超敏CRP和NSTEMI冠脈病變嚴(yán)重程度及預(yù)后的相關(guān)性研究
發(fā)布時間：2018-10-12 12:26
【摘要】：背景和目的隨著生活質(zhì)量的提升,人們越來越關(guān)注健康,急性冠脈綜合征逐漸變?yōu)槠潢P(guān)注的焦點(diǎn)。急性冠脈綜合征主要包括急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死以及不穩(wěn)定型心絞痛。超敏CRP是一種快速、簡便的生化檢驗(yàn)指標(biāo)。國內(nèi)外對于超敏CRP與急性ST段抬高型心肌梗死以及不穩(wěn)定型心絞痛之間的關(guān)系研究報(bào)道較多,對于超敏CRP與急性非ST抬高型心肌梗死之間的關(guān)系研究報(bào)道較少。急性非ST段抬高型心肌梗死的患者多以中老年為主,病情較為復(fù)雜,影響因素眾多。目前臨床上常用于評價(jià)急性非ST段抬高型心肌梗死的病情及預(yù)后情況的方法有GRACE評分和TIMI評分等,但這些評價(jià)方法步驟繁瑣、涉及冠心病危險(xiǎn)因素較多、耗時較長,而超敏CRP作為一種簡便、快速的生化檢驗(yàn)指標(biāo),具有巨大的優(yōu)勢。本文著重探究急性非ST型抬高型的心肌梗死病人的超敏CRP水平和冠脈病變之間嚴(yán)重程度的關(guān)系,以及探討超敏CRP能否預(yù)測急性非ST心肌梗死患者的預(yù)后。方法從大連醫(yī)科大學(xué)附屬一院二部病例查閱系統(tǒng)和NSTEMI數(shù)據(jù)庫中連續(xù)選取了 2014年01月01日至2015年12月31日住院的急性非ST段抬高型心肌梗死患者共522例,其中行冠脈造影的共287例,而抽血化驗(yàn)超敏CRP并行冠脈造影的共164例,這164例患者作為納入本次研究的對象。記錄所有患者的臨床資料,如性別、年齡、既往史(高血壓、糖尿病、腦血管疾病等)、超敏CRP、血脂、左室射血分?jǐn)?shù)等。然后相關(guān)人員對這些病人進(jìn)行了隨訪,記錄是否發(fā)生MACCE事件及生存時間。MACCE主要包括了全因性死亡、再發(fā)性心肌梗死、再發(fā)性心絞痛、需住院的治療的不穩(wěn)定性心絞痛以及心功能衰竭。隨訪截止日期為2016年12月31日。結(jié)果根據(jù)所有病人的大體情況,依據(jù)hs-CRP水平分為兩組,高h(yuǎn)s-CRP組(大于3.Omg/L)和低hs-CRP組(小于等于3.Omg/L)。其中高h(yuǎn)s-CRP組79例,低hs-CRP組85例。根據(jù)冠脈造影結(jié)果,為了便于量化分析比較冠脈病變嚴(yán)重程度,引入新Gensini評分,將整體冠脈狹窄程度轉(zhuǎn)化為具體直觀數(shù)值。新Gensini評分[3]:對冠狀動脈8個主要節(jié)段進(jìn)行狹窄評分,無異常發(fā)現(xiàn)為0分;狹窄范圍在1%-49%為1分;50%-74%為2分;75%-99%為3分;100%閉塞為4分。結(jié)果發(fā)現(xiàn)高h(yuǎn)s-CRP組和低hs-CRP組比較新Gensini評分有統(tǒng)計(jì)學(xué)意義(p0.05)。另外根據(jù)隨訪患者有無發(fā)生MACCE事件,分為MACCE組和無MACCE組,MACCE組患者31例,無MACCE組129例,失訪4例。未發(fā)生MACCE事件組的患者超敏CRP水平4.08±3.69mg/L明顯低于MACCE事件組的患者6.66± 1.91mg/L。通過單因素和多因素的COX回歸分析表明,超敏CRP是NSTEMI患者未來MACCE事件的獨(dú)立預(yù)測因素[RR=1.126,95%CI(1.052,1.205),P=0.001]。Kaplan-Meier 生存曲線表明隨著超敏 CRP水平的不斷升高,NSTEMI患者的無事件生存率明顯降低(log—rank x2=9.339,P=0.002)。結(jié)論1.超敏CRP水平與NSTEMI患者的冠脈病變嚴(yán)重程度有關(guān),研究證實(shí)CRP濃度越高,提示NSTEMI患者冠脈病變程度越重;2.超敏CRP可以預(yù)測NSTEMI患者的不良預(yù)后,研究證實(shí)CRP濃度越高,提示NSTEMI患者的預(yù)后越差。
[Abstract]:BACKGROUND & OBJECTIVE: With the improvement of quality of life, people pay more and more attention to health, and acute coronary syndrome gradually becomes the focus of its attention. Acute coronary syndromes mainly include acute ST-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction, and unstable angina. Hypersensitive CRP is a fast and simple biochemical test index. The relationship between hypersensitive CRP and acute ST-segment elevation myocardial infarction (AMI) and unstable angina pectoris was more and more reported at home and abroad, and the relationship between hypersensitive CRP and acute non-ST-elevation myocardial infarction was reported less. Patients with acute non-ST-segment elevation myocardial infarction were mostly middle-aged and elderly, with complex condition and many influencing factors. At present, the methods for evaluating the condition and prognosis of acute non-ST-segment elevation myocardial infarction include GRACE score and TIMI score, but these methods are complicated, involving more risk factors of coronary heart disease, longer time consumption, and hypersensitive CRP as a simple and convenient method. The rapid biochemical test index has great advantages. This paper focuses on the relationship between the hypersensitivity CRP level and the severity of acute non-ST elevation myocardial infarction patients, and discusses whether the hypersensitive CRP can predict the prognosis of patients with acute non-ST myocardial infarction. Methods A total of 522 patients with acute non-ST-segment elevation myocardial infarction hospitalized from Jan. 01, 2014 to December 31, 2015 were selected from the case review system and the NSTEMI database from the Affiliated Hospital of Dalian Medical University, including 287 cases of coronary angiography. A total of 164 cases of hypersensitive CRP parallel coronary angiography were used to test 164 patients as subjects for inclusion in the study. Record clinical data of all patients, such as sex, age, past history (hypertension, diabetes, cerebrovascular disease, etc.), hypersensitive CRP, blood lipid, left ventricular ejection fraction, etc. The patients were then followed up and documented for MACE events and survival time. MACE mainly includes all-cause death, recurrent myocardial infarction, recurrent angina, unstable angina pectoris requiring hospitalization, and heart failure. Follow-up cutoff date was December 31, 2016. Results According to the general condition of all patients, the hs-CRP level was divided into two groups: high hs-CRP group (greater than 3. Omg/ L) and low hs-CRP group (less than or equal to 3. Omg/ L). Among them, 79 cases were high hs-CRP group and 85 cases were low hs-CRP group. Based on the results of coronary angiography, in order to facilitate quantitative analysis and compare the severity of coronary lesions, a new Gaini score was introduced to translate the degree of overall coronary stenosis into a specific visual value. New Gaini score[3]: stenosis scores were performed on 8 major segments of the coronary artery, no anomalies noted as 0 points; stenosis ranged from 1% to 49% for 1 point; 50% to 74% for 2 points; 75% to 99% for 3 points; 100% occlusion was 4 points. The results showed that there was a statistically significant difference between the high hs-CRP group and the low hs-CRP group (P0.05). In addition, according to the presence or absence of MACE event in the follow-up patients, there were 31 patients with MACE group, 129 without MACE group, 129 without MACE group, and 4 cases lost to follow-up. Patients who did not have a MACE event group had a significantly lower CRP level of 4.08 Mt. 3.69mg/ L significantly lower than that of the MACE event group 6.66 mg/ L. A single factor and multivariate COX regression analysis indicated that hypersensitive CRP was an independent predictor of future MACE events in NSTEMI patients[RR = 1. 126, 95% CI (1. 052, 1. 205), P = 0. 001]. Kaplan-Meier survival curves show a significant decrease in the non-event survival rate of NSTEMI patients as the level of hypersensitive CRP increases (log = 0.93x2 = 9. 339, P = 0. 002). Conclusion 1. The higher CRP level was associated with the severity of coronary lesions in NSTEMI patients, and the higher the CRP concentration was demonstrated, the greater the degree of coronary lesions in NSTEMI patients; 2. Hypersensitive CRP can predict the poor prognosis of NSTEMI patients, and the higher CRP concentration results in the poorer prognosis of NSTEMI patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
，
本文編號：2266109
[Abstract]:BACKGROUND & OBJECTIVE: With the improvement of quality of life, people pay more and more attention to health, and acute coronary syndrome gradually becomes the focus of its attention. Acute coronary syndromes mainly include acute ST-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction, and unstable angina. Hypersensitive CRP is a fast and simple biochemical test index. The relationship between hypersensitive CRP and acute ST-segment elevation myocardial infarction (AMI) and unstable angina pectoris was more and more reported at home and abroad, and the relationship between hypersensitive CRP and acute non-ST-elevation myocardial infarction was reported less. Patients with acute non-ST-segment elevation myocardial infarction were mostly middle-aged and elderly, with complex condition and many influencing factors. At present, the methods for evaluating the condition and prognosis of acute non-ST-segment elevation myocardial infarction include GRACE score and TIMI score, but these methods are complicated, involving more risk factors of coronary heart disease, longer time consumption, and hypersensitive CRP as a simple and convenient method. The rapid biochemical test index has great advantages. This paper focuses on the relationship between the hypersensitivity CRP level and the severity of acute non-ST elevation myocardial infarction patients, and discusses whether the hypersensitive CRP can predict the prognosis of patients with acute non-ST myocardial infarction. Methods A total of 522 patients with acute non-ST-segment elevation myocardial infarction hospitalized from Jan. 01, 2014 to December 31, 2015 were selected from the case review system and the NSTEMI database from the Affiliated Hospital of Dalian Medical University, including 287 cases of coronary angiography. A total of 164 cases of hypersensitive CRP parallel coronary angiography were used to test 164 patients as subjects for inclusion in the study. Record clinical data of all patients, such as sex, age, past history (hypertension, diabetes, cerebrovascular disease, etc.), hypersensitive CRP, blood lipid, left ventricular ejection fraction, etc. The patients were then followed up and documented for MACE events and survival time. MACE mainly includes all-cause death, recurrent myocardial infarction, recurrent angina, unstable angina pectoris requiring hospitalization, and heart failure. Follow-up cutoff date was December 31, 2016. Results According to the general condition of all patients, the hs-CRP level was divided into two groups: high hs-CRP group (greater than 3. Omg/ L) and low hs-CRP group (less than or equal to 3. Omg/ L). Among them, 79 cases were high hs-CRP group and 85 cases were low hs-CRP group. Based on the results of coronary angiography, in order to facilitate quantitative analysis and compare the severity of coronary lesions, a new Gaini score was introduced to translate the degree of overall coronary stenosis into a specific visual value. New Gaini score[3]: stenosis scores were performed on 8 major segments of the coronary artery, no anomalies noted as 0 points; stenosis ranged from 1% to 49% for 1 point; 50% to 74% for 2 points; 75% to 99% for 3 points; 100% occlusion was 4 points. The results showed that there was a statistically significant difference between the high hs-CRP group and the low hs-CRP group (P0.05). In addition, according to the presence or absence of MACE event in the follow-up patients, there were 31 patients with MACE group, 129 without MACE group, 129 without MACE group, and 4 cases lost to follow-up. Patients who did not have a MACE event group had a significantly lower CRP level of 4.08 Mt. 3.69mg/ L significantly lower than that of the MACE event group 6.66 mg/ L. A single factor and multivariate COX regression analysis indicated that hypersensitive CRP was an independent predictor of future MACE events in NSTEMI patients[RR = 1. 126, 95% CI (1. 052, 1. 205), P = 0. 001]. Kaplan-Meier survival curves show a significant decrease in the non-event survival rate of NSTEMI patients as the level of hypersensitive CRP increases (log = 0.93x2 = 9. 339, P = 0. 002). Conclusion 1. The higher CRP level was associated with the severity of coronary lesions in NSTEMI patients, and the higher the CRP concentration was demonstrated, the greater the degree of coronary lesions in NSTEMI patients; 2. Hypersensitive CRP can predict the poor prognosis of NSTEMI patients, and the higher CRP concentration results in the poorer prognosis of NSTEMI patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
，
本文編號：2266109
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