本文選題：心血管事件 + 同型半胱氨酸　； 參考：《中國人民解放軍醫(yī)學(xué)院》2015年博士論文

【摘要】：背景：心血管疾病(cardiovascular disease,CVD)一直是威脅著人類的生命和健康的主要?dú)⑹帧＝陙?隨著人民生活水平的提高和社會(huì)老齡化的進(jìn)程,心血管疾病的發(fā)生也逐年增加。因此人們?cè)絹碓街匾晞?dòng)脈粥樣硬化性心血管病的早期診斷和早期治療,以降低該類疾病的病殘率和病死率,改善患者預(yù)后。動(dòng)脈僵硬度已成為心血管疾病和動(dòng)脈粥樣硬化疾病的獨(dú)立預(yù)測(cè)指標(biāo),目前認(rèn)為頸股動(dòng)脈脈搏波傳導(dǎo)速度(carotid-femoral PWV,cfPWV)是檢測(cè)動(dòng)脈硬化程度的“黃金標(biāo)準(zhǔn)”。高血漿同型半胱氨酸(homocysteine,Hey)水平已經(jīng)被視為是另一個(gè)預(yù)測(cè)心血管疾病及其死亡率的危險(xiǎn)因素。隨著對(duì)心血管疾病的發(fā)病機(jī)理的深入研究,在防控心血管事件的諸多措施中,評(píng)估和干預(yù)心血管疾病的危險(xiǎn)因素就顯的尤為重要。目前有研究提出血漿同型半胱氨酸水平提高同樣可導(dǎo)致動(dòng)脈粥樣硬化,對(duì)心血管疾病的有一定的預(yù)測(cè)作用。因此同型半胱氨酸與心血管事件(major adverse cardiovascular events,MACE)發(fā)生的相關(guān)性研究成為熱點(diǎn)。目的：既往研究顯示同型半胱氨酸水平與動(dòng)脈粥樣硬化呈正相關(guān),是心血管事件的獨(dú)立危險(xiǎn)因素。Hcy與心血管事件的關(guān)系多停留在橫斷面研究,在人群中Hcy對(duì)心血管事件的預(yù)測(cè)作用鮮有報(bào)道,尤其是在社區(qū)人群中。本課題目的是確定在社區(qū)人群中Hcy水平與動(dòng)脈僵硬度、心血管事件等的關(guān)系,探討Hcy水平對(duì)動(dòng)脈僵硬度和心血管事件的預(yù)測(cè)作用。方法：2007年9月至2009年1月,在北京市兩個(gè)社區(qū)人群進(jìn)行健康體檢,建立了數(shù)據(jù)完整的1680例心血管疾病危險(xiǎn)因素相關(guān)數(shù)據(jù)庫。在2013年2月至9月進(jìn)行隨訪,最終1499例受試者完成隨訪(隨訪率89.2%)。在這些基線及隨訪資料完整的社區(qū)人群中,除去死亡的52例有1447例隨訪前及隨訪后數(shù)據(jù)完整人群觀察血漿Hcy水平與動(dòng)脈僵硬度的關(guān)系,以及這兩項(xiàng)指標(biāo)變化值之間的關(guān)系。在這1499例人群中觀察血漿Hcy水平與心血管事件、全因死亡、心肌梗死及卒中發(fā)生的關(guān)系。基線及隨訪數(shù)據(jù)分析計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用x2檢驗(yàn),Hcy水平與動(dòng)脈僵硬度的關(guān)系采用Logistic分析進(jìn)行統(tǒng)計(jì)學(xué)處理,Hcy水平與心血管事件發(fā)生數(shù)據(jù)采用Cox回歸分析進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果：在1499例社區(qū)受試者(平均年齡61.4歲,男性630例,女性869例,平均隨訪4.8年)新發(fā)主要心血管事件157例,全因死亡52例,心血管事件死亡24例,新發(fā)心肌梗塞39例,新發(fā)卒中63例。①多元線性回歸分析顯示,基線Hcy與隨訪cfPWV顯著相關(guān)(β=0.817,P=0.01 5)；Logistic回歸分析顯示,校正混雜因素后,與Hcy最低四分位水平相比,第三、四分位水平動(dòng)脈硬化發(fā)生風(fēng)險(xiǎn)增加,其優(yōu)勢(shì)比(odds ratio,OR)分別為：第三分位(OR=1.833,95%可信區(qū)間[confidence interval,CI]:1.069-3.142,P=0.028),第四分位(OR=2.304,95% CI：1.261-4.209,P=0.00)；與Hcy最低四分位水平相比,第二、三、四分位水平cfPWV增加發(fā)生優(yōu)勢(shì)比(OR)分別為：第二分位(OR=1.656,95% CI：1.011-2.711,P=0.045),第三分位(OR=1.757,95%CI：1.097-2.813,P=0.019),第四分位(OR=1.756,95%CI： 1.058-2.915,P=0.029)②Cox回歸分析發(fā)現(xiàn)：在校正了傳統(tǒng)危險(xiǎn)因素及藥物治療后,Hcy是不良心血管事件的獨(dú)立預(yù)測(cè)因素(風(fēng)險(xiǎn)比[hazard ratio, HR]=1.022,95%CI:1.002-1.048, P=0.035),與心血管死亡事件相關(guān)(HR=1.271, 95%CI:1.019-1.587, P=0.034),也與全因死亡事件相關(guān)(HR=1.061,95%CI: 1.008-1.116, P=0.022)。在老年人群中結(jié)果一致。結(jié)論：在社區(qū)人群中,同型半胱氨酸水平是表示中央動(dòng)脈僵硬度cfPWV的獨(dú)立預(yù)測(cè)指標(biāo),血漿同型半胱氨酸水平與cfPWV的增加值(cf PWV δ)顯著相關(guān)。為臨床預(yù)測(cè)動(dòng)脈硬化程度提供新的預(yù)測(cè)指標(biāo)和理論依據(jù)。Hcy是MACE的獨(dú)立預(yù)測(cè)因素,與心血管死亡有關(guān)。提示檢測(cè)血漿Hcy對(duì)預(yù)測(cè)社區(qū)一般人群心血管事件的發(fā)生有重要意義,也時(shí)為臨床預(yù)測(cè)、診斷心血管事件的發(fā)生及嚴(yán)重程度提供新的思路和有效的參考指標(biāo)。
[Abstract]:Background: cardiovascular disease (CVD) is a major killer of human life and health. In recent years, with the improvement of the people's living standard and the aging of the society, the incidence of cardiovascular disease is increasing year by year. Early treatment to reduce the morbidity and mortality of the disease and improve the prognosis of the patients. Arterial stiffness has become an independent predictor of cardiovascular and atherosclerotic diseases. The carotid artery pulse wave velocity (carotid-femoral PWV, cfPWV) is considered as the "golden standard" for detecting the degree of arteriosclerosis. Homocysteine (Hey) levels have been considered as another risk factor for predicting cardiovascular disease and mortality. With the in-depth study of the pathogenesis of cardiovascular disease, the risk factors for assessing and intervening cardiovascular disease are particularly important in many measures to prevent and control cardiovascular events. Raised plasma homocysteine levels also lead to atherosclerosis and have a certain predictive effect on cardiovascular disease. Therefore, the correlation between homocysteine and cardiovascular events (major adverse cardiovascular events, MACE) is a hot spot. Atherosclerosis is a positive correlation, an independent risk factor for cardiovascular events, the relationship between.Hcy and cardiovascular events is mostly in cross-sectional study. The predictive role of Hcy on cardiovascular events is rarely reported in the population, especially in community populations. The purpose of this study is to determine the level of Hcy and arterial stiffness and cardiovascular disease in the community population. The predictive effect of Hcy level on arterial stiffness and cardiovascular events was investigated. Methods: from September 2007 to January 2009, a health check-up was conducted in two community groups in Beijing. A data complete database of 1680 cardiovascular disease risk factors was established. The follow-up was conducted from February 2013 to September, and 1499 subjects were finally tested. The follow-up (follow-up rate of 89.2%) was completed. In the community population with complete baseline and follow-up data, 52 cases of the removal of death had 1447 cases before and after the follow-up data to observe the relationship between plasma Hcy level and arterial stiffness, and the correlation between the changes in the values of the two indicators. The levels of plasma Hcy were observed in the 1499 population. The relationship between cardiovascular events, all causes of death, myocardial infarction and stroke. Baseline and follow-up data were analyzed by t test, x2 test was used for counting data. The relationship between Hcy level and arterial stiffness was statistically processed by Logistic analysis. The Hcy level and cardiovascular events data were analyzed by Cox regression analysis. Results: there were 157 new major cardiovascular events in 1499 community subjects (average age 61.4, male 630, female 869, average follow-up 4.8 years), 52 deaths, 24 cardiovascular events, 39 new myocardial infarction, and 63 cases of new stroke. (1) multivariate linear regression analysis showed that baseline Hcy was significantly associated with follow-up (cfPWV). Beta =0.817, P=0.01 5); Logistic regression analysis showed that after correction of confounding factors, compared with the lowest Hcy level of Hcy, the risk of third, fourth division level arteriosclerosis was increased, and its dominance (odds ratio, OR) was third (OR=1.833,95% confidence interval [confidence interval, CI]: 1.069-3.142, fourth). 4,95% CI:1.261-4.209, P=0.00); compared with the lowest four sub level of Hcy, second, third, four sub level cfPWV increased the dominance ratio (OR), respectively: Second Division (OR=1.656,95% CI:1.011-2.711, P=0.045), third division (OR=1.757,95%CI:1.097-2.813, P= 0.019), fourth (OR=1.756,95%CI:1.058-2.915,) After the correction of traditional risk factors and drug treatment, Hcy was an independent predictor of adverse cardiovascular events (risk than [hazard ratio, HR]=1.022,95%CI:1.002-1.048, P=0.035), associated with cardiovascular death (HR=1.271, 95%CI:1.019-1.587, P=0.034), and associated with all causes of death (HR=1.061,95%CI: 1.008). -1.116, P=0.022). Conclusion: homocysteine levels are independent predictors of central arterial stiffness cfPWV in the community population. Plasma homocysteine levels are significantly associated with the increase in the value of cfPWV (CF PWV delta). It provides a new predictor and theory for the clinical pretest of arteriosclerosis. .Hcy is an independent predictor of MACE and is associated with cardiovascular death. It is suggested that the detection of plasma Hcy is important for predicting the occurrence of cardiovascular events in community general population. It also provides new ideas and effective reference indicators for clinical prediction, the diagnosis of cardiovascular events and the severity of cardiovascular events.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R54

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