本文選題：心臟X綜合征 + 睡眠質(zhì)量��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景:心臟X綜合征(CSX)主要是指有心肌缺血證據(jù),冠狀動脈造影正�；蚪咏�,并排除冠狀動脈痙攣,瓣膜性心臟病,心肌病等其他特殊類型心臟疾病的一組癥候群。目前尚無大樣本人群的CSX的流行病學(xué)資料。既往小樣本的臨床研究顯示,在具有心肌缺血癥狀而冠狀動脈造影未見阻塞性病變的患者中,微血管疾病的發(fā)生率約為45%～60%。目前關(guān)于CSX機(jī)制的研究主要集中在微血管病變的機(jī)制、診斷和治療上。流行病學(xué)研究發(fā)現(xiàn)傳統(tǒng)危險(xiǎn)因素(高血壓病,糖尿病,吸煙等)、自主神經(jīng)功能紊亂等均可以導(dǎo)致CSX的發(fā)生。雖然臨床研究顯示CSX患者長期隨訪主要急性冠脈事件(心源性猝死和急性心肌梗死)較低,但大部分患者仍有心絞痛癥狀且生存質(zhì)量明顯受損。反復(fù)心絞痛和再入院加重了CSX患者的經(jīng)濟(jì)負(fù)擔(dān)和心理負(fù)擔(dān),造成社會資源的不必要的浪費(fèi)。因此,發(fā)現(xiàn)影響CSX患者心絞痛癥狀發(fā)作和中遠(yuǎn)期預(yù)后的危險(xiǎn)因素顯得尤為重要。睡眠醫(yī)學(xué)受到越來越多人的重視,睡眠障礙可以導(dǎo)致各種心血管代謝疾病(包括肥胖,高血壓,糖尿病,心血管疾病等)危險(xiǎn)增加。睡眠狀態(tài)下自主神經(jīng)活性的改變和呼吸調(diào)控的抑制,可導(dǎo)致機(jī)體神經(jīng)、呼吸和血流動力學(xué)改變,對心臟事件和腦血管疾病發(fā)生具有重要意義。睡眠質(zhì)量是對睡眠時(shí)長和睡眠質(zhì)量的綜合評價(jià)。臨床研究發(fā)現(xiàn)睡眠質(zhì)量和代謝綜合征,心血管疾病密切相關(guān)。我們假設(shè):睡眠質(zhì)量可能與CSX心絞痛癥狀發(fā)作和預(yù)后相關(guān)。目的:本文將通過隊(duì)列隨訪研究睡眠質(zhì)量與CSX患者中期預(yù)后的關(guān)系。方法:我們從2012年5月1日至2015年12月31日在山東大學(xué)齊魯醫(yī)院心內(nèi)科因冠心病可疑行冠狀動脈造影的所有患者中逐一篩選出135例CSX患者。臨床資料采集包括:病史采集(包括用藥史、精神病史等),體格檢查,實(shí)驗(yàn)室檢查(血脂、生化等)。我們分別使用匹茲堡睡眠質(zhì)量指數(shù)(PSQI)和冠狀動脈TIMI血流禎數(shù)評估患者睡眠質(zhì)量和冠狀動脈血流情況。我們對患者實(shí)行了 4年(平均1.8年)的隨訪,使用連續(xù)logistic回歸分析危險(xiǎn)因素與癥狀的關(guān)系;Cox回歸分析CSX患者再入院的預(yù)測因子;Kaplan-Meier曲線以分析睡眠質(zhì)量與CSX患者再入院的關(guān)系。結(jié)果:CSX患者睡眠質(zhì)量低發(fā)生率為62.5%,其中女性患者發(fā)生率為73.3%,男性患者發(fā)生率為44%。高睡眠質(zhì)量組與低睡眠質(zhì)量組的年齡、體重指數(shù)(BMI)、靜息心率、高血壓病、糖尿病、血脂異常、慢血流以及用藥情況均無統(tǒng)計(jì)學(xué)差異。低睡眠質(zhì)量組的女性患者比率高于高睡眠質(zhì)量組,而吸煙率則低于高睡眠質(zhì)量組。在我們的隨訪中,急性心肌梗死發(fā)生0例,腦梗塞1例,26名患者因反復(fù)心絞痛/急性冠脈綜合征再入院。66.9%的患者仍然有心絞痛癥狀發(fā)生,其中2.2%患者訴心絞痛較前加重,19.1%患者訴心絞痛發(fā)作較前無明顯改變。低睡眠質(zhì)量組癥狀改善或消失的比率明顯低于高睡眠質(zhì)量組。排除年齡、高血壓、糖尿病、高脂血癥等傳統(tǒng)心血管危險(xiǎn)因素以及BMI和慢血流影響后,睡眠質(zhì)量是患者癥狀變化的獨(dú)立預(yù)測因子(OR 3.397;95%CI 1.652-6.978;p=0.001)。低睡眠質(zhì)量的患者是高睡眠質(zhì)量患者因心絞痛再入院的風(fēng)險(xiǎn)3.0倍(HR 3.094 95%CI 1.161-8.245:p=0.024)。Kaplan-Meier生存曲線顯示低睡眠質(zhì)量組與高睡眠質(zhì)量組的再入院率存在明顯差異(p=0.033)。結(jié)論:CSX患者睡眠質(zhì)量低發(fā)生率較高;女性CSX患者低睡眠質(zhì)量發(fā)生率明顯高于男性患者。睡眠質(zhì)量是CSX患者心絞痛癥狀變化和再入院的獨(dú)立預(yù)測因子。睡眠質(zhì)量量表作為一種經(jīng)濟(jì),簡單,實(shí)用的篩查方法對發(fā)現(xiàn)高危CSX患者具有重要意義。
[Abstract]:Background: cardiac X syndrome (CSX) is mainly referred to as a group of symptoms of myocardial ischemia evidence, normal coronary angiography or close to normal, and a group of other special types of heart diseases that exclude coronary artery spasm, valvular heart disease, cardiomyopathy and other special types of heart disease. There is no epidemiological data on CSX in large sample population. In patients with myocardial ischemia and coronary angiography, the incidence of microvascular disease is about 45% to 60%., and the current research on the CSX mechanism is mainly focused on the mechanism, diagnosis and treatment of microvascular lesions. Epidemiological studies have found that traditional risk factors (hypertension, diabetes, smoking, etc.) The main neurological disorders can all lead to the occurrence of CSX. Although clinical studies have shown that the major acute coronary events (sudden cardiac death and acute myocardial infarction) in CSX patients are lower in long-term follow-up, most patients still have angina symptoms and the quality of life is significantly impaired. Recurrent angina and rehospitalization aggravate the financial burden and heart of patients with CSX. It is an unnecessary waste of social resources. Therefore, it is particularly important to find the risk factors affecting the symptoms of angina and the median prognosis of CSX patients. Sleep medicine is being paid more and more attention to. Sleep disorders can lead to various cardiovascular metabolic diseases (including obesity, hypertension, diabetes, cardiovascular disease, etc.) The changes in the activity of autonomic nerves and the inhibition of respiratory regulation during sleep can lead to changes in the body's nerve, respiration and hemodynamics, which are of great significance for the occurrence of cardiac events and cerebrovascular diseases. The quality of sleep is a comprehensive evaluation of the length of sleep and the quality of sleep. Clinical studies have found the quality of sleep and metabolism. Signs, cardiovascular disease is closely related. We hypothesized that sleep quality may be associated with the onset and prognosis of CSX angina pectoris. Objective: This article will study the relationship between sleep quality and medium-term prognosis of CSX patients through a cohort. Methods: from May 1, 2012 to December 31, 2015, we were suspicious of coronary heart disease in the Department of Cardiology, Qilu Hospital, Shandong University. 135 patients with CSX were screened out of all patients undergoing coronary angiography. Clinical data collection included history collection (including history of medication, psychiatric history, etc.), physical examination, laboratory examination (blood lipid, biochemistry, etc.). We assessed the quality of sleep with the Pittsburgh sleep mass index (PSQI) and the frame of the coronary artery TIMI, respectively. The patients were followed up for 4 years (an average of 1.8 years). We used continuous logistic regression to analyze the relationship between risk factors and symptoms; Cox regression analysis of predictors of reentry in CSX patients; Kaplan-Meier curve to analyze the relationship between sleep quality and readmission in CSX patients. Results: low sleep quality in CSX patients occurred. The rate of female patients was 62.5%, and the incidence of female patients was 73.3%. The incidence of male patients was the age of 44%. high sleep quality group and low sleep quality group, body mass index (BMI), resting heart rate, hypertension, diabetes, dyslipidemia, slow blood flow and drug use. The rate of female patients in low sleep quality group was higher than that of high sleep quality. In our follow-up, 0 cases of acute myocardial infarction, 1 cases of cerebral infarction, and 26 patients with angina pectoris / acute coronary syndrome in.66.9% still had angina, of which 2.2% patients complained of severe angina pectoris, and 19.1% patients complained of angina pectoris. The rate of improvement or disappearance of the low sleep quality group was significantly lower than that in the high sleep quality group. After eliminating the traditional cardiovascular risk factors, such as age, hypertension, diabetes, hyperlipidemia, and the influence of BMI and slow blood flow, the quality of sleep was an independent predictor of the patient's symptoms (OR 3.397; 95%CI 1.652-6.978; p=0.001). The patients with high quality sleep quality were 3 times as high as the risk of angina pectoris reentry (HR 3.094 95%CI 1.161-8.245:p=0.024).Kaplan-Meier survival curve showing a significant difference in the reentry rate between the low sleep quality group and the high sleep quality group (p=0.033). Conclusion: the incidence of low sleep sleep in CSX patients was higher, and the low sleep quality of female CSX patients was low. The quality of sleep is an independent predictor of changes in angina symptoms and readmission in CSX patients. The sleep quality scale is of great significance as an economical, simple and practical screening method for the discovery of high-risk CSX patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541

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