紅細(xì)胞體積分布寬度與急性冠脈綜合征患者冠脈病變程度的相關(guān)研究
發(fā)布時(shí)間：2018-08-04 12:54
【摘要】：目的:紅細(xì)胞體積分布寬度(RDW)是血常規(guī)檢測(cè)中常規(guī)的一部分,反映循環(huán)紅細(xì)胞大小不均勻的信息,高RDW值反映紅細(xì)胞(RBC)的體積變化較大。此參數(shù)已被證明是預(yù)測(cè)各種心血管疾病,如心力衰竭、穩(wěn)定的冠狀動(dòng)脈疾病和急性心肌梗死(AMI)的發(fā)病率和死亡率的相關(guān)指標(biāo)。本研究回顧性數(shù)據(jù)分析RDW在急性冠脈綜合征(ACS)患者中的變化及與冠狀動(dòng)脈粥樣硬化嚴(yán)重程度之間的相關(guān)性,同時(shí)分析ACS的獨(dú)立危險(xiǎn)因素,RDW與白細(xì)胞分類計(jì)數(shù)(WBC)之間的相關(guān)性,為RDW與ACS之間的相關(guān)性提供一個(gè)可能的發(fā)生機(jī)制。方法:回顧式隨機(jī)選取2015年10月-2016年10月在陜西省人民醫(yī)院心血管內(nèi)科因“胸痛”就診住院并行冠脈造影檢查的216例患者。1.依據(jù)冠脈造影診斷、血清心肌酶學(xué)改變及病史分為ACS組患者163例;正常對(duì)照組53例,比較2組資料一般臨床指標(biāo)有無(wú)差異。2.ACS組依據(jù)臨床類型不同分為:不穩(wěn)定型心絞痛(UA)73例,非ST段抬高性心肌梗死(NSTEAMI)24例,ST段抬高型心肌梗死(STEAMI)66例。按照冠脈血管病變支數(shù)將ACS組分為單支血管病變組、雙支血管病變組及多支血管病變組。依據(jù)冠脈造影術(shù)結(jié)果:病變累積血管的部位、血管病變支數(shù)、血管狹窄及彌漫程度行Gensini評(píng)分。探討RDW、WBC和Gensini積分之間是否存在線性相關(guān)關(guān)系;以ACS發(fā)生與否作為因變量,進(jìn)行二元logistic回歸分析ACS發(fā)生的危險(xiǎn)因素。結(jié)果:1.一般臨床資料比較:(1)ACS組在吸煙、高血壓病史、糖尿病病史、血肌酐中與對(duì)照組相比明顯升高,ACS組男性多于對(duì)照組,P0.05;(2)在依據(jù)血管病變支數(shù)分三亞組間比較采用方差分析,在甘油三酯(TG)、總膽固醇(TC)、低密度脂蛋白(LDL-C)等差異具有顯著統(tǒng)計(jì)學(xué)意義。2.ACS組較對(duì)照組RDW水平明顯升高(P0.01)。3.在不同血管病變支數(shù)的亞組中RDW隨著血管病變支數(shù)的增加而升高。4.不同臨床分型的三亞組及對(duì)照組RDW水平的比較,結(jié)果顯示:UA組、NSTEAMI組、STEAMI組三組分別與對(duì)照組比較,RDW值明顯升高,差異均有顯著性意義,P0.01。STEAMI組分別與UA組比較,差異有顯著性意義,P=0.006。UA組和STEAMI組分別于NSTEAMI組RDW均值比較,差異無(wú)顯著性意義。5.Gensini積分與RDW和WBC之間的相關(guān)性分析,結(jié)果顯示RDW及WBC與Gensini積分呈顯著正相關(guān),相關(guān)系數(shù)分別為(r=0.501,P0.001)和(r=0.379,P0.001);RDW與WBC也呈正相關(guān),相關(guān)系數(shù)(r=0.361,P0.001)。6.ACS發(fā)生的危險(xiǎn)因素的多元logistic回歸分析結(jié)果顯示:RDW、性別為ACS的獨(dú)立危險(xiǎn)因素,高密度脂蛋白膽固醇(HDL-C)為其保護(hù)性因素。結(jié)論:1、RDW水平在ACS組明顯高于對(duì)照組。2、RDW值升高與冠脈病變嚴(yán)重程度(Gensini積分)呈正相關(guān),表明RDW增高可反映冠狀動(dòng)脈病變的病變嚴(yán)重程度。3、logistic回歸分析在控制了其他影響因素外,RDW升高為ACS的獨(dú)立預(yù)測(cè)因子,HDL-C升高為其獨(dú)立保護(hù)性因素。4、RDW升高與WBC呈顯著正相關(guān)性,表明RDW增高可能與機(jī)體的慢性炎反應(yīng)有關(guān)。
[Abstract]:Objective: erythrocyte volume distribution width (RDW) is a routine part of routine blood routine examination, which reflects the information of the uneven size of circulating red blood cells. The high RDW value reflects the volume change of erythrocyte (RBC). This parameter has been proved to be a predictor of morbidity and mortality of various cardiovascular diseases, such as heart failure, stable coronary artery disease and acute myocardial infarction (AMI). In this study, we retrospectively analyzed the changes of RDW in patients with acute coronary syndrome (ACS) and its correlation with the severity of coronary atherosclerosis, and analyzed the correlation between the independent risk factor of ACS and the leukocyte classification count (WBC). It provides a possible mechanism for the correlation between RDW and ACS. Methods: 216 patients with chest pain and coronary angiography were randomly selected from October 2015 to October 2016 in the Department of Cardiovascular Medicine of Shaanxi Provincial people's Hospital. According to the diagnosis of coronary angiography, the changes of serum myocardial enzymes and history were divided into three groups: ACS group (n = 163) and normal control group (n = 53). 2. According to clinical type, 73 patients with unstable angina pectoris (UA) were divided into two groups: unstable angina pectoris (UA). 24 patients with non-St segment elevation myocardial infarction (NSTEAMI) and 66 patients with St segment elevation myocardial infarction (STEAMI). According to the number of coronary artery lesion branches, the ACS group was divided into single vessel lesion group, double vessel disease group and multi vessel disease group. According to the results of coronary angiography, Gensini score was performed on the location, number of branches, stenosis and diffuse degree of the lesion. To explore whether there is a linear correlation between ACS and Gensini integral, and to analyze the risk factors of ACS by binary logistic regression analysis with ACS as dependent variable. The result is 1: 1. Comparison of general clinical data: (1) smoking, history of hypertension, history of diabetes, and serum creatinine in ACS group were significantly higher than those in control group (P 0.05); (2) ANOVA was used to compare the three subgroups according to the number of branches of vascular lesions. There was significant difference in triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C). 2. The RDW level in ACS group was significantly higher than that in control group (P0.01). In the subgroups with different branches of vascular lesions, RDW increased with the increase of the number of branches. 4. 4. The results showed that the levels of RDW in the three groups were significantly higher than those in the control group (P 0.01) and that in the control group was significantly higher than that in the UA group. There was no significant difference in the mean value of RDW between NSTEAMI group and STEAMI group. 5. There was no significant correlation between Gensini integral and RDW and WBC. The results showed that RDW, WBC and Gensini score were positively correlated. The correlation coefficients were (r = 0.501) and (r ~ (0.379) P ~ (0.001) respectively. The correlation coefficient (r = 0.361) was also positively correlated with WBC. 6. The multiple logistic regression analysis of the risk factors of ACS showed that the sex was the independent risk factor for ACS, and the high density lipoprotein cholesterol (HDL-C) was the protective factor. 6. The results of multiple logistic regression analysis showed that RDW was an independent risk factor for ACS, and high density lipoprotein cholesterol (HDL-C) was the protective factor. Conclusion the level of RDW in ACS group is significantly higher than that in control group. The increase of RDW is positively correlated with the severity of coronary artery disease (Gensini score). The results showed that the increase of RDW could reflect the severity of coronary artery disease. 3 logistic regression analysis showed that the increase of HDL-C was significantly correlated with the increase of WBC, which was the independent predictor of the increase of RDW to the level of ACS, and the increase of RDW was significantly correlated with WBC. It is suggested that the increase of RDW may be related to the chronic inflammation reaction of the body.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
本文編號(hào)：2163945
[Abstract]:Objective: erythrocyte volume distribution width (RDW) is a routine part of routine blood routine examination, which reflects the information of the uneven size of circulating red blood cells. The high RDW value reflects the volume change of erythrocyte (RBC). This parameter has been proved to be a predictor of morbidity and mortality of various cardiovascular diseases, such as heart failure, stable coronary artery disease and acute myocardial infarction (AMI). In this study, we retrospectively analyzed the changes of RDW in patients with acute coronary syndrome (ACS) and its correlation with the severity of coronary atherosclerosis, and analyzed the correlation between the independent risk factor of ACS and the leukocyte classification count (WBC). It provides a possible mechanism for the correlation between RDW and ACS. Methods: 216 patients with chest pain and coronary angiography were randomly selected from October 2015 to October 2016 in the Department of Cardiovascular Medicine of Shaanxi Provincial people's Hospital. According to the diagnosis of coronary angiography, the changes of serum myocardial enzymes and history were divided into three groups: ACS group (n = 163) and normal control group (n = 53). 2. According to clinical type, 73 patients with unstable angina pectoris (UA) were divided into two groups: unstable angina pectoris (UA). 24 patients with non-St segment elevation myocardial infarction (NSTEAMI) and 66 patients with St segment elevation myocardial infarction (STEAMI). According to the number of coronary artery lesion branches, the ACS group was divided into single vessel lesion group, double vessel disease group and multi vessel disease group. According to the results of coronary angiography, Gensini score was performed on the location, number of branches, stenosis and diffuse degree of the lesion. To explore whether there is a linear correlation between ACS and Gensini integral, and to analyze the risk factors of ACS by binary logistic regression analysis with ACS as dependent variable. The result is 1: 1. Comparison of general clinical data: (1) smoking, history of hypertension, history of diabetes, and serum creatinine in ACS group were significantly higher than those in control group (P 0.05); (2) ANOVA was used to compare the three subgroups according to the number of branches of vascular lesions. There was significant difference in triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C). 2. The RDW level in ACS group was significantly higher than that in control group (P0.01). In the subgroups with different branches of vascular lesions, RDW increased with the increase of the number of branches. 4. 4. The results showed that the levels of RDW in the three groups were significantly higher than those in the control group (P 0.01) and that in the control group was significantly higher than that in the UA group. There was no significant difference in the mean value of RDW between NSTEAMI group and STEAMI group. 5. There was no significant correlation between Gensini integral and RDW and WBC. The results showed that RDW, WBC and Gensini score were positively correlated. The correlation coefficients were (r = 0.501) and (r ~ (0.379) P ~ (0.001) respectively. The correlation coefficient (r = 0.361) was also positively correlated with WBC. 6. The multiple logistic regression analysis of the risk factors of ACS showed that the sex was the independent risk factor for ACS, and the high density lipoprotein cholesterol (HDL-C) was the protective factor. 6. The results of multiple logistic regression analysis showed that RDW was an independent risk factor for ACS, and high density lipoprotein cholesterol (HDL-C) was the protective factor. Conclusion the level of RDW in ACS group is significantly higher than that in control group. The increase of RDW is positively correlated with the severity of coronary artery disease (Gensini score). The results showed that the increase of RDW could reflect the severity of coronary artery disease. 3 logistic regression analysis showed that the increase of HDL-C was significantly correlated with the increase of WBC, which was the independent predictor of the increase of RDW to the level of ACS, and the increase of RDW was significantly correlated with WBC. It is suggested that the increase of RDW may be related to the chronic inflammation reaction of the body.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
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