本文選題：高齡 + 反應(yīng)性充血指數(shù)(RHI)��； 參考：《中國人民解放軍醫(yī)學(xué)院》2017年博士論文

【摘要】：背景:血管內(nèi)皮是人體內(nèi)最大的內(nèi)分泌器官,具有重要的生理及病理生理功能。內(nèi)皮功能的損傷,在心血管疾病的進(jìn)程及最終轉(zhuǎn)歸中起到了重要的作用。此前多項研究已經(jīng)證實血管內(nèi)皮功能的影響因素與心血管危險該因素相關(guān),主要包括年齡、體重指數(shù)、性別、血脂、糖尿病、冠心病、高血壓等。并明確了血管內(nèi)皮功能障礙可能導(dǎo)致遠(yuǎn)期心血管事件增加。但對于老年群體,是否還有其他可能影響血管內(nèi)皮功能的因素。以及血管內(nèi)皮功能對老年人群的心血管事件預(yù)測價值,特別是對相對近期的心血管事件預(yù)測價值,并不十分清楚。本研究擬探討血管內(nèi)皮功能的重要指標(biāo)-血管反應(yīng)性充血指數(shù)(RHI)在老年人群中的影響因素,以及其對近期(≤2年)心血管事件的單獨預(yù)測價值以及復(fù)合心腎功能指標(biāo)后的預(yù)測價值。方法:本研究為前瞻、隊列研究。研究對象為解放軍總醫(yī)院1686名常規(guī)查體及住院老年患者。除外研究對象患腫瘤、感染、長期臥床、機(jī)械通氣、雙上臂血壓不一致等情況。在2015年2月至7月間完成血管內(nèi)皮功能的檢查及其他包括年齡、疾病史、身高、體重、血壓、心率、血液化驗指標(biāo)等結(jié)果的收集。將觀察對象根據(jù)RHI四分位及是否合并冠心病及糖尿病分組,明確影響血管內(nèi)功能的可能因素。研究對象隨訪至2017年2月,根據(jù)RHI、NT-proBNP、eGFR指標(biāo)的中位數(shù)分為高、低兩組,明確各組研究對象在隨訪期間心血管事件的發(fā)生情況。應(yīng)用Cox比例風(fēng)險模型評估RHI對近期心血管時間的預(yù)測價值。并在RHI的基礎(chǔ)上,加入NT-proBNP及eGFR,共同評估此復(fù)合指標(biāo)對近期心血管事件發(fā)生的預(yù)測價值。結(jié)果:在1686例研究對象(平均年齡75.3 ± 10歲)中,診斷血脂紊亂1309人,高血壓776人,糖尿病592人,冠心病542人,慢性腎功能不全69人。將研究對象分按照RHI四分位分為四組,結(jié)果發(fā)現(xiàn)隨RHI高的組與低的組相比,年齡更小、吸煙比率更少、患高血壓比例更低、患糖尿病比例更低、BMI更低、收縮壓更低、空腹血糖更低、糖化血紅蛋白更低、總膽固醇更低、高密度脂蛋白膽固醇更高、肌酐更低、NT-proBNP更低、eGFR更高(P for all 0.01)。經(jīng)單因素分析顯示In-RHI (自然對數(shù)轉(zhuǎn)換后RHI)與年齡、吸煙、高血壓、BMI、舒張壓、空腹血糖、全血糖化血紅蛋白、膽固醇、低密度脂蛋白膽固醇、肌酐、NT-proBNP呈負(fù)相關(guān)(P for all 0.05 );與eGFR呈正相關(guān)(P0.001 )。多因素線性回歸分析顯示In-RHI與年齡、吸煙、BMI、糖化血紅蛋白、低密度脂蛋白膽固醇、NT-proBNP呈負(fù)相關(guān)(P for all 0.05 );與eGFR呈正相關(guān)(P=0.017 )。將研究對象按照有無冠心病及糖尿病分組,RHI在無冠心病及糖尿病組中,中位數(shù)為2.05 (IQR 1.82-2.28 );在單冠心病組中,中位數(shù)為1.91 (IQR 1.76-1.96);在單糖尿病組中,中位數(shù)為1.56 (IQR 1.52-1.61);在冠心病+糖尿病組中,中位數(shù)為1.38 (IQR 1.31-1.42)。無冠心病及糖尿病組與單冠心病組相比,無明顯統(tǒng)計學(xué)差異(P0.05);而明顯高于糖尿病及糖尿病+冠心病組(P0.01)。糖尿病組亦高于糖尿病+冠心病組(P0.01)。ROC曲線提示RHI對冠心病診斷價值不大。經(jīng)過中位時間為21.6個月的隨訪,發(fā)現(xiàn)發(fā)生心血管事件人群中,年齡、糖尿病、冠心病患病率、BMI、糖化血紅蛋白、甘油三酯、高密度脂蛋白膽固醇、尿酸、NT-proBNP、eGFR、β受體阻滯劑、ACEI或ARB應(yīng)用率與未發(fā)生心血管事件人群顯著不同(P0.05)。發(fā)生心血管事件的人群RHI較未發(fā)生心血管事件人群更低(P0.001)。采用Cox 比例風(fēng)險模型分析,校正年齡、BMI、糖尿病、冠心病等因素后,心血管事件發(fā)生僅與年齡、RHI、NT-proBNP、eGFR相關(guān)(年齡:HR 1.021 95%CI 1.075-1.154, NT-proBNP: HR 1.089 95%CI 1.034-1.161,RHI: HR 0.722 95%CI 0.691-0.844,eGFR: HR 0.958 95%CI 0.858-0.984)。將RHI聯(lián)合NT-proBNP和(或eGFR)后,對心血管事件的預(yù)測價值進(jìn)一步增加(單獨 NT-proBNP C-Statistics=0.592 ( 95%CI 0.524-0.662 ),聯(lián)合 RHI 后C-Statistics=0.714 ( 95%CI 0.657-0.765 ) , NT-proBNP+eGFR+RHI 后C-Statistics=0.737 (95%CI0.678-0.791 。且對糖尿病和(或)冠心病人群的預(yù)測價值更大。結(jié)論:在老年人群中,多種因素可影響血管內(nèi)皮功能。且血管內(nèi)皮功能對近期心血管事件具有預(yù)測價值,聯(lián)合NT-proBNP和(或eGFR)后,這種預(yù)測價值進(jìn)一步提高。
[Abstract]:Background: vascular endothelium is the largest endocrine organ in the human body and has important physiological and pathophysiological functions. The damage of endothelial function plays an important role in the process and final outcome of cardiovascular disease. Several previous studies have confirmed that the factors affecting vascular endothelial function are related to the risk factors of cardiovascular disease, the main package Including age, body mass index, sex, blood lipid, diabetes, coronary heart disease, hypertension, and so on. It is clear that vascular endothelial dysfunction may lead to an increase in long-term cardiovascular events. But for older groups, there are other factors that may affect vascular endothelial function and the predictive value of intravascular skin function on cardiovascular events in elderly people. This study is not very clear about the predictive value of relative recent cardiovascular events. This study intends to explore the influential factors of vascular endothelial function - the vascular reactive hyperemia index (RHI) in the elderly population, as well as its single pretest value for the recent (less than 2 years) cardiovascular events and the predictive value of the composite heart and kidney function index. Value. Methods: This study was prospective, cohort study. The subjects were 1686 general and hospitalized elderly patients in the General Hospital of the PLA. Except for the cases of cancer, infection, long stay in bed, mechanical ventilation, and the inconsistency of blood pressure in the double upper arm. Between February 2015 and July, the examination of vascular endothelial function and other diseases including age and disease were completed. History, height, weight, blood pressure, heart rate, blood test index and other results. The subjects were determined to affect the intravascular function according to the RHI four subdivision and the grouping of coronary heart disease and diabetes. The subjects were followed up to February 2017, according to the median of the RHI, NT-proBNP, and eGFR indexes. A Cox proportional hazard model was used to evaluate the predictive value of RHI to the recent cardiovascular events. On the basis of RHI, NT-proBNP and eGFR were added to evaluate the predictive value of this composite index on the occurrence of recent cardiovascular events. Results: 1686 subjects (average age 75.3 +. At the age of 10, 1309 people were diagnosed with dyslipidemia, 776 people with hypertension, 592 diabetes, 542 patients with coronary heart disease and 69 chronic renal insufficiency. The subjects were divided into four groups according to RHI four. The results showed that the group with high RHI was younger, less smoking ratio, lower proportion of hypertension, lower proportion of hypertension, lower diabetes ratio, and lower BMI, Lower systolic blood pressure, lower fasting blood sugar, lower glycated hemoglobin, lower total cholesterol, higher density lipoprotein cholesterol, lower creatinine, lower NT-proBNP, and higher eGFR (P for all 0.01). By single factor analysis, In-RHI (natural logarithmic conversion RHI) and age, smoking, hypertension, BMI, diastolic blood pressure, fasting blood glucose, and full blood glucose blood red Protein, cholesterol, low density lipoprotein cholesterol, creatinine, NT-proBNP were negatively correlated (P for all 0.05); positive correlation with eGFR (P0.001). Multivariate linear regression analysis showed that In-RHI was negatively correlated with age, smoking, BMI, glycosylated hemoglobin, low density lipoprotein cholesterol, and NT-proBNP (P for all 0.05); positive correlation with In-RHI. The median of RHI in the group without coronary heart disease and diabetes was 2.05 (IQR 1.82-2.28), and the median was 1.91 (IQR 1.76-1.96) in the mono coronary heart disease group, and the median was 1.56 (IQR 1.52-1.61) in the single diabetic group, and the median of 1.38 (IQR 1.31-1.42) in the group of coronary heart disease and diabetes was 1.38 (IQR 1.31-1.42). There was no significant difference in coronary heart disease and diabetes group compared with single coronary heart disease group (P0.05), but significantly higher than diabetes and diabetes + coronary heart disease group (P0.01). The diabetes group was also higher than the diabetes + coronary heart disease group (P0.01).ROC curve suggesting that RHI was of little value in the diagnosis of coronary heart disease. After a median time of 21.6 months, the heart blood was found. Age, diabetes, coronary heart disease, BMI, glycated hemoglobin, triglycerides, high density lipoprotein cholesterol, uric acid, NT-proBNP, eGFR, beta blockers, ACEI, or ARB were significantly different from those without cardiovascular events (P0.05). The population of cardiovascular events was more RHI than no cardiovascular event population. Lower (P0.001). Using the Cox proportional hazard model analysis, correction of age, BMI, diabetes, coronary heart disease and other factors, cardiovascular events were associated with age, RHI, NT-proBNP, eGFR (age: HR 1.021 95%CI 1.075-1.154, NT-proBNP: HR 1.089 95%CI). The predictive value of RHI combined with NT-proBNP and (or eGFR) for cardiovascular events was further increased (separate NT-proBNP C-Statistics=0.592 (95%CI 0.524-0.662), C-Statistics=0.714 (95%CI 0.657-0.765) after combined RHI, and 0.737 (and for diabetes and / or coronary heart disease) after NT-proBNP+eGFR+RHI. The predictive value is greater. Conclusion: in the elderly, a variety of factors can affect vascular endothelial function. And vascular endothelial function is of predictive value for recent cardiovascular events. This predictive value is further improved after combined with NT-proBNP and (or eGFR).
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R54

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 陳偉偉;高潤霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;鄭哲;蔣立新;胡盛壽;;《中國心血管病報告2014》概要[J];中國循環(huán)雜志;2015年07期

2 劉力生;;中國高血壓防治指南2010[J];中華高血壓雜志;2011年08期

，

本文編號：2064897