發(fā)布時間：2018-06-01 08:41

  本文選題：冠狀動脈疾病 + 易損斑塊��； 參考：《山東大學》2017年碩士論文

【摘要】：背景:冠狀動脈粥樣硬化性心臟病(冠心病,coronary heart disease,CHD)的發(fā)病率及死亡率呈逐年上升趨勢,嚴重威脅人類的健康。動脈粥樣硬化(Atherosclerosis,AS)斑塊破裂和血栓形成是導致急性心血管事件的病理機制。對可能發(fā)生破裂的易損斑塊(vulnerable plaque)的早期識別成為篩選易損病人(vulnerable patient)以積極干預急性心血管事件進程的重要手段,斑塊穩(wěn)定性也已成為療效評價的重要依據(jù)。AS斑塊從穩(wěn)定變?yōu)橐讚p的過程涉及到炎癥、免疫、代謝、凝血等多個環(huán)節(jié)。研究表明,炎癥介導參與血栓形成,然而在形成血栓時斑塊并不發(fā)生破裂,而是因斑塊表面糜爛、潰瘍、鈣化結節(jié)形成引發(fā)斑塊進展。同時,晚近病理檢測易損斑塊中有少量鈣化或點狀鈣化。因此,我們提出假設,炎癥因子,鈣化因素共同促進斑塊進展。IL-6與動脈粥樣硬化的關系已有較多基礎及臨床研究。研究顯示IL-6(high-sensitive C-reactive protein,hs-CRP)可以作為預測冠心病事件的獨立危險因素。IL-6為預測炎癥的進展及遠期心血管危險事件的重要炎性指標。ALP與鈣化密切相關,而國內外研究多著眼于參與骨形成及肝相關疾病的研究。ALP是否介導冠心病病變嚴重程度進展,增加斑塊易損性,發(fā)生急性冠脈事件,以及炎癥因子IL-6與鈣化因素ALP與冠心病病變嚴重程度的相關性研究國內外未見相關報道。因此深入研究IL-6、ALP與冠狀動脈粥樣硬化性心臟病及斑塊穩(wěn)定性的關系,對探索冠心病與斑塊穩(wěn)定性新的干預靶點具有重要意義。目的:本研究以冠狀動脈造影評價冠狀動脈病變和Gensini積分量化冠脈病變程度,通過測定急性心肌梗死(acute myocardial infarction,AMI)、不穩(wěn)定心絞痛(unstable angina pectoris,UAP)、穩(wěn)定性心絞痛(stab.le angina pectoris,SAP)患者和對照組的血清IL-6和ALP水平,探討血清IL-6和ALP水平預測冠狀動脈病變嚴重程度及急性冠脈事件的作用。方法:選擇經冠狀動脈造影術(CAG)確診的CHD患者60例,其中不穩(wěn)定型心絞痛(UAP)20例,急性心肌梗死(AMI)20例,穩(wěn)定型心絞痛(SAP)20例。20例CAG顯示無狹窄的患者作為對照組。詳細記錄患者的病歷資料,包括一般臨床資料和生化指標。酶聯(lián)免疫吸附試驗(ELISA)法檢測4組患者血清IL-6、ALP的水平,同時檢測血脂指標、空腹血糖(GLU)等水平。Gensini評分分析冠脈病變程度,相關性分析判斷各組IL-6及ALP與Gensini評分的相關關系并進行統(tǒng)計學分析。結果:1.AMI及UAP組的IL-6及ALP血清水平明顯高于SAP組及對照組(P均0.01),AMI組IL-6及ALP血清水平顯著高于UAP組(P0.05)。2.冠心病組(SAP組+UAP組+AMI組)IL-6及ALP水平分別與Gensini評分呈顯著的正相關(r= 0.322,P0.05與r= 0.421,P0.01)3.AMI 組患者 ALP 與 Gensini 評分呈顯著的正相關(r=0.674,P0.01)。4.UAP組IL-6與Gensini評分呈顯著的正相關(r=0.488,P0.05)。5.SAP組IL-6及ALP水平分別與Gensini評分無相關。結論:IL-6和ALP水平在易損患者中顯著增高,提示IL-6和ALP與斑塊的不穩(wěn)定及破裂關系密切。冠心病患者中IL-6和ALP水平隨著Gensini積分的增加而升高,說明其與冠脈狹窄程度呈正相關,提示IL-6和ALP參與冠脈進展。AMI組ALP水平與Gensini積分呈正相關,關系密切,提示ALP與冠脈急性事件(心肌梗死)病變嚴重程度密切相關,ALP可以作為判斷ACS病情嚴重程度的預測指標。
[Abstract]:Background: the incidence and mortality of coronary atherosclerotic heart disease (coronary heart disease, coronary heart disease, CHD) are increasing year by year, which seriously threaten human health. Atherosclerotic (Atherosclerosis, AS) plaque rupture and thrombosis are the pathological mechanism leading to acute cardiovascular events. The vulnerability to possible rupture Early identification of vulnerable plaque has become an important means of screening vulnerable patients (vulnerable patient) to actively intervene in the process of acute cardiovascular events. Plaque stability has also become an important basis for the evaluation of therapeutic effects..AS patches from stable to fragile processes involve inflammation, immunity, metabolism, and coagulation. Inflammation mediates involvement in thrombosis, but the plaque does not break up in the formation of thrombus, but is due to plaque surface erosion, ulcers, and calcified nodules that cause plaque progress. At the same time, there is a small amount of calcification or dot calcification in the late pathological detection vulnerable plaques. Therefore, we hypothesized that inflammatory factors and calcification contribute to plaque progression. The relationship between IL-6 and atherosclerosis has many basic and clinical studies. Research shows that IL-6 (high-sensitive C-reactive protein, hs-CRP) can be used as an independent risk factor for predicting coronary heart disease events.IL-6 is an important inflammatory indicator of the progression of inflammation and the important inflammatory index of long-term cardiovascular risk events.ALP is closely related to calcification, and at home and abroad. The study focuses on whether.ALP is involved in the involvement of bone formation and liver related diseases, whether it mediates the progression of the severity of coronary artery disease, increases plaque vulnerability, causes acute coronary events, and the correlation of inflammatory factors IL-6 and calcification factor ALP to the severity of coronary heart disease, and there are no relevant reports on the severity of coronary heart disease. Therefore, IL-6, ALP The relationship with coronary atherosclerotic heart disease and plaque stability is of great significance for exploring new intervention targets for coronary artery disease and plaque stability. Objective: To evaluate coronary artery lesion and Gensini score to quantify the degree of coronary artery disease by coronary angiography, and to determine acute myocardial infarction (acute myocardial infarctio) by measuring the degree of coronary artery disease. N, AMI), unstable angina pectoris (unstable angina pectoris, UAP), serum IL-6 and ALP levels in patients with stable angina pectoris (stab.le angina pectoris, SAP) and control group, and to explore the role of serum levels and levels in predicting the severity of coronary artery disease and acute coronary events. 60 cases, including 20 cases of unstable angina (UAP), 20 cases of acute myocardial infarction (AMI), 20 cases of stable angina pectoris (SAP), and 20 cases of.20 CAG showed that the patients without stenosis were used as the control group. The patient's medical records were recorded in detail, including general clinical data and biochemical indexes. Enzyme linked immunosorbent assay (ELISA) was used to detect the serum IL-6, ALP water in the 4 groups of patients. At the same time, blood lipid index, fasting blood glucose (GLU) and other level.Gensini scores were used to analyze the degree of coronary artery disease. Correlation analysis was used to determine the correlation between IL-6 and ALP and Gensini scores in each group. Results: the serum levels of IL-6 and ALP in 1.AMI and UAP groups were significantly higher than those of SAP and control groups (P all 0.01). The level of IL-6 and ALP in the group of coronary heart disease (group SAP +UAP +AMI) was significantly higher than that of group UAP (P0.05).2. (group SAP +UAP group), and the level of IL-6 and ALP had a significant positive correlation (r= 0.322, P0.05 and r= 0.421). The levels of IL-6 and ALP in group SAP were not related to the Gensini score. Conclusion: the level of IL-6 and ALP increased significantly in vulnerable patients, suggesting that IL-6 and ALP are closely related to the instability and rupture of plaque. The level of IL-6 and ALP increases with the increase of Gensini integral in patients with coronary heart disease, indicating that it is positively related to the degree of coronary stenosis. The level of ALP in group.AMI was positively correlated with Gensini score, which was closely related, suggesting that ALP was closely related to the severity of acute coronary events (myocardial infarction), and ALP could be used as a predictor of the severity of ACS.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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