本文選題：微循環(huán)阻力指數(shù) + 心絞痛　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探究微循環(huán)阻力指數(shù)(indexofmicrocirculatoryresistance,IMR)在心絞痛患者中的相關(guān)影響因素,為心絞痛患者微循環(huán)受損的預(yù)防及治療尋求敏感指標(biāo)。[方法]回顧性選擇2014年12月到2017年3月在云南省第二人民醫(yī)院心內(nèi)科住院行IMR測量病人中診斷為心絞痛的部分病例81例,先常規(guī)行冠脈造影術(shù)(coronary angiography,CAG)檢查,CAG術(shù)后應(yīng)用壓力-溫度導(dǎo)絲技術(shù)測量靶血管的IMR值,IMR值以25為分界值[1],將上述病例分為兩組:IMR正常組(IMR25)及IMR升高組(IMR≥25),收集病例資料包括性別、年齡、身高、體重、吸煙史、飲酒史、高血壓病史、糖尿病史、血脂、尿酸、肌酐、冠脈狹窄程度、瘤樣擴(kuò)張、TIMI 血流(thrombolysis in myocardial infarction flow,TIMI flow)。通過比較兩組間各臨床因素的差異,并應(yīng)用統(tǒng)計(jì)學(xué)軟件篩選導(dǎo)致IMR值升高的預(yù)測因素。[結(jié)果]1.應(yīng)用壓力-溫度導(dǎo)絲技術(shù)測量研究對象的IMR值,手術(shù)成功率高,所有研究對象均未發(fā)生手術(shù)并發(fā)癥,操作安全、簡便、可重復(fù)性強(qiáng)、特異性高及不受心外膜循環(huán)影響。2.本研究相關(guān)性分析得出IMR升高組與IMR正常組在總膽固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白膽固醇(lowdensity lipoprotein cholesterin,LDL-C)、吸煙、慢血流-無復(fù)流(slow coronary flow or no coronary reflow,SCF/NR)、糖尿病、冠脈狹窄程度中存在明顯差異(P均0.05),具有統(tǒng)計(jì)學(xué)意義。而IMR升高組與IMR正常組在性別、年齡、體重指數(shù)(body mass index,BMI)、飲酒、高血壓、尿酸、肌酐、瘤樣擴(kuò)張中無明顯差異(P均0.05),無統(tǒng)計(jì)學(xué)意義。3.本研究二分類logistic回歸分析中得出:最終SCF/NR、糖尿病、吸煙留在模型內(nèi),且回歸系數(shù)是正值,對應(yīng)的OR值1,即SCF/NR(B值=0.82、OR=2.27、P0.001)、糖尿病(B 值=0.21、OR=1.23、P=0.003)、吸煙(B 值=0.18、OR=1.06、P=0.004),結(jié)果提示SCF/NR、糖尿病、吸煙為IMR值升高的獨(dú)立危險因素,即SCF/NR、糖尿病、吸煙為冠狀動脈微循環(huán)受損的獨(dú)立危險因素。[結(jié)論]1.微循環(huán)阻力指數(shù)的測量是一種操作簡便、安全、可重復(fù)性強(qiáng)、特異性高的評判冠狀動脈微循環(huán)的微創(chuàng)檢查技術(shù)。2.在心絞痛患者中,冠狀動脈微循環(huán)障礙與TC、TG、LDL-C、SCF/NR、吸煙、糖尿病、冠脈狹窄程度呈顯著相關(guān)。3.在心絞痛患者中,SCF/NR、糖尿病、吸煙是冠狀動脈微循環(huán)受損的獨(dú)立危險因素。
[Abstract]:[objective] to explore the related factors of index of microcirculation resistance index (IMR) in patients with angina pectoris, and to seek sensitive indexes for the prevention and treatment of microcirculation damage in patients with angina pectoris. [methods] from December 2014 to March 2017, 81 patients with angina pectoris diagnosed as angina pectoris were selected retrospectively, who were hospitalized in Department of Cardiology, second people's Hospital of Yunnan Province. The IMR value of target vessel was measured by pressure-temperature guide wire technique after CAG operation. The IMR value was 25. The patients were divided into two groups: normal group (n = 25) and elevated IMR group (n = 25). Case data, including sex, were collected. Age, height, weight, smoking history, drinking history, history of hypertension, history of diabetes, blood lipid, uric acid, creatinine, degree of coronary artery stenosis, tumor-like dilatation of TIMI blood flow and thrombolysis in myocardial infarction flow. By comparing the differences of clinical factors between the two groups, and using statistical software to screen the predictive factors that lead to the increase of IMR value. [result] 1. The IMR value of the subjects was measured by pressure-temperature guide wire technique. The success rate of operation was high. All the subjects had no complications. The operation was safe, simple, reproducible, specific and not affected by epicardial circulation. The correlation analysis of this study showed that the IMR elevation group and the normal IMR group had total cholesterol TC, triglyceride-triglyceride lipoprotein, low density lipoprotein cholesterol low density lipoprotein in LDL-Con, smoking, slow coronary flow or no coronary refraction, diabetes mellitus, low blood flow and low coronary flow or no coronary refraction. There were significant differences in the degree of coronary stenosis (P < 0.05). However, there was no significant difference in sex, age, body mass index (BMI), alcohol consumption, hypertension, uric acid, creatinine, tumor-like dilatation between IMR elevated group and normal IMR group (P < 0.05). In this study, logistic regression analysis showed that SCF / NR, diabetes mellitus and smoking remained in the model, and the regression coefficient was positive. The corresponding OR value was 1, i.e. SCF/NR(B value was 0.82%, OR value was 2.27, P 0.001, diabetes mellitus B value was 0.21 / 0.23, and smoking B value was 0.18 ORR 1.06P ~ (0.004), the results indicated that SCF / NR, diabetes, diabetes mellitus, diabetes, Smoking was an independent risk factor for increased IMR, i.e. SCF / NR, diabetes, and smoking as an independent risk factor for coronary microcirculation damage. [conclusion] 1. The measurement of resistance index of microcirculation is a simple, safe, reproducible and specific technique to evaluate coronary microcirculation. In patients with angina pectoris, coronary microcirculation disorders were significantly correlated with TCG-TGG LDL-Cnr, smoking, diabetes, and coronary stenosis. SCF / NR, diabetes and smoking are independent risk factors for coronary microcirculation damage in patients with angina pectoris.
【學(xué)位授予單位】：昆明醫(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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