【摘要】：背景改革開放近幾十年來我國經(jīng)濟建設(shè)取得了舉世矚目的成就,廣大人民群眾的物質(zhì)文化生活水平得到了極大的提高,青少年及中老年人的飲食與生活教之以前也發(fā)生了巨大變化,高脂、高糖及高蛋白的飲食和鍛煉的缺乏,工作和社會壓力的增加使得我國居民的心血管疾病的發(fā)病率逐年攀升。我國已慢慢步入老年化國家行列,老年心血管疾病患病率遠高于青年人且病情重、合并癥多、死亡率高,是我國目前所面臨的嚴重的社會和公共衛(wèi)生問題。冠心病是心血管疾病的主要疾病之一,也是引起心臟性猝死(SCD)的主要原因,嚴重影響患者的工作和生活,增加患者的精神和經(jīng)濟負擔。尿酸與冠心病的關(guān)系一直是多年來的研究熱點,其水平的增高不但與痛風的患病關(guān)系密切,而且隨著臨床與基礎(chǔ)研究的不斷深入發(fā)現(xiàn),尿酸還與冠心病的患病密切相關(guān)。研究發(fā)現(xiàn)尿酸既可通過對冠心病的傳統(tǒng)危險因素的影響又可通過對冠狀動脈的直接作用影響冠心病的發(fā)生和發(fā)展。目前國內(nèi)外的研究多集中于尿酸對于冠狀動脈總體病變程度的影響,但關(guān)于老年冠心病患者血清尿酸水平對于左主干、前降支、右冠狀動脈、回旋支是否具有不同的影響的研究較少引起廣大醫(yī)務(wù)工作者的重視。本研究擬通過對老年冠心病患者的血清尿酸水平對冠狀動脈狹窄程度的影響,探討尿酸對冠狀動脈不同分支狹窄程度的影響,為心血管病的預(yù)防與治療提供一定的臨床依據(jù)。目的探討老年冠心病患者尿酸對冠狀動脈狹窄程度的影響。方法選擇老年冠心病患者137例,根據(jù)尿酸水平將所有對象分位第1分位組(141-279mmol/L)34例、第2分位組(279.5-418mmol/L)35例、第3分位組(418.5-557mmol/L)34例、第4分位組(557.5-692mmol/L)34例。所有受試者均行冠狀動脈造影,采用Gensini積分系統(tǒng)評價狹窄程度。結(jié)果4分位組冠狀動脈總體及右冠狀動脈Gensini積分顯著高于1分位組[(60.15±8.78)分vs(53.73±6.04)分,(12.03±3.12)分vs(6.44±1.52)分,P0.05]。4分位組左回旋支Gensini積分顯著高于3分位組及2分位組[(14.32±3.70)分vs(10.97±4.13)分,(10.60±3.18)]分,P0.05。3分位組左回旋支Gensini積分明顯低于1分位組[(10.97±4.13)分vs(15.58±3.85)分,P0.05]。3分位組右冠狀動脈Gensini積分明顯高于1分位組[(12.00±2.35)分vs(6.44±1.52)分,P0.05]。3分位組右冠狀動脈Gensini積分高于2分位組[(12.00±2.35)分vs(10.20±2.91)分,P0.05]。2分位組右冠狀動脈Gensini積分明顯高于1分位組(P0.05)。2分位組左回旋支Gensini積分明顯低于1分位組[(10.60±3.18)分vs(15.58±3.85)分,P0.05]。血清尿酸水平與右冠狀動脈Gensini積分相關(guān)系數(shù)為0.385、與冠狀動脈總體病變Gensini積分相關(guān)系數(shù)為0.305,均呈顯著正相關(guān),P均0.05;尿酸與高密度脂蛋白膽固醇水平呈負相關(guān),相關(guān)系數(shù)為-0.196,P0.05;尿酸與收縮壓、舒張壓、甘油三脂及空腹血糖水平呈正相關(guān),相關(guān)系數(shù)分別為0.157、0.155、0.189及0.267,P均0.05。多元線性回歸分析結(jié)果顯示,尿酸為右冠狀動脈和冠狀動脈總體病變的獨立危險因素。結(jié)論右冠狀動脈病變Gensini積分、回旋支病變Gensini積分、冠狀動脈總體病變Gensini積分與老年冠心病患者血清尿酸水平密切相關(guān)。
[Abstract]:Background China's economic construction has made remarkable achievements in recent decades of reform and opening up. The material and cultural living standards of the broad masses of the people have been greatly improved. Great changes have taken place in the diet and life education of young people and middle-aged and old people before, including the lack of diet and exercise with high fat, sugar and protein, work and society. The incidence of cardiovascular disease in the elderly is much higher than that in the young. The incidence of cardiovascular disease in the elderly is much higher than that in the young. There are many complications and high mortality. It is a serious social and public health problem in China. Sudden cardiac death (SCD) is one of the main causes of heart disease, which seriously affects the work and life of patients and increases their mental and economic burden. It has been found that uric acid can influence the occurrence and development of coronary heart disease through both the influence of traditional risk factors and the direct effect of coronary artery. The study of whether serum uric acid levels have different effects on left main coronary artery, anterior descending coronary artery, right coronary artery and circumflex coronary artery in elderly patients with coronary heart disease has received less attention from medical workers. Objective To investigate the effect of uric acid on the severity of coronary artery stenosis in elderly patients with coronary heart disease.Methods 137 elderly patients with coronary heart disease were selected and divided into the first group (141-279 mmol/L) and the second group (34 cases) according to the level of uric acid. Group A (279.5-418 mmol/L), Grade 3 (418.5-557 mmol/L), Grade 4 (557.5-692 mmol/L) and Grade 3 (34). All subjects underwent coronary angiography, and the degree of stenosis was assessed by Gensini score system. Results The total coronary artery score and the Gensini score of right coronary artery in Grade 4 group were significantly higher than that in Grade 1 group [(60.15+8.78) vs (53.73+6.0). 4) score, (12.03 + 3.12) vs (6.44 + 1.52), P 0.05].Gensini score of left circumflex branch in 4-position group was significantly higher than that of 3-position group and 2-position group [(14.32 + 3.70) vs (10.97 + 4.13), (10.60 + 3.18)] score, P 0.05.3-position group was significantly lower than that of 1-position group [(10.97 + 4.13) vs (15.58 + 3.85), P 0.05]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (6.44 (+ 1.52), P 0.05)]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (10.20 (+ 2.91), P 0.05)]. Gensini score of the right coronary artery in the two-position group was significantly higher than that in the one-position group (P 0.05). Gensini score of the left circumflex branch in the two-position group The correlation coefficient between serum uric acid and Gensini integral of right coronary artery was 0.385, and that between serum uric acid and total coronary artery lesion was 0.305 (P 0.05). Uric acid was negatively correlated with high density lipoprotein cholesterol (P 0.196, P 0.05). The correlation coefficients were 0.157, 0.155, 0.189 and 0.267, respectively, P were 0.05. Multivariate linear regression analysis showed that uric acid was an independent risk factor for right coronary artery and coronary artery lesions. The integral Gensini score of coronary artery disease is closely related to serum uric acid level in elderly patients with coronary heart disease.
【學位授予單位】：濟南大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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相關(guān)期刊論文 前5條

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