本文選題：急性冠脈綜合征 + 光學(xué)相干斷層成像　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在應(yīng)用光學(xué)相干斷層成像技術(shù)(optical coherence tomography,OCT)對(duì)急性冠脈綜合征(acute coronary syndrome,ACS)患者的罪犯血管病變特點(diǎn)進(jìn)行比較分析。方法:本研究入選2015年3月至2017年2月于河北醫(yī)科大學(xué)第二醫(yī)院心內(nèi)五科就診并行OCT檢查的ACS患者。入院后收集其基線資料:年齡,體重,吸煙史,是否合并高血壓、糖尿病,總膽固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、肌酸激酶同工酶(creatine kinase isoenzymeMB,CK-MB)、血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)水平、GRACE評(píng)分、CRUSADE評(píng)分。入院后行擇期冠狀動(dòng)脈造影術(shù)及OCT檢查,分析ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)和非ST段抬高型急性冠脈綜合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者病變特點(diǎn),并記錄檢查過(guò)程中是否出現(xiàn)心肌缺血表現(xiàn)。收集術(shù)后72小時(shí)內(nèi)Scr水平并與入院時(shí)基線水平相比較。隨訪30天,觀察記錄其主要心臟不良事件(major adverse cardiac events,MACE)發(fā)生情況。采用SPSS 20.0統(tǒng)計(jì)軟件分析處理數(shù)據(jù)。以P0.05定義為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1研究共入選23例患者,STEMI患者11例,NSTE-ACS患者12例,性別、年齡、體重、合并的危險(xiǎn)因素(高血壓、糖尿病、吸煙史)、TC、TG、LDL、CK-MB、BUN、Scr、術(shù)后72小時(shí)內(nèi)Scr、CRUSADE評(píng)分等基線資料比較無(wú)統(tǒng)計(jì)學(xué)差異。STEMI患者GRACE評(píng)分高于NSTE-ACS患者(133.91±14.22 vs 111.17±11.34,P=0.000)。2 STEMI與NSTE-ACS患者比較,其斑塊破裂(plaque rupture,PR)、斑塊侵蝕(plaque erosion,PE)、易損性斑塊的發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(54.5%vs.16.7%P=0.057;18.2%vs.0 P=0.122;63.6%vs.66.7%P=0.879),而血栓形成的發(fā)生率有統(tǒng)計(jì)學(xué)差異(54.4%vs.8.3%P=0.016)。兩組患者均未檢出鈣化結(jié)節(jié)(calcification nodule,CN)、冠狀動(dòng)脈痙攣及自發(fā)性冠狀動(dòng)脈夾層(spontaneous coronary artery dissection,SCAD)等病變。合并糖尿病的ACS患者的PR發(fā)生率顯著高于未合并糖尿病者(71.4%vs.18.8%,P=0.015)。3與CAG比較,行OCT檢查操作時(shí)間延長(zhǎng)(28.98±3.19 vs.41.53±7.28P=0.000)、對(duì)比劑用量增多(74.09±15.46 vs.99.30±17.97 P=0.000),檢查過(guò)程中心肌缺血發(fā)生率兩者比較無(wú)顯著差異(4.3%vs.8.7%P=0.55)。術(shù)后72小時(shí)內(nèi)Scr水平較入院時(shí)基線水平比較無(wú)統(tǒng)計(jì)學(xué)差異(P=0.740),未見(jiàn)患者發(fā)生對(duì)比劑腎病。隨訪30天內(nèi),僅NSTE-ACS組有1例患者出現(xiàn)再發(fā)心絞痛,余患者未見(jiàn)MACE事件發(fā)生。結(jié)論:1應(yīng)用OCT技術(shù)可以有效觀察STEMI與NSTE-ACS患者的罪犯血管病變特點(diǎn)。2 STEMI與NSTE-ACS患者的病變特點(diǎn)存在差異。3 OCT檢查在ACS患者中應(yīng)用安全有效。
[Abstract]:Objective: to compare and analyze the characteristics of criminal vascular lesions in patients with acute coronary syndrome (ACS) by optical coherence tomography (Oct). Methods: from March 2015 to February 2017, patients with ACS underwent OCT examination in five departments of the second Hospital of Hebei Medical University. Baseline data were collected after admission: age, weight, smoking history, hypertension, diabetes mellitus, Total cholesterol (TC), triglyceride (TG), low density lipoprotein (density), creatine kinase isoenzyme (CK-MBN), blood urea nitrogenin (BUNA), serum creatinine (SCR), creatine kinase isoenzyme (creatine kinase isoenzyme), creatine kinase isoenzyme (creatine kinase isoenzyme), creatine kinase isoenzyme (creatine kinase isoenzyme), serum creatinine serum creatinine After admission, selective coronary angiography and OCT examination were performed to analyze the pathological characteristics of ST-segment elevation myocardial infarction (ST-segment elevation myocardial infraction) and non-ST-segment elevation acute coronary syndrome (non-ST-segment elevation acute coronary syndromeNSTE-ACSS) in patients with ST-segment elevation myocardial infarction (ST-segment) and non-ST-segment elevation acute coronary syndrome (non-ST-segment elevation acute coronary syndromeNSTE-ACSS). Myocardial ischemia was recorded during the examination. Scr levels were collected 72 hours after operation and compared with baseline levels at admission. After 30 days follow-up, the occurrence of major adverse cardiac events was observed and recorded. SPSS 20.0 statistical software was used to analyze and process the data. With P0.05 definition as the difference is statistically significant. Results A total of 23 patients with STEMI, 11 patients with NSTE-ACS, 12 patients with NSTE-ACS, gender, age, weight, and risk factors (hypertension, diabetes mellitus) were enrolled in the 1: 1 study. There was no significant difference in baseline data such as the score of CRUSADE within 72 hours after operation. The GRACE score of STEMI patients was higher than that of NSTE-ACS patients (133.91 鹵14.22 vs 111.17 鹵11.34 STEMI vs NSTE-ACS). There was no significant difference in the incidence of vulnerable plaques in plaque rupture, plaque erosion and plaque erosion. There was no significant difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of vulnerable plaques. There was no significant difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of plaque erosion. There was no statistical difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of vulnerable plaques. No calcification nodule, coronary spasm and spontaneous coronary artery dissection were detected in both groups. The incidence of PR in ACS patients with diabetes mellitus was significantly higher than that in patients without diabetes mellitus. Compared with CAG, the operation time of OCT examination was increased by 28.98 鹵3.19 vs.41.53 鹵7.28 P0.000, and the dosage of contrast agent was increased by 74.09 鹵15.46 vs.99.30 鹵17.97 P0.000. There was no significant difference in the incidence of myocardial ischemia between the two groups. There was no significant difference in Scr level within 72 hours after operation compared with baseline level at admission. No contrast nephropathy was found in the patients. Only one patient in NSTE-ACS group developed recurrent angina pectoris during 30 days follow-up. No MACE event occurred in other patients. Conclusion OCT technique can be used to observe the pathological features of criminals in patients with STEMI and NSTE-ACS. There is a difference in pathological characteristics between STEMI and NSTE-ACS. 3 OCT examination is safe and effective in ACS patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.4

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