本文選題：冠狀動脈疾病 + 脂肪酸類　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的通過回顧性和前瞻性隨訪調(diào)查相結(jié)合的研究方法,研究Omerga-3多不飽和脂肪酸(n-3PUFAS)對穩(wěn)定型心絞痛患者脂蛋白磷脂酶A2(Lp-PLA2)、低密度脂蛋白(LDL)和脂蛋白a水平的影響,為Omerga-3多不飽和脂肪酸治療穩(wěn)定型心絞痛提供臨床依據(jù)。方法回顧性研究對青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院心血管內(nèi)科2014年1月至2015年1月收錄的全部穩(wěn)定型心絞痛患者的出院病例于本院“聯(lián)眾系統(tǒng)”進行檢索,共納入了214例患者,排除不符合納入要求的和失訪的患者,實際隨訪人數(shù)為150人,隨訪內(nèi)容包括患者一般信息,冠心病危險因素(年齡、性別、體重指數(shù)、高血壓、糖尿病、血脂異常、吸煙史)、目前藥物治療情況、出院后1年內(nèi)魚油使用情況。隨訪終止時間為2015年6月30日,根據(jù)患者魚油使用情況將患者分為魚油組和常規(guī)組,其中魚油組為36人,常規(guī)組114人。門診或電話通知隨訪患者返院檢測Lp-PLA2及脂蛋白a,初步觀察n-3PUFAS對Lp-PLA2及脂蛋白a水平的影響。前瞻性研究選取青島大學(xué)附屬醫(yī)院心內(nèi)科80名經(jīng)冠狀動脈造影診斷為穩(wěn)定型心絞痛的患者,隨機分為對照組和試驗組,每組各40例。所有納入的對象均根據(jù)情況給予規(guī)范化的抗冠心病治療,包括阿司匹林抗血小板、瑞舒伐他汀降血脂、降壓、β受體阻滯劑。試驗組的病人在規(guī)范抗冠心病治療的基礎(chǔ)上給予n-3PUFAS膠囊1g/日(湯臣倍健牌魚油軟膠囊),對照組在規(guī)律抗冠心病治療的基礎(chǔ)上給予相同劑量的安慰劑(大豆油膠囊),療程為3個月,干預(yù)前后采集空腹靜脈血檢測Lp-PLA2、LDL及脂蛋白a等的水平,根據(jù)西雅圖心絞痛量表(SAQ)賦分方法比較兩組患者在使用不同治療方法出院后1年內(nèi)心絞痛發(fā)作情況,評價n-3PUFAS治療冠心病穩(wěn)定性心絞痛患者的臨床療效。結(jié)果回顧性研究:1、共納入150例臨床診斷為穩(wěn)定性心絞痛的患者,魚油組34例,常規(guī)組114例。兩組之間在年齡、性別、體重指數(shù)、吸煙史、高血壓史、糖尿病史等方面沒有統(tǒng)計學(xué)差異(P均0.05)。2、魚油組的血漿Lp-PLA2水平較非魚油組明顯降低,差異有統(tǒng)計學(xué)意義(t=1.627,P0.05)。而脂蛋白a兩組之間無明顯統(tǒng)計學(xué)差別(t=0.153,P0.05)。前瞻性研究:1、干預(yù)前兩組患者的基線資料及血清學(xué)指標組間無差異(P0.05)。2、治療后,試驗組中Lp-PLA2水平明顯下降(t=3.825,P0.05),對照組Lp-PLA2水平也明顯下降(t=2.115,P0.05),差異有統(tǒng)計學(xué)意義。3、試驗組治療前后Lp-PLA2的差值比對照組治療前后Lp-PLA2差值明顯增加(t=2.813,P0.05)。試驗組治療前后LDL的差值比對照組治療前后的差值也明顯增加(t=2.813,P0.05)。試驗組、對照組脂蛋白a治療前后及兩組治療前后差值的比較均無統(tǒng)計學(xué)意義。4、西雅圖心絞痛量表評定積分比較:軀體活動受限程度、心絞痛穩(wěn)定狀態(tài)、心絞痛發(fā)作情況、治療滿意度方面,治療后試驗組積分明顯高于對照組(t值分別為2.455,3.216,2.984,3.001,P均0.05);在疾病認識程度方面,兩組比較無明顯差異,但試驗組的積分較對照組有升高趨勢(t=1.132,P0.05)。5、安全性方面:兩組未記錄到明顯不良反應(yīng),治療前后血分析、肝腎功能、尿常規(guī)、大便常規(guī)均無明顯異常。結(jié)論n-3PUFAS能降低穩(wěn)定型心絞痛患者的Lp-PLA2、LDL水平,但對脂蛋白a的水平無明顯影響。
[Abstract]:Objective to study the effect of Omerga-3 polyunsaturated fatty acid (n-3PUFAS) on the level of lipoprotein phospholipase A2 (Lp-PLA2), low density lipoprotein (LDL) and lipoprotein a in patients with stable angina, and to provide a clinical basis for the treatment of stable angina pectoris by Omerga-3 polyunsaturated fatty acid (Omerga-3). Methods a retrospective study was carried out to retrieve all the patients discharged from the Department of cardiovascular medicine of the Affiliated Hospital of Qiingdao University Medical College from January 2014 to January 2015. 214 patients were included in the hospital. The patients were excluded from the required and lost patients. The follow-up number was 150, and the follow-up was followed up. The contents included general information of patients, risk factors of coronary heart disease (age, sex, body mass index, hypertension, diabetes, dyslipidemia, smoking history), current drug treatment, and the use of fish oil within 1 years after discharge. The end of follow-up was June 30, 2015. The patients were divided into fish oil group and routine group according to the use of fish oil. 36 people in the oil group and 114 people in the routine group. Lp-PLA2 and lipoprotein a were detected by outpatient or telephone follow-up. The effect of n-3PUFAS on the level of Lp-PLA2 and lipoprotein a was preliminarily observed. 80 patients in Department of Cardiology of the Affiliated Hospital of Qiingdao University were randomly divided into the control group and the control group, and the patients were randomly divided into the control group and the control group. The experimental group, 40 cases in each group. All the subjects were given standardized anti CHD treatment according to the situation, including aspirin antiplatelet, rosuvastatin lowering blood lipid, depressor, beta blocker. The patients in the test group were given n-3PUFAS capsule 1g/ day on the basis of standardizing anti coronary heart disease treatment (Tomson health brand fish oil soft capsule), The group was given the same dose of placebo (soybean oil capsule) on the basis of regular anti coronary heart disease treatment. The treatment course was 3 months. The level of Lp-PLA2, LDL and lipoprotein a were collected before and after the intervention. The two groups of patients were compared with the Seattle angina scale (SAQ) for 1 years after the discharge of different treatments. The clinical effect of n-3PUFAS on angina pectoris patients was evaluated. Results 1, 150 cases were included in the clinical diagnosis of stable angina pectoris, 34 cases of fish oil group and 114 cases in routine group. There was no statistics between the two groups in age, sex, weight index, smoking history, hypertension history, diabetes history and so on. The study difference (P 0.05).2, the plasma Lp-PLA2 level of fish oil group was significantly lower than that of non fish oil group, the difference was statistically significant (t=1.627, P0.05), but there was no significant difference between the two groups of lipoprotein (t=0.153, P0.05). 1, there was no difference between the base line data and the serological index group (P0.05).2 in the two groups before intervention (P0.05), after treatment, test The level of Lp-PLA2 in the group was significantly decreased (t=3.825, P0.05), and the level of Lp-PLA2 in the control group was also significantly decreased (t=2.115, P0.05), and the difference was statistically significant.3. The difference value of Lp-PLA2 before and after treatment in the test group was significantly higher than that of the control group before and after treatment (t=2.813, P0.05). The difference between the LDL in the experimental group before and after treatment was also better than that before and after the treatment of the control group. Significantly increased (t=2.813, P0.05). The test group, the comparison group before and after treatment of lipoprotein A and the difference between the two groups before and after treatment were not statistically significant.4, Seattle angina scale evaluation score: the degree of physical activity restriction, angina stable state, angina pectoris condition, treatment satisfaction, after treatment, the test group scores were significantly higher than the scores. The control group (t value was 2.455,3.216,2.984,3.001, P was 0.05), and there was no significant difference between the two groups in the degree of disease recognition, but the score of the test group was higher than that of the control group (t=1.132, P0.05).5, the safety of the two groups did not record the obvious adverse reactions, the blood analysis, the liver and kidney function, the urine routine, and the routine stool were not clear before and after the treatment. Conclusion n-3PUFAS can reduce the level of Lp-PLA2 and LDL in patients with stable angina pectoris, but has no significant effect on the level of lipoprotein a.

【學(xué)位授予單位】：青島大學(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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