本文選題：冠心病 + 急性心肌梗死�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本課題通過檢測(cè)血清親環(huán)素A(CyPA)在不同程度冠脈病變患者中濃度的變化,并進(jìn)一步探討急性心肌梗死患者CyPA濃度與血清B型鈉尿肽前體(pro-BNP)水平、左心室大小、射血分?jǐn)?shù)的關(guān)系,探討血清親環(huán)素A濃度在不同冠脈病變程度尤其是急性心肌梗死患者中變化的意義及其對(duì)預(yù)后評(píng)估的價(jià)值。方法:1.入組2016年01月01日-2016年09月01日在我科行冠脈造影或急診冠脈造影的急性前壁心肌梗死患者60例作為研究對(duì)象,并選取同期因心絞痛住院的穩(wěn)定型心絞痛組患者30例作為試驗(yàn)對(duì)照組,選取疑似冠心病但行造影檢查冠脈光滑無病變的患者為正常對(duì)照組30例作為正常對(duì)照組,使用ELISA方法測(cè)定所有入選對(duì)象的血清CyPA水平(CyPA),分析親環(huán)素A在各組間的水平差異,使用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì),P0.01差異有統(tǒng)計(jì)學(xué)意義。2.對(duì)急性心肌梗死組患者進(jìn)一步分析,所有入選的急性心肌梗死患者均為急性前壁心肌梗死,均在發(fā)病后12小時(shí)內(nèi)常規(guī)服用負(fù)荷量雙聯(lián)抗血小板聚集藥物,且行冠脈造影明確并成功開通罪犯血管,對(duì)冠脈行Gensini積分,并測(cè)定其入院后24小時(shí)、10天血漿pro-BNP,入院后1月及3月常規(guī)行超聲心動(dòng)圖檢查,記錄左室前后徑大小(LV)、左室射血分?jǐn)?shù)(LVEF),分析CYPA與上述因子的相關(guān)性。結(jié)果:1.血清CyPA濃度在急性心肌梗死組患者中最高,其次穩(wěn)定型心絞痛組高于冠脈正常組,冠脈正常組血清CyPA濃度最低(P0.01);2..急性前壁心肌梗死組患者CyPA濃度與Gensini積分具有很好的線性相關(guān)性(r:0.661,p0.001),與10天時(shí)的pro-BNP具有相好相關(guān)性(r:0.792,p0.001),但與24小時(shí)內(nèi)pro-BNP無線性相關(guān);與發(fā)病后1月、3月的LV具有良好的相關(guān)性(1月r:0.906,P0.001,3月r:0.839 P0.001),與發(fā)病后的動(dòng)態(tài)超聲心電圖的1月、3月的LVEF呈負(fù)的直線相關(guān)(1月r:-0.877,P0.001,3月r:-0.792,P0.001)。結(jié)論:1.冠心病患者血清CyPA水平高于對(duì)照組,表明血清CyPA一定程度上可反應(yīng)患者冠脈病變程度;2.血清CyPA在急性心肌梗死患者中明顯高于穩(wěn)定型心絞痛患者的血清CyPA,提示在冠脈不穩(wěn)定斑塊形成過程中,親環(huán)素A發(fā)揮著一定作用3.在急性心肌梗死患者中可以看到血清CyPA水平與AMI患者心功能變化及近期左心室重構(gòu)有關(guān),對(duì)急性心肌梗死而言,CyPA水平可能是其不良預(yù)后的獨(dú)立危險(xiǎn)因素,有助于臨床AMI危險(xiǎn)分層。
[Abstract]:Objective: to investigate the changes of serum cyclophile A (CyPA) concentration in patients with different degrees of coronary artery disease, and to investigate the levels of CyPA and pro-BNP in patients with acute myocardial infarction (AMI), as well as the size of left ventricle. To explore the significance of the changes of serum cyclophile A concentration in patients with different coronary lesions, especially in patients with acute myocardial infarction (AMI), and its value in evaluating the prognosis of patients with acute myocardial infarction (AMI). Method 1: 1. From January 01, 2016 to September 01, 2016, 60 patients with acute anterior myocardial infarction underwent coronary angiography or emergency coronary angiography in our department. 30 patients with stable angina pectoris who were hospitalized with angina pectoris in the same period were selected as the control group, and 30 patients with suspected coronary heart disease who underwent angiographic examination of smooth coronary artery disease were selected as the normal control group. The serum CyPA level of all the subjects was measured by Elisa, and the level of cyclophile A was analyzed. SPSS 19.0 statistical software was used to analyze the difference between the two groups (P0.01). Further analysis of patients with acute myocardial infarction showed that all patients with acute myocardial infarction were acute anterior wall myocardial infarction and were routinely treated with dual antiplatelet drugs within 12 hours after onset of acute myocardial infarction. The Gensini score of coronary artery was determined and the plasma pro-BNPs were measured 24 hours and 10 days after admission. Echocardiography was performed 1 month and 3 months after admission. Left ventricular anteroposterior diameter (LV) and left ventricular ejection fraction (LVEF) were recorded and the correlation between CYPA and these factors was analyzed. The result is 1: 1. Serum CyPA concentration was the highest in acute myocardial infarction group, followed by stable angina pectoris group higher than coronary normal group, the lowest serum CyPA concentration (P0.01) was found in normal coronary artery group (P0.01). There was a good linear correlation between CyPA concentration and Gensini score (r: 0.661p0.001) and pro-BNP at 10 days (r: 0.792p0.001), but it was correlated with the wireless property of pro-BNP within 24 hours. There was a good correlation between LV in 1 month and LV in 3 months (r: 0.906, P 0.001, r: 0.839, P 0.001). There was a negative linear correlation between LVEF and LVEF in 1 month and 3 months after onset (r: -0.877n, P 0.001, r: -0.792P0.001, respectively). Conclusion 1. The level of serum CyPA in patients with coronary heart disease was higher than that in control group, which indicated that serum CyPA could reflect the degree of coronary artery disease in patients to some extent. Serum CyPA was significantly higher in patients with acute myocardial infarction than in patients with stable angina pectoris, suggesting that cyclin A plays a role in the formation of unstable plaque in coronary artery. In patients with acute myocardial infarction, it can be seen that the level of serum CyPA is related to the changes of cardiac function and left ventricular remodeling in patients with AMI. For acute myocardial infarction, the level of CyPA may be an independent risk factor for poor prognosis. It is helpful for clinical AMI risk stratification.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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