本文選題：阻塞性睡眠呼吸暫停綜合征 + 經(jīng)皮冠狀動脈介入治療　； 參考：《鄭州大學(xué)》2015年碩士論文

【摘要】：背景與目的半個多世紀(jì)以來,隨著社會經(jīng)濟(jì)水平的提高,人類生活方式、飲食結(jié)構(gòu)的改變,我國人民疾病的發(fā)生譜和死亡譜也發(fā)生著極大的變化。20世紀(jì)末期,各種慢性病已成為整個疾病譜的主流,尤其是心血管疾病所占的比例巨大�！吨袊难懿蟾�2013概要》顯示:心血管病死亡占城鄉(xiāng)總死亡原因的首位,其中農(nóng)村地區(qū)為38.7%,城市為41.1%[1],且患病率處于持續(xù)上升階段,成為威脅人類健康的主要殺手。急性冠脈綜合征(acute coronary syndrome,ACS)是一種普遍存在并對人類有嚴(yán)重危害性的心血管疾病,它以冠狀動脈粥樣斑塊破裂或出血,繼發(fā)完全或不完全性冠脈阻塞為病理生理學(xué)基礎(chǔ)。目前對ACS的治療,除了藥物預(yù)防及控制心血管病危險因素等措施外,經(jīng)皮冠狀動脈介入手術(shù)(percutaneous coronary intervention,PCI)漸漸起到了越來越重要的作用,成為治療冠心病最有效的方法之一[2]。尤其是藥物洗脫支架(drug eluting stent,DES)的出現(xiàn),使術(shù)后支架內(nèi)再狹窄(in-stent restenosis,ISR)的發(fā)生率降低,利于PCI術(shù)在人群中被廣泛的接受和推廣。但由于ACS患者本身常存在血管內(nèi)皮損傷、血栓形成,現(xiàn)有條件無法及時發(fā)現(xiàn)其是否存在抗血小板藥物抵抗等高危因素,ISR仍然是PCI術(shù)后的重要難題[4,5]。ACS患者冠脈ISR的發(fā)生率可高達(dá)10%左右[6]。為了提高PCI術(shù)的臨床應(yīng)用效果,許多專家學(xué)者對ISR的影響因素做了分析與探討。既往回顧性研究表明,影響冠脈ISR的因素主要包括血漿纖維蛋白原(fibrinogen,FIB)水平增高、吸煙、高血壓、糖尿病及冠脈多支病變[7]等。阻塞性睡眠呼吸暫停綜合征(obstructive sleep apnea syndrome,OSAS)作為一種反復(fù)發(fā)作上呼吸道阻塞的睡眠紊亂性疾病,流行病學(xué)調(diào)查顯示:65歲以上人群OSAS發(fā)病率達(dá)到45%以上[8],而且發(fā)病率呈逐年上升趨勢。近年來研究發(fā)現(xiàn)其與心血管疾病的危險因素如高血壓、心律失常、冠心病、肺動脈高壓等有著密切的關(guān)系,可能參與了心血管疾病的發(fā)生、發(fā)展過程。另外,Dai Yumino等人的研究結(jié)果表明:OSAS可導(dǎo)致ACS患者PCI術(shù)后再次心肌梗死、住院期間死亡等心血管不良事件的發(fā)生率升高,但對于它是否與ISR的發(fā)生率有關(guān),且會對ISR的發(fā)生率產(chǎn)生多大的影響,國內(nèi)外相關(guān)報道較少。本研究旨在分析OSAS與PCI術(shù)后冠脈ISR是否具有相關(guān)性,OSAS是否為ISR的獨立危險因素,并探討其影響ISR的可能機(jī)制,為ISR的二級預(yù)防提供臨床依據(jù)。對象與方法:選取2013年1月至2014年12月期間在鄭州大學(xué)第一附屬醫(yī)院心內(nèi)科行PCI治療并于術(shù)后12個月行冠狀動脈造影復(fù)查的ACS患者158例,根據(jù)其復(fù)查造影結(jié)果分為:支架內(nèi)再狹窄組(ISR組)和非支架內(nèi)再狹窄組(非ISR組),其中ISR組39例,男性28例,平均年齡(57.92±9.40)歲;非ISR組119例,男性102例,平均年齡(57.67±9.53)歲。搜集所有患者入院時的基本臨床資料、生化指標(biāo)以及冠脈介入手術(shù)相關(guān)資料,采用二分類Logistic回歸分析的方法分析OSAS是否為ISR的獨立危險因素。結(jié)果:1.單因素分析結(jié)果顯示:①ISR組OSAS患者比率較非ISR組高(62%vs37%),P=0.007,差異具有統(tǒng)計學(xué)意義;②ISR組糖尿病患者比率較非ISR組高(28%vs 12%),P=0.015,差異具有統(tǒng)計學(xué)意義;③ISR組支架直徑較非ISR組小(2.93±0.40 mm vs 3.22±0.55 mm),P=0.001,差異具有統(tǒng)計學(xué)意義。2.二分類Logistic回歸分析結(jié)果示:OSAS(OR=2.937,95%CI:1.336-6.456)、糖尿病(OR=2.818,95%CI:1.088-7.301)可能是支架內(nèi)再狹窄的危險因素,較大的支架直徑(OR=0.312,95%CI:0.132-0.735)可能是支架內(nèi)再狹窄的保護(hù)因素。結(jié)論:1.OSAS、糖尿病和支架直徑與冠狀動脈ISR密切相關(guān);2.OSAS、糖尿病可能是冠脈ISR的獨立危險因素,較大的支架直徑可能是ISR的保護(hù)性因素。
[Abstract]:Background and purpose for more than half a century, with the improvement of the social and economic level, the change of human life style and diet structure, the incidence and death spectrum of the people's disease have also changed greatly in the late.20 century. All kinds of chronic diseases have become the main stream of the whole disease spectrum, especially the proportion of cardiovascular diseases. < China Cardiovascular disease report 2013 shows that cardiovascular disease death accounts for the first cause of total death in urban and rural areas, including 38.7% in rural areas and 41.1%[1] in the city, and the prevalence rate is on the rising stage, becoming the major killer of human health. Acute coronary syndrome (acute coronary syndrome, ACS) is a common existence and strict to human beings. Severe cardiovascular disease with coronary atherosclerotic plaque rupture or hemorrhage and secondary complete or incomplete coronary occlusion as a pathophysiological basis. The current treatment of ACS, in addition to drug prevention and control of cardiovascular risk factors, is performed by percutaneous coronary intervention (percutaneous coronary intervention, PCI). It is becoming more and more important to become one of the most effective methods for the treatment of coronary heart disease [2]. especially the emergence of drug eluting stent (DES), which reduces the incidence of in-stent restenosis (ISR) after the operation and is widely accepted and popularized in the crowd. However, the ACS patient itself has been widely accepted and promoted. There is often vascular endothelial injury, thrombosis, the existing conditions can not be found in time to be found in the presence of anti platelet drug resistance and other high-risk factors, ISR is still an important problem after PCI operation, the incidence of coronary ISR in [4,5].ACS patients can be as high as 10% [6]. in order to improve the clinical application of PCI, many experts and scholars on the influencing factors of ISR The analysis and discussion were done. The previous retrospective study showed that the factors affecting the coronary ISR include increased plasma fibrinogen (fibrinogen, FIB), smoking, hypertension, diabetes and multiple coronary artery disease [7]. Obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS) as a recurrent seizure. The epidemiological survey shows that the incidence of OSAS in people over 65 years old is up to 45% [8], and the incidence is increasing year by year. In recent years, the study found that there is a close relationship with the risk factors of cardiovascular diseases such as hypertension, arrhythmia, coronary heart disease, pulmonary hypertension and so on, which may be involved in the heart blood. In addition, the results of Dai Yumino et al. Have shown that OSAS can lead to a recurrence of myocardial infarction in ACS patients after PCI and the incidence of cardiovascular adverse events during hospitalization, but whether it is associated with the incidence of ISR and how much effect on the incidence of ISR, related reports at home and abroad. The purpose of this study is to analyze the correlation between OSAS and the coronary ISR after PCI, whether OSAS is an independent risk factor for ISR, and explore the possible mechanism of its influence on ISR, and provide a clinical basis for the two level prevention of ISR. Object and method: from January 2013 to December 2014, PCI treatment in the Department of Cardiology at the First Affiliated Hospital of Zhengzhou University was selected. And 158 cases of ACS patients underwent coronary angiography 12 months after operation. According to their reexamination results, they were divided into stent restenosis group (group ISR) and non stent restenosis group (non ISR group), of which group ISR was 39 cases, male 28 cases, average age (57.92 + 9.40) years, 119 cases in non ISR group, 102 men, and average age (57.67 + 9.53) years. All The basic clinical data, biochemical indexes and the related data of coronary intervention were used to analyze the independent risk factors of OSAS as ISR by two classification Logistic regression analysis. Results: 1. the results of single factor analysis showed that (1) the ratio of OSAS patients in group ISR was higher than that of non ISR group (62%vs37%), P=0.007, and the difference was statistically significant. (2) the ratio of diabetic patients in group ISR was higher than that in non ISR group (28%vs 12%) and P=0.015, and the difference was statistically significant. (3) the diameter of the stent in ISR group was smaller than that of non ISR group (2.93 + 0.40 mm vs 3.22 + 0.55 mm), and the difference was statistically significant for.2. two classification of Logistic regression analysis. 088-7.301) may be a risk factor for restenosis in the stent. Larger stent diameter (OR=0.312,95%CI:0.132-0.735) may be a protective factor for restenosis in the stent. Conclusion: 1.OSAS, diabetes and stent diameter are closely related to coronary artery ISR; 2.OSAS, diabetes may be an independent risk factor for coronary ISR, and a larger stent diameter may be possible. It is a protective factor for ISR.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4;R766

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