本文選題：冠心病 + 血清堿性磷酸酶�。� 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:回顧性分析血清堿性磷酸酶(ALP)水平與冠心病(CHD)的相關性,及其對CHD進行危險分層的價值。方法:采集因胸痛、胸悶住院并行冠狀動脈造影檢查的研究對象314例,收集他們的年齡、性別、血壓等一般資料及肝功能、腎功能、血脂、血糖等實驗室生化檢查資料。根據冠狀動脈造影結果確診CHD221例,其中穩(wěn)定型心絞痛(SAP)62例、不穩(wěn)定型心絞痛(UAP)89例和急性心肌梗死(AMI)70例。CHD組中,ALP升高者51例,ALP正常者170例。據Gensini評分記錄冠狀動脈狹窄程度,Gensini40為嚴重狹窄組,有151例。據Rentrop分級評價冠狀動脈側支循環(huán)(CCC)情況,Rentrop 0-1級為冠狀動脈側支循環(huán)受損,有112例。并隨訪半年,記錄CHD組主要心血管不良事件(MACCE)的發(fā)生情況�；仡櫺苑治鯝LP水平與CHD的臨床分型、冠脈病變程度、冠脈側支循環(huán)及發(fā)生MACCE的相關性,并分析ALP與其他傳統(tǒng)指標的關聯(lián),探討ALP水平與CHD的相關性。結果:1.ALP濃度升高者共為59例,檢出率為18.79%。其中CHD組51例,異常率為23.08%;非CHD組8例,異常率為8.6%。前者明顯高于后者,差異有統(tǒng)計學意義,x2值為4.738,P0.05。ALP升高者中男性50例,檢出率84.7%;女性9例,檢出率15.3%。差異無統(tǒng)計學意義,P0.05。2.CHD組在男性、年齡、吸煙、高血壓、血糖、總膽固醇、甘油三酯、低密度脂蛋白、C反應蛋白、ALP水平均高于非CHD組,CHD組高密度脂蛋白水平低于非CHD組,僅年齡、高血壓、血糖、C-反應蛋白、高密度脂蛋白、ALP水平差別有統(tǒng)計學意義。多變量logistic回歸分析結果表明ALP水平升高是CHD的獨立影響因素(OR1.027,95%CI 1.013-1.040,P0.05)。3.ALP水平在冠狀動脈嚴重狹窄組(101.3±50.6U/L)非嚴重狹窄組(78.0±38.8U/L),差異有統(tǒng)計學意義,P0.05。采用多變量logistic回歸分析結果表明ALP水平升高是冠狀動脈狹窄的獨立影響因素(OR1.013,95%CI 1.103-1.023,P0.05)。4.ALP水平在多支血管病變組(80.80±29.37U/L)雙支血管病變組(76.53±18.15U/L)單支血管病變組(73.95±23.15U/L),差別無統(tǒng)計學意義,P0.05。5.ALP水平在SAP組(78.08±50.05U/L)、UAP組(80.08±48.80U/L)、AMI組(79.80±50.30U/L)無明顯差異。6.CHD組中有112例(51%)觀察到CCC受損。ALP水平和CCC受損分級之間有相關性,高ALP水平與CCC受損相關(65%vs 51%,p=0.03)7.單變量回歸分析表明,糖尿病、高血壓、年齡和ALP水平是影響CHD發(fā)生MACCE的因素。多變量logistic回歸分析結果表明ALP水平升高是CHD發(fā)生MACCE的獨立影響因素(OR1.112,95%CI 1.203-1.623,P0.05)。8.ALP水平與冠脈狹窄積分、高血壓、C-反應蛋白呈正相關,r值分別是0.452、0.166、0.387。結論:1.血清ALP水平與CHD呈正相關,它可能是CHD的獨立危險因素。2.ALP水平還與冠狀動脈狹窄程度相關,可能是反映冠狀動脈病情嚴重程度的一個指標。3.ALP水平可用與評估CCC是否受損。4.ALP升高可作為CHD發(fā)生MACCE的危險因素之一。5.ALP水平與C-反應蛋白呈線性正相關。
[Abstract]:Objective: to retrospectively analyze the correlation between serum alkaline phosphatase (ALP) level and coronary heart disease (CHD), and the value of risk stratification in CHD. Methods: 314 patients with chest pain and chest tightness were examined by coronary angiography, and their age, sex, blood pressure, liver function, renal function, blood lipid, blood sugar and other laboratory biochemical data were collected. According to the results of coronary angiography, there were 62 cases of stable angina pectoris, 89 cases of unstable angina pectoris and 70 cases of acute myocardial infarction AMI. According to Gensini score, coronary artery stenosis was recorded as severe stenosis group (151 cases). According to the Rentrop classification, the CCCs of coronary collateral circulation were evaluated. Rentrop 0-1 grade was damaged in the collateral circulation of coronary artery, there were 112 cases. The incidence of major adverse cardiovascular events (MAC) in CHD group was recorded after half a year follow-up. The correlation between ALP level and clinical type of CHD, severity of coronary artery disease, collateral circulation of coronary artery and occurrence of MACCE was analyzed retrospectively. The correlation between ALP and other traditional indexes was analyzed, and the correlation between ALP level and CHD was discussed. Results: 1. The ALP concentration was increased in 59 cases, and the detection rate was 18.79%. The abnormal rate was 23.08 in CHD group and 8.6 in non- group. The former was significantly higher than the latter, and the difference was statistically significant (P 0.05. 05.ALP 4.738g) in 50 males (84.7%) and 9 females (15.3%). There was no significant difference in the levels of CHD, age, smoking, hypertension, blood glucose, total cholesterol, triglyceride, low density lipoprotein C-reactive protein (LDL-C) in CHD group compared with that in non-CHD group. There were significant differences in ALP levels among hypertension, glucose C-reactive protein and high density lipoprotein. The results of multivariate logistic regression analysis showed that the increase of ALP level was an independent factor of CHD. The CI 1.013-1.040 P0.05U 路3.ALP level was significantly higher in the coronary artery stenosis group (101.3 鹵50.6 UL / L) than in the non-severe stenosis group (78.0 鹵38.8 UL / L, P 0.05). Multivariate logistic regression analysis showed that elevated ALP level was an independent influencing factor for coronary artery stenosis (CI 1.103-1.023 P0.05N .4.ALP level was 80.80 鹵29.37U / L in multivessel disease group) and 76.53 鹵18.15U / L group in single vessel disease group (73.95 鹵23.15U / L), there was no significant difference. There was no significant difference in P0.05.ALP level between SAP group (78.08 鹵50.05U / L) and SAP group (80.08 鹵48.80U / L + 58.80U / L). High ALP level is associated with CCC damage. Univariate regression analysis showed that diabetes, hypertension, age and ALP levels were the factors influencing MACCE in CHD. Multivariate logistic regression analysis showed that the increase of ALP level was the independent influencing factor of MACCE in CHD. The correlation between the level of ALP and coronary stenosis score was 0.203 ~ 1.623 (P < 0.05), and the positive correlation value of C-reactive protein in hypertension was 0.452n0.166n 0.387, respectively. Conclusion 1. Serum ALP level was positively correlated with CHD, which may be an independent risk factor for CHD. 2. ALP level was also correlated with coronary artery stenosis. ALP level may be a marker of severity of coronary artery disease. 3. ALP level can be used to evaluate whether CCC is damaged or not. 4. ALP elevation may be one of the risk factors for MACCE in CHD. 5. ALP level is linearly correlated with C- reactive protein.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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