女性缺血性心脏病的临床特点及合并抑郁状态的研究

发布时间：2018-11-17 09:15

【摘要】：目的：探讨女性缺血性心脏病的临床特点；研究女性缺血性心脏病患者冠脉阻塞程度及伴发抑郁状态对血浆Ghrelin水平的影响，从而进一步指导女性缺血性心脏病的诊断和治疗。方法：收集2011年5月至2012年4月期间在我院住院的有缺血性心脏病症状的女性患者基本资料和住院期间各项检查结果，共计504例；采集2012年7月至2012年12月期间于我院住院的有缺血性心脏病症状、拟行冠脉造影检查的女性患者空腹状态时的肘静脉血，酶联免疫法测定血浆Ghrelin水平，并于抽血当天（入院第二天）对患者进行医院焦虑抑郁量表（HADS）问卷。结果： ①阻塞性冠脉病变组较非阻塞性冠脉病变患者相比，胸痛症状明显增多（31.63%vs.22.48%）；非阻塞性冠脉病变组与阻塞性冠脉病变组相比，心慌症状明显增多（21.71%vs.15.34%）。但两组患者最多见的症状都表现为胸闷。 ②与非阻塞性冠脉病变组相比，阻塞性冠脉病变组患者年龄明显偏大（60.69岁vs.63岁），绝经时间更长（11.21年vs.13.34年），收缩压和舒张压明显升高（129.51mmHg vs.135.38mmHg，77.97mmHg vs.81.21mmHg），左室射血分数明显降低（67.04%vs.64.76%），外周血中性粒细胞明显增多（55.67%vs.63.75%），血红蛋白明显降低（123.31g/l vs.120.70g/l），血尿酸明显增高（284.95umol/l vs.305.98umol/l），胆固醇明显升高（4.47mmol/l vs.5.02mmol/l），甘油三酯明显升高（1.82mmol/l vs.2.50mmol/l），，低密度脂蛋白明显升高（2.37mmol/l vs.3.01mmol/l），血浆纤维蛋白原明显升高（2.90g/l vs.3.46g/l），空腹血糖明显升高（5.17mmol/l vs.5.76mmol/l），高血压史（56.2%vs.77.1%）、卒中史（9.6%vs.16.7%）、糖尿病史（23.3%vs.34.5%）、吸烟史（2.1%vs.6.8%）、冠心病家族史（21.8%vs.37.4%）、合并外周动脉粥样硬化（71.45%vs.83.1%）、合并甲状腺功能减退症（11.8%vs.16.5%）、胸片示心影变大（54.35%vs.62.6%）发生率更高，上述指标的差异均具有统计学意义（P0.05）。 ③对比阻塞性冠脉病变组及非阻塞性冠脉病变组，抑郁的发生率无统计学差异（P0.05）；与非阻塞性冠脉病变组相比，阻塞性冠脉病变组血浆Ghrelin水平显著降低（10.14ng/ml vs.8.81ng/ml, P0.05），差异有统计学意义；已发生阻塞性冠脉病变的女性患者，对比抑郁组和非抑郁组，合并抑郁症的患者血浆Ghrelin水平明显降低（9.11ng/ml vs.7.52ng/ml, P0.05），差异有统计学意义。结论： ①女性缺血性心脏病患者冠脉病变严重程度对患者临床症状有一定的影响。 ②女性缺血性心脏病冠脉病变严重程度由多种因素共同决定，包括患者年龄、绝经时间、入院时血压和心脏收缩功能、外周血中性粒细胞和血红蛋白水平、血尿酸、胆固醇、甘油三酯、低密度脂蛋白、血浆纤维蛋白原水平、空腹血糖以及是否具有高血压史、卒中史、糖尿病史、吸烟史、冠心病家族史、甲状腺功能减退、外周动脉粥样硬化及胸片示心影是否变大。 ③女性缺血性心脏病患者发生抑郁与否与冠脉病变严重程度无关；女性缺血性心脏病患者冠脉发生阻塞性病变时血浆Ghrelin水平明显降低，合并抑郁时血浆Ghrelin水平进一步降低。
[Abstract]:Purpose: To study the clinical characteristics of women with ischemic heart disease, and to study the effect of the degree of coronary obstruction and the status of depression on the level of plasma Ghrelin in women with ischemic heart disease, so as to further guide the diagnosis and treatment of ischemic heart disease in women. Treatment. Methods: From May 2011 to April 2012, we collected the basic data of the female patients with the symptoms of the ischemic heart disease in our hospital and the results of all the examinations during the hospitalization, with a total of 504 cases, and collected in our hospital from July 2012 to December 2012. The plasma Ghrelin level was determined by the enzyme-linked immunosorbent assay in the fasting state of women with ischemic heart disease, and the plasma Ghrelin level was determined by the enzyme-linked immunosorbent assay, and the patient was subjected to a hospital anxiety and depression scale on the day of the blood draw (the second day of admission). (HA Results: The symptoms of chest pain increased significantly (31. 63% vs. 22. 48%) compared with those with non-obstructive coronary artery disease (31. 63% vs. 22. 48%).. 71% vs. 15.34%), both groups The most common symptoms in the patients were chest distress. The age of patients with obstructive coronary lesions was significantly higher (60. 69 years vs. 63 years) compared with the non-obstructive coronary artery disease group, with a significant increase in systolic and diastolic blood pressure (129.51mmHg vs. 133.38 mmHg, 77. 97mmHg vs. 81.21mmHg), and a significant decrease in the left ventricular ejection fraction. (67. 04% vs. 64. 76%), the number of peripheral blood neutrophils (55. 67% vs. 63. 75%), the significant decrease in hemoglobin (123.31g/ l vs. 120. 70g/ l), the significant increase in blood uric acid (284. 95uml/ l vs. 305. 98uml/ l), a marked increase in cholesterol (4.47mmol/ l vs. 5.02mmol/ l), a marked increase in triglyceride (1.82 mmol/ l vs. 2. 50mmol/ l), and a marked increase in low-density lipoprotein (2.37mmo The plasma fibrinogen was significantly higher (2.90g/ l vs. 3.46g/ l), and the plasma fibrinogen increased significantly (5.17mmol/ l vs. 5.76mmol/ l), the history of hypertension (56. 2% vs. 77.1%), the history of stroke (90.6% vs. 16.7%), the history of stroke (2.1% vs. 63.8%), the family history of coronary heart disease (21.8% vs. 37.4%), and the combined peripheral atherosclerosis. (71.45% vs. 83.1%), combined with hypothyroidism (11. 8% vs. 16. 5%), chest X-ray showed a higher incidence (54. 35% vs. 62.6%) and the above-mentioned index There was no significant difference in the incidence of plasma Ghrelin in the patients with obstructive coronary artery disease (P0.05). The plasma Ghrelin level in the patients with obstructive coronary artery disease was significantly lower (10.14ng/ ml vs. 8. 81n) compared with the non-obstructive coronary artery disease group (P <0.05). There was a significant difference in the plasma Ghrelin level in patients with obstructive coronary artery disease, compared with the depressive and non-depressed groups (9.11 ng/ ml vs. 7. 52n). g/m 1, P0.05), and the difference was of statistical significance. The severity of the coronary artery disease in patients with heart disease has a certain effect on the clinical symptoms of the patient. The severity of the coronary artery disease in the patients with heart disease is determined by a number of factors, including the age of the patient, the time of menopause, the blood pressure and the systolic function of the heart at the time of admission, and the neutral particles in the peripheral blood. cell and hemoglobin levels, blood uric acid, cholesterol, triglycerides, low density lipoproteins, plasma fibrinogen levels, fasting blood glucose, and whether there is a history of hypertension, stroke history, history of diabetes, smoking history, coronary heart disease, The history of family, hypothyroidism, peripheral atherosclerosis and chest X-ray showed that the heart and shadow of the patients with ischemic heart disease were not related to the severity of the coronary artery disease, and the plasma Ghr in patients with ischemic heart disease in the patients with obstructive pulmonary disease
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R541.4;R749.4

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