冠心病合并代谢综合征患者血脂特征及剩余心血管风险研究

发布时间：2018-02-28 13:04

本文关键词： 冠心病代谢综合征血脂剩余心血管风险　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨冠心病合并代谢综合征患者血脂特征和使用目前调脂方案治疗后此类患者血脂水平以及其剩余心血管风险研究。方法:收集2013年~2015年于我院明确诊断的冠心病合并代谢综合征患者121例作为观察组(其中高血压患者116例,糖尿病患者97例),同时收集单纯冠心病仅有血脂异常患者103例作对照组,两组患者至入院起每晚服用1粒阿托伐他汀胶囊(20mg/粒),余治疗按冠心病常规治疗,两组无差别,同时代谢综合征组按高血压、糖尿病指南用药。观察治疗时间1年,分别收集两组患者治疗前及治疗后甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白、载脂蛋白A1、载脂蛋白B结果以及治疗中(后)两组患者主要心脑血管事件发生率的比较。结果:1.在两组患者基础资料对比中,体质指数(27.65±2.84 vs 22.74±2.85,P0.001)、血压值:收缩压(151.41±14.83 vs 129.93±5.54,P0.001)、舒张压(86.14±9.62 vs71.21±6.19,P0.001)、空腹静脉血糖(8.28±1.86 vs 5.47±0.60,P0.001)。2.治疗前两组患者血脂比较,甘油三酯(3.19±2.05 vs 2.31±0.84,P=0.009)、总胆固醇(4.39±1.22 vs 4.65±1.35,P=0.136)、高密度脂蛋白(0.93±0.22 vs 1.04±0.26,P=0.018)、低密度脂蛋白(2.73±0.92 vs 3.09±1.13,P=0.078)代谢综合征组较单纯组比较,以高甘油三酯及低高密度脂蛋白胆固醇为主,两组具有显著差异。3.单纯组使用阿托伐他汀治疗前后血脂比较,甘油三酯(2.31±0.84 vs 1.24±0.43,P=0.016)、总胆固醇(4.65±1.35 vs 3.63±0.87,P=0.003)、高密度脂蛋白(1.04±0.26vs 1.12±0.16,P=0.031)、低密度脂蛋白(3.09±1.13 vs 1.56±0.73,P=0.021),阿托伐他汀对单纯冠心病组的治疗前后有明显统计学差异,治疗后患者血脂可达理想血脂水平。4.代谢综合征组使用阿托伐他汀治疗前后血脂水平比较,总胆固醇(4.39±1.22 vs3.78±0.90,P=0.014)、低密度脂蛋白(2.73±0.92 vs 1.68±0.69,P=0.004),甘油三酯(3.19±2.05 vs 3.06±1.49,P=0.514)、高密度脂蛋白(0.93±0.22 vs 0.89±0.78,P=0.089),阿托伐他汀对冠心病合并代谢综合征组总胆固醇及低密度脂蛋白胆固醇治疗前后差异具有统计学意义,对其高甘油三酯、低高密度脂蛋白血脂水平在治疗前后无统计学意义。5.冠心病合并代谢综合征组较单纯冠心病组心脑血管事件发生率比较,脑卒中(15.71%vs 3.88%,P=0.024)、再发心绞痛症状(34.71%vs 11.65%,P=0.001)、再发心肌梗死(1.65%vs 0.00%,P=0.037)、支架内再狭窄(3.31%vs 0.97%,P=0.020)、因心衰再入院或多次入院(28.93%vs 3.88%,P=0.001)两组比较具有显著差异。结论:1.冠心病合并代谢综合征患者血脂特点以高甘油三酯、低高密度脂蛋白为主;2.冠心病合并代谢综合征患者使用目前单用他汀类药物治疗并不能使其血脂达到理想血脂水平;3.考虑其与剩余心血管风险有关,需进一步探讨此类患者调脂方案。
[Abstract]:Objective: to investigate the characteristics of blood lipids in patients with coronary heart disease complicated with metabolic syndrome, the level of blood lipids and their residual cardiovascular risk after treatment with current lipid regulation regimen. Methods: from 2013 to 2015, the diagnosis was confirmed in our hospital. One hundred and twenty-one patients with coronary heart disease complicated with metabolic syndrome were treated as observation group (116 patients with hypertension). 97 patients with diabetes mellitus, 103 patients with only abnormal blood lipid were collected as control group. From admission to hospital, the patients in the two groups were given 20 mg of Atto vastatin capsule every night. The remaining treatment was treated according to the routine treatment of coronary heart disease, and there was no difference between the two groups. At the same time, the patients in the metabolic syndrome group were treated according to the guidelines of hypertension and diabetes mellitus. The treatment time was 1 year. The triglycerides, total cholesterol, low density lipoprotein, high density lipoprotein were collected before and after treatment in both groups. Comparison of Apolipoprotein A1, Apolipoprotein B results and the incidence of main Cardiovascular and Cerebrovascular events in two groups of patients during and after treatment. Results: 1. In comparison of basic data of two groups of patients, Body mass index (BMI) was 27.65 卤2.84 vs 22.74 卤2.85 渭 P 0.001g, blood pressure: systolic blood pressure 151.41 卤14.83 vs 129.93 卤5.54 g P 0.001g, diastolic blood pressure 86.14 卤9.62 vs71.21 卤6.19g P0.001g, fasting venous blood glucose 8.28 卤1.86 vs 5.47 卤0.60P 0.001n. Triglyceride 3. 19 卤2. 05 vs 2. 31 卤0. 84 pectin 0.009, total cholesterol 4. 39 卤1. 22 vs 4. 65 卤1. 35 pectin 0.136, high density lipoprotein 0. 93 卤0. 22 vs 1. 04 卤0. 26 P0. 018, low density lipoprotein 2. 73 卤0. 92 vs 3. 09 卤1. 13P0. 078) the metabolic syndrome group was dominated by high triglyceride and low density lipoprotein cholesterol. There was significant difference between the two groups. 3. Comparison of serum lipids before and after treatment with Atto vastatin in simple group, Triglyceride 2. 31 卤0. 84 vs 1. 24 卤0. 43 P0. 016, TC 4. 65 卤1. 35 vs 3. 63 卤0. 87 P0. 003, HDL-C 1. 04 卤0. 26 vs 1. 12 卤0. 16 P0. 031, LDL 3. 09 卤1. 13 vs 1. 56 卤0. 73P0. 021. There was a significant difference between the two groups before and after treatment. After treatment, the serum lipids could reach the ideal lipid level. 4. Comparison of serum lipids before and after treatment with Atto vastatin in metabolic syndrome group, Total cholesterol was 4.39 卤1.22 vs3.78 卤0.90 vs3.78, low density lipoprotein 2. 73 卤0. 92 vs 1. 68 卤0. 69 P0. 004, triglyceride 3. 19 卤2. 05 vs 3. 06 卤1. 49 P0. 514, high density lipoprotein 0. 93 卤0. 22 vs 0. 89 卤0. 78 P0. 089. Atto vastatin had significant difference in total cholesterol and low density lipoprotein cholesterol before and after treatment in patients with coronary heart disease and metabolic syndrome. There was no statistical significance before and after treatment for high triglyceride and low density lipoprotein. 5. The incidence of cardiovascular and cerebrovascular events in coronary heart disease with metabolic syndrome group was higher than that in simple coronary heart disease group. There were significant differences between the two groups in stroke (15.71vs 3.88p 0.024g), recurrent angina pectoris (34.71vs 11.65P 0.001), myocardial infarction (1.65vs 0.00P 0.037), restenosis in stent (3.31 vs 0.97p 0.020), readmission or multiple admission for heart failure (28.93vs 3.88cu). Conclusion 1.Conclusion\\\; Lipids are characterized by high triglycerides, Patients with coronary heart disease complicated with metabolic syndrome could not reach the ideal level of blood lipids by using statins alone. It is necessary to further explore the program of lipid regulation for these patients.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R589

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