本文選題：冠心病 + 紅細胞膜鞘磷脂含量��； 參考：《安徽醫(yī)科大學》2015年碩士論文

【摘要】：背景:冠心病(coronary heart disease,CHD)是指冠狀動脈粥樣硬化致使管腔狹窄或閉塞,導致心肌缺氧或壞死而引起的心臟疾病,是嚴重危害人類健康的疾病之一。急性冠脈綜合征(acute coronary syndrome,ACS)是一組以冠脈粥樣硬化不穩(wěn)定斑塊破裂或糜爛導致冠狀動脈內(nèi)血栓形成為主要發(fā)病基礎的臨床綜合征,是冠心病的嚴重類型,越來越多的證據(jù)提示紅細胞尤其是紅細胞膜脂質(zhì)參與了不穩(wěn)定斑塊的發(fā)生和發(fā)展。鞘磷脂作為紅細胞膜脂質(zhì)的重要組成成分之一,與動脈粥樣硬化有著密切的關系,我們的前期研究發(fā)現(xiàn)紅細胞膜鞘磷脂含量(sphingomyelin content of erythrocyte membranes,SEM)的升高與ACS有著獨立的正相關性,提示SEM可能參與了不穩(wěn)定斑塊的形成及發(fā)展,但SEM對冠心病患者的預后是否具有預測價值目前尚無文獻報道。目的:通過前瞻性隨訪研究,評價SEM與冠心病患者終點事件發(fā)生風險的相關性,探討SEM對冠心病患者預后的價值。方法:選取398例經(jīng)冠脈造影檢查確診為冠心病的患者,采用酶學方法測定其SEM值,并在出院后對其進行隨訪,隨訪中位數(shù)時間為990天。通過Cox回歸方法和Kaplan-Meier曲線分析SEM水平對隨訪期間患者發(fā)生初級終點事件和次級終點事件的預測價值。結果:1.有事件發(fā)生組患者的SEM水平[114.46(72.92-145.10)ug/mg]顯著性高于無事件發(fā)生組患者[82.42(30.81-117.76)ug/mg](p0.001)。2.以SEM的中位數(shù)(92.06ug/mg)為截點將患者分為兩組,SEM92.06ug/mg組患者的初級終點事件的發(fā)生率高于SEM≤92.06ug/mg組患者,差異有統(tǒng)計學意義(p=0.001),僅全因死亡存在此顯著差異(p=0.001)。SEM92.06ug/mg組患者的次級終點事件的發(fā)生率高于SEM≤92.06ug/mg組患者,差異有統(tǒng)計學意義(p=0.032),但在次級終點事件中再血管化治療和心功能衰竭的差異都無統(tǒng)計學意義。3.Cox回歸分析發(fā)現(xiàn)SEM對冠心病患者初級終點事件有預測價值(RR值3.287,95%CI 1.441-7.498,p=0.005),其中僅對初級終點事件中的全因死亡(RR值4.295,95%CI 1.358-13.585,p=0.013)有預測價值。而SEM對次級終點事件的發(fā)生無明顯預測作用。4.Kaplan-Meier曲線顯示SEM92.06ug/mg組患者的初級終點事件的發(fā)生率顯著性高于SEM≤92.06ug/mg組患者(p=0.001),但其中僅全因死亡存在此顯著性差異(p=0.001)。結論:SEM升高對冠心病患者初級終點事件的發(fā)生風險有一定的預測價值,且僅對初級終點事件中的全因死亡的發(fā)生有預測價值。
[Abstract]:Background: coronary heart disease (heart) is a kind of heart disease which is caused by coronary atherosclerosis, which leads to stenosis or occlusion of the lumen, hypoxia or necrosis of myocardium. It is one of the serious diseases endangering human health. Acute coronary syndrome (ACS) is a group of clinical syndrome, which is based on the rupture of unstable plaque or erosion of coronary artery, and is a serious type of coronary heart disease. More and more evidence suggests that erythrocytes, especially erythrocyte membrane lipids, are involved in the occurrence and development of unstable plaque. As an important component of erythrocyte membrane lipids, sphingomyelin content of erythrocyte membrane (SEM) is closely related to atherosclerosis. Our previous studies have found that the increase of sphingomyelin content of erythrocyte membrane sem has an independent positive correlation with ACS. It is suggested that SEM may be involved in the formation and development of unstable plaques, but whether SEM can predict the prognosis of patients with coronary heart disease has not been reported. Objective: to evaluate the relationship between SEM and the risk of end point events in patients with coronary heart disease (CHD), and to evaluate the value of SEM in the prognosis of patients with coronary heart disease (CHD). Methods: the SEM values of 398 patients with coronary artery disease diagnosed by coronary angiography were determined by enzymatic method and followed up after discharge. The median follow-up time was 990 days. Cox regression method and Kaplan-Meier curve were used to analyze the predictive value of SEM level in patients with primary and secondary endpoint events during follow-up. The result is 1: 1. The level of SEM [114.46(72.92-145.10)ug/mg] in the event-prone group was significantly higher than that in the non-event-occurring group [82.42(30.81-117.76)ug/mg] p 0.001. 2. The incidence of primary endpoint events in the SEM92.06ugr / mg group was higher than that in the SEM 鈮，

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