本文選題：冠心病 + ACS��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:冠狀動脈粥樣硬化性心臟病是一個常見的心血管疾病,每年死于心血管疾病的人數(shù)多于任何其它死因。在2012年有1750萬人死于心血管疾病,占全球死亡總數(shù)的31%。這些死者中,估計740萬人死于冠心病,670萬人死于中風(fēng),但其確切機(jī)制尚不清楚。以往認(rèn)為高血壓、高脂血癥、肥胖、糖尿病、吸煙等危險因素與動脈粥樣硬化相關(guān),然而,最近的研究表明,動脈粥樣硬化的發(fā)病機(jī)制可能與多種因素引起的慢性炎癥相關(guān)。炎癥因子在動脈粥樣硬化斑塊、血栓形成、血小板聚集及各種并發(fā)癥中發(fā)揮作用,進(jìn)而出現(xiàn)臨床急性心血管事件。既往的研究重點(diǎn)關(guān)注促炎因子的作用,而隨著抗炎因子的發(fā)現(xiàn),探討冠狀動脈粥樣硬化保護(hù)性因子及多功能因子成為近年來的研究熱點(diǎn)。白介素-37(Interleukin-37,IL-37)是2000年發(fā)現(xiàn)的白介素家族成員,其顯示出了強(qiáng)大的抗炎作用,并發(fā)現(xiàn)其與多種人類炎癥性疾病相關(guān)。2011年Broaschi等人在人類的冠狀動脈和頸動脈粥樣硬化斑塊的泡沫細(xì)胞中發(fā)現(xiàn)了IL-37,提示IL-37參與了動脈粥樣硬化性疾病的發(fā)生及發(fā)展。然而,血漿IL-37在急性冠狀動脈綜合征患者(Acute coronary syndrome,ACS)中的水平還有待研究。本研究主要探討在ACS患者中IL-37的血漿水平與促炎因子白介素-18(Interleukin-18,IL-18)、超敏C反應(yīng)蛋白(C Reactive Protein,CRP)水平及冠脈病變程度的關(guān)系。方法:2016年1月至2016年12月因胸悶、胸痛等癥狀就診于河北醫(yī)科大學(xué)第二醫(yī)院的符合納入標(biāo)準(zhǔn)的患者作為研究對象。根據(jù)患者的癥狀、心電圖、血清超敏肌鈣蛋白及我院冠狀動脈造影檢查分為對照組、穩(wěn)定型心絞痛及不穩(wěn)定型心絞痛患者以及急性心肌梗死患者,每組25例。所有急性心肌梗死患者在入院時即行靜脈采血,其余患者在入院次日清晨空腹采集。同時收集標(biāo)本對應(yīng)患者的一般情況和相關(guān)臨床資料。常規(guī)檢測腦鈉肽(Brain Natriuretic Peptide,BNP)、左室舒張末徑(Left Ventricular End Diastolic Diameter,LVEDD)、左室射血分?jǐn)?shù)(Left Ventricular Ejection Fraction,LVEF)、心肌肌鈣蛋白(Cardiac troponin,c TNI)、心肌激酶(Creatine kinase isoenzyme,CK-MB)、肌酐(Creatinine,Cr)、CRP、總膽固醇(Total Cholesterol,CHOL)、甘油三酯(Triglyceride,TG)、低密度脂蛋白膽固醇(Low Density Lipoprotein,LDL)以及根據(jù)患者冠狀動脈造影術(shù)結(jié)果而得出的冠脈Gensini評分;用酶聯(lián)免疫吸附法(Enzyme-1inked immunosorbentassay,ELISA)檢測血清IL-37、IL-18。結(jié)果:1基本資料分析:患者性別、年齡、Cr、CHOL、TG、LDL、高血壓、糖尿病以及服藥史等基本資料在對照組、穩(wěn)定組、不穩(wěn)定組以及心梗組之間差異無統(tǒng)計學(xué)意義。心梗組的LVEF較對照組、穩(wěn)定組、不穩(wěn)定組降低,且差異具有統(tǒng)計學(xué)意義(P0.05)。LVEF在對照組、穩(wěn)定組及不穩(wěn)定組之間差異無統(tǒng)計學(xué)意義。心梗組LVEDD、BNP、c TNI、CRP、Gensini評分、CK-MB較對照組、穩(wěn)定組、不穩(wěn)定組明顯升高,且差異有統(tǒng)計學(xué)意義(P0.05)。LVEDD、BNP、c TNI、CRP、Gensini評分、CK-MB在對照組、穩(wěn)定組、不穩(wěn)定組之間差異無統(tǒng)計學(xué)意義。2 IL-37及IL-18的血漿水平和組內(nèi)比較:IL-37的四組血漿水平分布均為非正態(tài)分布,故應(yīng)用中位數(shù)與四分位間距表示。對照組、穩(wěn)定組、不穩(wěn)定組、心梗組的血漿IL-37水平分別為39.71(35.85,46.10)pg/ml、35.92(32.20,58.35)pg/ml、54.81(34.10,60.33)pg/ml、55.64(37.90,62.50)pg/ml。進(jìn)一步分析發(fā)現(xiàn):心梗組與不穩(wěn)定組IL-37血漿水平無差異(P0.05),對照組與穩(wěn)定組IL-37血漿水平無差異(P0.05),但是心梗組和不穩(wěn)定組IL-37血漿水平明顯高于對照組、穩(wěn)定組,且具有統(tǒng)計學(xué)差異(P0.05)。IL-18的四組血漿水平分布均為非正態(tài)分布,故應(yīng)用中位數(shù)與四分位間距表示。對照組、穩(wěn)定組、不穩(wěn)定組、心梗組的血漿IL-18水平分別為382.69(290.71,662.03)pg/ml、475.76(253.52,839.56)pg/ml、835.17(447.52,1514.82)pg/ml、1437.96(697.13,2473.42)pg/ml。進(jìn)一步分析發(fā)現(xiàn):心梗組與不穩(wěn)定組IL-18血漿水平無差異(P0.05),對照組與穩(wěn)定組IL-18血漿水平無差異(P0.05),但是心梗組和不穩(wěn)定組IL-18血漿水平明顯高于對照組、穩(wěn)定組,且具有統(tǒng)計學(xué)差異(P0.05)。3相關(guān)分析:臨床資料與IL-37之間的相關(guān)性分析顯示:IL-37濃度與BNP、c TNI、Cr、CK-MB、LVEDD、CHOL、TG、LDL、Gensini評分無明顯相關(guān),與CRP之間具有正相關(guān)性(r=0.26,P=0.008),與LVEF之間具有負(fù)相關(guān)性(r=-0.51,P0.001)。IL-37與IL-18之間的相關(guān)性的分析:經(jīng)Spearman相關(guān)分析,血清中IL-37與IL-18具有正相關(guān)性(r=0.21,P=0.04)。結(jié)論:IL-37血漿水平在ACS組中明顯高于穩(wěn)定組及對照組,且具有統(tǒng)計學(xué)差異(P0.05),IL-37與IL-18、CRP具有正相關(guān)性,提示IL-37是冠心病相關(guān)的炎癥因子,有可能成為ACS患者新型的炎癥生物標(biāo)志物。
[Abstract]:Objective: coronary atherosclerotic heart disease is a common cardiovascular disease. The number of deaths from cardiovascular disease is more than any other cause of death every year. In 2012, 17 million 500 thousand people died of cardiovascular disease, which accounted for 31%. of the total number of deaths in the world. An estimated 7 million 400 thousand died in coronary heart disease and 6 million 700 thousand died of stroke, but the exact mechanism was It's not clear that risk factors such as hypertension, hyperlipidemia, obesity, diabetes, smoking and other risk factors are associated with atherosclerosis. However, recent studies have shown that the pathogenesis of atherosclerosis may be associated with chronic inflammation caused by a variety of factors. Inflammatory factors are in atherosclerotic plaques, thrombosis, platelet aggregation, and each other. Clinical acute cardiovascular events are involved in the complications. Previous studies focus on the role of pro-inflammatory factors. With the discovery of anti-inflammatory factors, the study of the protective factors and multifunction factors of coronary atherosclerosis has become a hot topic in recent years. Interleukin-37 (IL-37) -37 (IL-37) was found in 2000. Members of the mediator family showed strong anti-inflammatory effects and found that they were associated with a variety of human inflammatory diseases.2011 Broaschi and others found IL-37 in the human coronary and carotid atherosclerotic plaque foam cells, suggesting that IL-37 was involved in the occurrence and development of atherosclerotic disease. However, plasma IL-37 The level of Acute coronary syndrome (ACS) in patients with acute coronary syndromes (ACS) remains to be studied. This study focuses on the relationship between the plasma level of IL-37 in ACS patients and the proinflammatory factor -18 (Interleukin-18, IL-18), the hypersensitivity C reactive protein (C Reactive) level, and the degree of coronary artery disease. Methods: January 2016 By December 2016, patients who were diagnosed with chest tightness and chest pain were treated in the second hospital of Hebei Medical University as subjects. According to the symptoms, electrocardiogram, serum hypersensitivity troponin, and our coronary angiography, the patients were divided into control group, stable angina and unstable angina pectoris, and acute myocardium. Patients with infarction were 25 in each group. All patients with acute myocardial infarction were collected at the time of admission to the hospital. The rest of the patients were collected on the fasting morning on the next day. At the same time, the general situation and related clinical data of the patients were collected. The Brain Natriuretic Peptide (BNP) and the left ventricular end diastolic diameter (Left Ventricular End Diastol) were routinely examined. IC Diameter, LVEDD), left ventricular ejection fraction (Left Ventricular Ejection Fraction, LVEF), cardiac troponin (Cardiac troponin, C TNI), myocardial kinase, triglyceride, triglyceride, low density lipoprotein cholesterol Y Lipoprotein, LDL) and coronary Gensini score based on patients' coronary angiography; serum IL-37 and IL-18. results were detected by enzyme linked immunosorbent assay (Enzyme-1inked Immunosorbentassay, ELISA): 1 basic data analysis: patient sex, age, Cr, CHOL, TG, hypertension, diabetes and medicine history. In the control group, there was no significant difference between the stable group, the unstable group and the myocardial infarction group. The LVEF of the myocardial infarction group was lower than the control group, the stable group and the unstable group, and the difference was statistically significant (P0.05).LVEF in the control group. The difference between the stable group and the unstable group was not statistically significant. The myocardial infarction group was LVEDD, BNP, C TNI, CRP, Gensini score and CK-MB. The control group, the stable group and the unstable group were significantly higher, and the difference was statistically significant (P0.05).LVEDD, BNP, C TNI, CRP, Gensini score, CK-MB in the control group, the stable group, the unstable group was not statistically significant.2 IL-37 and IL-18 plasma level and intra group comparison: the four groups of IL-37 were in the non normal distribution, so application In the control group, the stable group and the unstable group, the plasma IL-37 level of the myocardial infarction group was 39.71 (35.85,46.10) pg/ml, 35.92 (32.20,58.35) pg/ml, 54.81 (34.10,60.33) pg/ml, 55.64 (37.90,62.50) pg/ml. further analysis found that there was no difference between the plasma level of IL-37 in the myocardial infarction group and the unstable group (P0.05), the control group and the stable group. The plasma level of IL-37 was not different (P0.05), but the plasma level of IL-37 in the myocardial infarction group and the unstable group was significantly higher than that of the control group. The four groups of plasma levels in the stable group, with statistical difference (P0.05).IL-18, were all non normal distribution, so the median and four division intervals were shown. The control group, the stable group, the unstable group, the plasma IL-18 of the myocardial infarction group. The level of 382.69 (290.71662.03) pg/ml, 475.76 (253.52839.56) pg/ml, 835.17 (447.521514.82) pg/ml, 1437.96 (697.132473.42) pg/ml. further analysis showed that there was no difference in the level of IL-18 plasma in the myocardial infarction group and the unstable group (P0.05), and there was no difference between the control group and the stable group (P0.05), but the blood of the myocardial infarction group and the unstable group were blood. The plasma level was significantly higher than that of the control group, and the stable group was statistically different (P0.05).3 correlation analysis. The correlation analysis between clinical data and IL-37 showed that the concentration of IL-37 had no significant correlation with BNP, C TNI, Cr, CK-MB, LVEDD, CHOL, TG, and the correlation between the values and the negative correlation. -0.51, P0.001) analysis of the correlation between.IL-37 and IL-18: after Spearman correlation analysis, the serum IL-37 and IL-18 have positive correlation (r=0.21, P=0.04). Conclusion: IL-37 plasma level in ACS group is significantly higher than that in the stable group and the control group, and has a statistical difference (P0.05). Guan's inflammatory factors may become new inflammatory biomarkers in ACS patients.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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