本文選題：尿酸 + 不穩(wěn)定型心絞痛　； 參考：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討血清尿酸與不穩(wěn)定心絞痛患者冠狀動(dòng)脈病變程度相關(guān)性及其預(yù)測(cè)心血管不良事件的可能性。方法:選取入住我科病人270例(根據(jù)其主訴癥狀暫擬為不穩(wěn)定型心絞痛),男性138例,女性132例,根據(jù)經(jīng)皮冠狀動(dòng)脈造影術(shù)和患者主訴癥狀及心肌壞死標(biāo)志物結(jié)果分為不穩(wěn)定型心絞痛組188例和對(duì)照組82例。收集病例的臨床資料(性別,年齡,高血壓病史,糖尿病史,吸煙史);實(shí)驗(yàn)室檢查數(shù)據(jù)(生化常規(guī),血常規(guī),凝血功能);冠狀動(dòng)脈造影術(shù)結(jié)果(計(jì)算Gensini積分),比較不同組間血清尿酸水平與冠狀動(dòng)脈病變程度的相關(guān)性;通過(guò)通信設(shè)備及門診收集完成對(duì)不穩(wěn)定型心絞痛組病人術(shù)后6個(gè)月起2年期內(nèi)是否發(fā)生心血管不良心血管事件(包括反復(fù)發(fā)作的不穩(wěn)定性心絞痛、新發(fā)心肌梗死、缺血性心律失常、腦血管事件、心源性猝死、充血性心力衰竭)跟蹤隨訪收集工作,通過(guò)非條件多因素二元Logistic回歸模型分析血清尿酸水平是否為預(yù)測(cè)心血管不良事件的獨(dú)立預(yù)測(cè)因子。結(jié)果:1.不穩(wěn)定型心絞痛組的男性比例、平均年齡及高血壓病患病率、糖尿病患病率、吸煙史均高于對(duì)照組;不穩(wěn)定型心絞痛組患者尿酸水平及低密度脂蛋白水平明顯高于對(duì)照組(333.07±65.95vs284.02±68.29,P=0.001;2.73±0.85vs2.47±0.84,P=0.024),高密度脂蛋白(HDL)水平則低于對(duì)照組(1.03±0.26vs1.21±0.36,P=0.001)。2.雙支病變組尿酸水平高于單支病變組和對(duì)照組(326.89±48.99vs299.75±60.24,P=0.008;326.89±48.99vs284.02±68.29,P=0.001),多支病變組尿酸水平高于雙支病變組和單支病變組及對(duì)照組(365.35±62.55vs326.89±48.99,P=0.001;365.35±62.55vs299.75±60.24,P0.001;365.35±62.55vs284.02±68.29,P0.001)。3.尿酸與Gensini積分呈正相關(guān)(r=0.548,P0.001),高密度脂蛋白與Gensini積分呈負(fù)相關(guān)(r=-0.088,P=0.043),低密度脂蛋白與Gensini積分呈正相關(guān)(r=0.046,P=0.001)。4.預(yù)測(cè)不穩(wěn)定型心絞痛患者心血管不良事件的因子為尿酸(OR=4.431,95%CI1.003-1.017,P0.001)和高密度脂蛋白(OR=0.869,95%CI 0.125-1.353,P=0.022)。5.尿酸水平與年齡呈正相關(guān)(r=0.265,P=0.0.041),尿酸水平與肌酐水平呈正相關(guān)(r=1.476,P=0.023)。6.不同尿酸水平組心血管不良事件發(fā)生率存在差異(57.14%vs60.86%vs62.22%vs65.96%,P0.001),發(fā)生反復(fù)發(fā)作的不穩(wěn)定性心絞痛的概率存在顯著差異(34.69%vs36.96%vs39.13%vs40.43%,P0.001),發(fā)生充血性心力衰竭的概率存在差異(18.37%vs19.57%vs20.02%vs21.27%,P=0.042),且隨著尿酸水平提高其全部心血管不良事件、發(fā)生不穩(wěn)定性心絞痛、充血性心力衰竭的概率增大。結(jié)論:1.不穩(wěn)定型心絞痛患者尿酸水平明顯高于對(duì)照組,高血清尿酸水平是不穩(wěn)定型心絞痛的危險(xiǎn)因素之一。2.血清尿酸水平與冠狀動(dòng)脈病變程度存在相關(guān)性,其水平隨冠狀動(dòng)脈病變程度增加而升高。3.血清尿酸水平與不穩(wěn)定型心絞痛患者遠(yuǎn)期心血管不良事件的發(fā)生呈正相關(guān),尿酸升高可以作為不穩(wěn)定型心絞痛患者遠(yuǎn)期預(yù)后不良的預(yù)測(cè)因子之一。
[Abstract]:Objective: to investigate the correlation between serum uric acid and coronary artery disease in patients with unstable angina pectoris and the possibility of predicting adverse cardiovascular events. Methods: a total of 270 patients (138 males and 132 females) with unstable angina pectoris according to their main complaints were selected. According to the results of percutaneous coronary angiography, main complaint symptoms and myocardial necrosis markers, 188 cases of unstable angina pectoris group and 82 cases of control group were divided into two groups. Collect clinical data (sex, age, history of hypertension, history of diabetes, history of smoking), laboratory data (biochemical routine, blood routine), Results of coronary angiography (Gensini score was calculated to compare the correlation between serum uric acid level and severity of coronary artery disease in different groups). Whether cardiovascular adverse cardiovascular events (including recurrent unstable angina pectoris, new myocardial infarction) occurred in 2 years from 6 months after operation in patients with unstable angina pectoris were completed by means of communication equipment and outpatient collection. Ischemic arrhythmias, cerebrovascular events, sudden cardiac death, congestive heart failure) follow up and collect, To analyze whether serum uric acid level is an independent predictor of cardiovascular adverse events by non conditional multivariate Logistic regression model. The result is 1: 1. The proportion of men, average age, prevalence of hypertension, diabetes mellitus and smoking history in unstable angina pectoris group were higher than those in control group. The levels of uric acid and low density lipoprotein in patients with unstable angina pectoris were significantly higher than those in the control group (333.07 鹵68.29P0. 001and 2. 73 鹵0. 84 0.85vs2.47 鹵0. 84), while the levels of high density lipoprotein (HDL) were lower than those in the control group (1. 03 鹵0.26vs1.21 鹵0. 36). The level of uric acid in the double vessel lesion group was higher than that in the single vessel lesion group and the control group (326.89 鹵60.24 48.99vs299.75 鹵326.89 鹵68.29). The uric acid level in the multi-vessel lesion group was higher than that in the double vessel lesion group and the single vessel lesion group and the control group. The level of uric acid was 365.35 鹵62.55vs299.75 鹵60.24 P 0.001 鹵365.35 鹵62.55vs284.02 鹵68.29P 1. There was a positive correlation between uric acid and Gensini score, a negative correlation between high density lipoprotein and Gensini score, a positive correlation between low density lipoprotein and Gensini score, a negative correlation between HDL and Gensini score, and a positive correlation between low density lipoprotein and Gensini score. The risk factors for predicting cardiovascular adverse events in patients with unstable angina pectoris were as follows: uric acid ORL 4.431 / 95 CI 1.003-1.017 P0.001) and high density lipoprotein (HDL) 0.86995 CI 0.125-1.353Pai 0.0222.5.The risk factors for predicting cardiovascular adverse events in patients with unstable angina pectoris were as follows: 4.431% CI 1.003-1.017 P0.001). There was a positive correlation between uric acid level and age, and a positive correlation between uric acid level and creatinine level, and a positive correlation between uric acid level and creatinine level. There were significant differences in the incidence of cardiovascular adverse events in different uric acid groups (57.14 vs 60.86 and 52.22 vs 65.96), and there were significant differences in the probability of recurrent unstable angina pectoris (34.69 vs 36.96 vs 39.13 vs 40.43). There were significant differences in the probability of congestive heart failure (18.37 vs 19.57 vs 20.02 vs 21.27) and with the uric acid level (P 0.042). To improve all adverse cardiovascular events, Unstable angina pectoris increases the probability of congestive heart failure. Conclusion 1. The level of uric acid in patients with unstable angina pectoris was significantly higher than that in the control group, and high serum uric acid level was one of the risk factors of unstable angina pectoris. The level of serum uric acid was correlated with the severity of coronary artery lesion, and the level of uric acid increased with the increase of coronary artery lesion. The level of serum uric acid was positively correlated with the occurrence of long-term cardiovascular adverse events in patients with unstable angina pectoris. Elevated uric acid may be one of the predictors of poor long-term prognosis in patients with unstable angina pectoris.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【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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