【摘要】：目的:(1)研究影響患者血漿脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)水平的臨床因素,證實(shí)Lp-PLA2與冠心病(CHD)的相關(guān)關(guān)系,探討其在行經(jīng)皮介入治療(PCI)的CHD患者近期預(yù)后中的價(jià)值。(2)研究不同類型心房顫動(dòng)(AF)患者Lp-PLA2水平,及其與Lp-PLA2之間的關(guān)系,探討Lp-PLA2在房顫中的作用機(jī)制。方法:(1)入選懷疑CHD患者662例,對入選患者行冠狀動(dòng)脈造影(CAG)檢查,依造影結(jié)果將患者分為冠心病組(n=460)、非冠心病組(n=202)。分別以是否接受PCI治療以及PCI治療患者中是否有MACE發(fā)生為標(biāo)準(zhǔn)分出亞組,即PCI治療組和非PCI治療組,MACE組和非MACE組。檢測各組患者血液生化指標(biāo)及心臟超聲結(jié)果,記錄患者基本臨床資料及隨訪期間內(nèi)有無MACE發(fā)生,對各變量與CHD、PCI治療及PCI治療后MACE的關(guān)系作logistic回歸分析。(2)將入選的122例AF患者分為陣發(fā)性房顫組(A,n=38),持續(xù)性房顫組(B,n=40),永久性房顫組(C,n=44),隨機(jī)選取41例竇性心律患者為對照組(D),記錄患者臨床資料及檢測指標(biāo)。結(jié)果:(1)Lp-PLA2水平于CHD患者中明顯高于非CHD患者,在PCI治療組高于非PCI治療組,用Lp-PLA2診斷CHD的最佳值為231.85ng/ml。(2)回歸分析發(fā)現(xiàn)①Lp-PLA2是CHD患病以及CHD患者需要接受PCI治療的危險(xiǎn)因素(OR 1.066,95%CI1.051-1.082,OR 1.008,95%CI1.000-1.015);②Lp-PLA2(OR 1.003,95%CI1.017-1.048)、射血分?jǐn)?shù)(OR 1.864,95%CI0.751-1.995)、剩余Gensini積分(OR 1.079,95%CI1.062-1.097)及冠心病類型(OR 3.949,95%CI1.126-13.857)是接受PCI治療的CHD患者近期MACE的危險(xiǎn)因素。(3)Lp-PLA2與LDL-C(r=0.316)、剩余Gensini積分(r=0.357)、病變血管支數(shù)(r=0.714)、hs-CRP(r=0.488)、動(dòng)脈粥樣硬化指數(shù)(r=0.261)、血糖濃度(r=0.192)及纖維蛋白原(r=0.268)呈正相關(guān);與HDL-C(r=-0.250)、CO2CP(r=-0.134)、WBC(r=-0.219)呈負(fù)相關(guān)。(4)Lp-PLA2與hs-CRP水平在持續(xù)性房顫組及永久性房顫組明顯高于陣發(fā)性房顫組及對照組(p0.05)。LAD在永久性房顫組及持續(xù)性房顫組大于陣發(fā)性房顫組和對照組(p0.05)。(5)陣發(fā)房顫組中hs-CRP與LAD成正相關(guān),持續(xù)性房顫組及永久性房顫組中Lp-PLA2、hs-CRP與LAD均呈正相關(guān)。結(jié)論:①Lp-PLA2水平于CHD患者中明顯高于非CHD患者,PCI治療組高于非PCI治療組,PCI術(shù)后有MACE發(fā)生者高于無MACE者;②檢測Lp-PLA2水平對擬診CHD患者的診斷和PCI術(shù)后患者近期預(yù)后有重要預(yù)測價(jià)值;③Lp-PLA2水平與LDL-C hs-CRP、動(dòng)脈粥樣硬化指數(shù)、血糖、纖維蛋白原呈正相關(guān),與HDL-C、CO2CP、WBC呈負(fù)相關(guān)。
[Abstract]:Objective: (1) to study the clinical factors influencing plasma lipoprotein associated phospholipase A 2 (Lp-PLA2) and to confirm the relationship between Lp-PLA2 and coronary heart disease (CHD). To investigate the value of Lp-PLA2 in the short-term prognosis of CHD patients undergoing percutaneous intervention (PCI). (2) to study the level of Lp-PLA2 in patients with different types of atrial fibrillation (AF) and its relationship with Lp-PLA2, and to explore the mechanism of Lp-PLA2 in atrial fibrillation. Methods: (1) 662 patients with suspected CHD were examined by coronary angiography (CAG). The patients were divided into coronary heart disease group (n = 460) and non-coronary heart disease group (n = 202). The patients were divided into two subgroups according to whether or not they received PCI and whether there was Mace in PCI patients, that is, PCI treatment group and non-PCI treatment group, Mace group and non-MACE group. The blood biochemical indexes and the results of echocardiography were detected, and the basic clinical data of the patients and whether Mace occurred during the follow-up period were recorded. Logistic regression analysis was used to analyze the relationship between variables and Mace after PCI. (2) one hundred and twenty-two patients with AF were divided into three groups: paroxysmal atrial fibrillation group (An 38), persistent atrial fibrillation group (n = 40) and permanent atrial fibrillation group (C n = 44). 41 patients with sinus rhythm were randomly selected as control group. In group D, the clinical data and detection indexes were recorded. Results: (1) the level of Lp-PLA2 in CHD patients was significantly higher than that in non-CHD patients, and was higher in PCI group than in non-PCI group. The best value of Lp-PLA2 in the diagnosis of CHD was 231.85 ng / ml. (2) the regression analysis found that 1Lp-PLA2 was the risk factor for CHD and for patients with CHD requiring PCI (OR 1.066 / 95CI1.051-1.082OR 1.008 / 95CI1.000-1.015), 2Lp-PLA2 (OR 1.003t95CI1.017-1.048), ejection fraction (OR 1.86495 CI0.751-1.995), the remaining Gensini score (OR 1.0799595CI1.062-1.097) and the type of coronary heart disease (OR 3.99495 CI1.126-13.857) were accepted as well as the remaining Gensini score (OR 1.07995 95 CI 1.062-1.097) and the type of coronary heart disease (OR 3.994 95 CI 1.126-13.857). (3) Lp-PLA2 was positively correlated with LDL-C (r-0.316), residual Gensini score (r-0.357), the number of diseased vessels (r-0.714), hs-CRP (r-0.488), atherosclerosis index (r-0.261), blood glucose concentration (r0.192) and fibrinogen (r-0.268). (4) the levels of Lp-PLA2 and hs-CRP in persistent atrial fibrillation group and permanent atrial fibrillation group were significantly higher than those in paroxysmal atrial fibrillation group and control group (p0.05). Lad in permanent atrial fibrillation group and persistent atrial fibrillation group was higher than that in paroxysmal atrial fibrillation group and control group (p0.05). (5). There was a positive correlation between hs-CRP and lad in the fibrillation group. There was a positive correlation between Lp-PLA _ 2 hs-CRP and lad in patients with persistent atrial fibrillation and permanent atrial fibrillation. Conclusion the level of% 1Lp-PLA2 in CHD patients was significantly higher than that in non-CHD patients treated with PCI, and the incidence of Mace in non-PCI patients was higher than that in patients without Mace. 2Detection of Lp-PLA2 level has important predictive value in the diagnosis of CHD patients and the short-term prognosis of patients after PCI. The level of Lp-PLA2 is positively correlated with LDL-C hs-CRPP, atherosclerosis index, blood glucose and fibrinogen, and negatively correlated with HDL-CnCO2CPP WBC.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4;R541.75

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