病的住院患者,符合入選及排除標(biāo)準(zhǔn)者共205例。所有入選者均收集一般資料,并行化驗(yàn)血同型半胱氨酸、頸部血管彩超、冠狀動(dòng)脈造影3項(xiàng)檢查,依據(jù)冠狀動(dòng)脈造影結(jié)果分為兩組,病例組108例,對(duì)照組97例。分別計(jì)算頸動(dòng)脈斑塊、高同型半胱氨酸血癥(HHcy)以及頸動(dòng)脈斑塊聯(lián)合HHcy診斷冠心病(CHD)的靈敏度(Se)、特異度(Sp)、陽(yáng)性預(yù)測(cè)值(PPV)、陰性預(yù)測(cè)值(NPV),并比較不同診斷試驗(yàn)的評(píng)價(jià)指標(biāo)。判斷頸動(dòng)脈斑塊Crouse積分、血同型半胱氨酸水平高低與冠脈病變嚴(yán)重程度的相關(guān)性。結(jié)果:1、冠心病不同危險(xiǎn)因素之間比較,如高血壓、糖尿病、血脂異常、家族史等,兩組之間沒(méi)有差別(P0.05);兩組之間的頸動(dòng)脈斑塊及血Hcy水平有差別(P0.05)。2、頸動(dòng)脈斑塊診斷冠心病的靈敏度為82.4%,特異度為35.0%,陽(yáng)性預(yù)測(cè)值為58.6%,陰性預(yù)測(cè)值為64.2%。3、HHcy診斷冠心病的靈敏度為63.0%,特異度為38.1%,陽(yáng)性預(yù)測(cè)值為53.1%,陰性預(yù)測(cè)值為48.0%。4、頸動(dòng)脈斑塊與HHcy串聯(lián)聯(lián)合診斷冠心病的靈敏度為52.8%,特異度為59.8%,陽(yáng)性預(yù)測(cè)值為59.4%,陰性預(yù)測(cè)值為53.2%;頸動(dòng)脈斑塊與HHcy并聯(lián)聯(lián)合診斷冠心病的靈敏度為92.6%,特異度為12.4%,陽(yáng)性預(yù)測(cè)值為54.1%,陰性預(yù)測(cè)值為60.0%。5、Pearson相關(guān)性檢驗(yàn)顯示:在89例頸動(dòng)脈斑塊陽(yáng)性的冠心病患者中,Gensini積分與Crouse積分的相關(guān)系數(shù)為0.234(P=0.027);Gensini積分與血Hcy水平的相關(guān)系數(shù)為0.250(P=0.018)。結(jié)論:1、頸動(dòng)脈斑塊和血同型半胱氨酸水平二者聯(lián)合對(duì)冠心病有一定的預(yù)測(cè)價(jià)值,二者聯(lián)合預(yù)測(cè)價(jià)值優(yōu)于二者中單一因素對(duì)冠心病的預(yù)測(cè)價(jià)值。2、頸動(dòng)脈斑塊Crouse積分、血同型半胱氨酸水平高低與冠脈病變嚴(yán)重程度存在相關(guān)性。
[Abstract]:Aim: to study the predictive value of carotid plaque and serum homocysteine level in coronary artery disease (CHD) and the correlation between plasma homocysteine level and severity of coronary artery disease.Methods: 205 patients who were diagnosed as coronary heart disease from July 2015 to August 2016 in the Department of Cardiology of the first Hospital of Shanxi Medical University were collected.All the participants collected general data and examined homocysteine, color Doppler ultrasound and coronary arteriography. According to the results of coronary angiography, they were divided into two groups: 108 cases in the case group and 97 in the control group.The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque, hyperhomocysteinemia and carotid plaque combined with HHcy in the diagnosis of coronary artery disease were calculated respectively.The correlation between carotid plaque Crouse score, serum homocysteine level and severity of coronary artery lesion was evaluated.Results 1. The risk factors of coronary heart disease were compared, such as hypertension, diabetes, dyslipidemia, family history, etc.There was no difference between the two groups in Hcy levels in carotid plaque and blood. The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque were 82.4, 35.0g, 58.6 and 64.2hHHcy in diagnosing coronary heart disease, respectively, and the sensitivity of carotid plaque in diagnosing coronary heart disease was 82.4, the specificity was 35.0, the positive predictive value was 58.6 and the negative predictive value was 64.2.3HHcy in the diagnosis of coronary heart disease.Sensitivity was 63.0, specificity was 38.1, positive predictive value was 53.1, negative predictive value was 48.0. 4. The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque and HHcy were 52.8, 59.8, 59.4and 53.2, respectively.The sensitivity, specificity, positive predictive value and negative predictive value of HHcy in the diagnosis of coronary heart disease were 92.6 and 12.4, respectively. The negative predictive value was 60.0.5Pearson correlation test showed that in 89 patients with coronary heart disease with positive carotid plaque, the correlation between Gensini score and Crouse score was significant.The correlation coefficient between the Gensini integral and the blood Hcy level was 0.234 and 0.027 and the correlation coefficient was 0.250 and 0.018.Conclusion the combination of carotid plaque and serum homocysteine level has certain predictive value for coronary heart disease. The combined predictive value of the two factors is better than that of single factor in predicting coronary heart disease. The Crouse score of carotid plaque is better than that of the single factor.The level of homocysteine was correlated with the severity of coronary artery disease.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4

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