亚临床甲状腺功能减低症与冠心病的相关关系研究

发布时间：2018-03-16 21:04

本文选题：Gensini评分　切入点：亚临床甲减　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景:近年来,冠状动脉性心脏病(coronary heart disease CHD)发病人数和死亡人数在我国快速上升,逐步成为我国成年人主要死亡原因之一。冠心病的危险因素很多,已经明确的包括有性别、血压升高、年龄、血脂代谢异常、抽烟、DM和IGT、腹型肥胖以及家族史等。但是许多新的冠心病危险因素近年来逐渐被发现,如已有相关研究发现CHD的发病可能与亚临床甲减(SH)存在关联,其机制很有可能是通过干扰血脂代谢、影响血小板平均体积(MPV),最终导致冠脉动脉硬化,促使CHD的发生。目的:探讨SH与CHD的关系。方法:选择2012年7月1日—2014年7月1日在山西医科大学第一医院心内科住院患者共280例,均在住院期间行冠状动脉造影术检查后诊断为冠心病。其中CHD合并SH(实验组)138例,未合并SH(对照组)142例。分别检测各组血脂水平,包括:甘油三酯(TG),总胆固醇(TC),高密度脂蛋白(HDL),低密度脂蛋白胆固醇(LDL)及MPV,计算出每位患者的Gensini总积分;进一步将实验组又分为三个亚组,即:一支病变组、两支病变组以及三支病变组,分别检测出各组的血清游离甲状腺素(FT4),游离三碘甲腺原氨酸(FT3),促甲状腺激素(TSH),TC,TG,HDL-C,LDL-C,MPV,计算出各组的冠状动脉Gensini总积分,记录基本临床资料。结果:在控制性别、糖尿病、吸烟、高血压等其它因素后得出:(1)组间Gensini总积分相对比:实验组冠状动脉Gensini总积分高于对照组,具有统计学差异(P0.05);(2)亚组内TSH比较:实验组内三支病变亚组及双支病变亚组TSH高于单支病变亚组,具有统计学差异(P0.05);(3)MPV比较:实验组明显高于对照组,两者具有统计学差异(P0.05);实验组内多支病变组与单支病变组相比,后者低于前者,且具有统计学差异(P0.05),实验组内TSH值和MPV值呈正相关,相关系数r=0.478;(4)血脂比较:实验组LDL-C,TC,TG水平高于对照组,差异有统计学意义(P0.05);实验组内三支病变组、双支病变组与单支病变组相比,前者高于后者,且具有统计学差异(P0.05)。结论:SH是冠心病的危险因素之一,可能通过影响血脂代谢及MPV水平增加CHD患病风险。
[Abstract]:Background: in recent years, the incidence and death rate of coronary heart disease have increased rapidly in China, and have gradually become one of the leading causes of death among adults in China. There are many risk factors for coronary heart disease. Sex, elevated blood pressure, age, dyslipidemia, smoking, diabetes mellitus and IGT, abdominal obesity, and family history have been identified, but many new risk factors for coronary heart disease have been identified in recent years. If relevant studies have found that the pathogenesis of CHD may be associated with subclinical hypothyroidism, its mechanism is likely to interfere with the metabolism of blood lipids, affect the mean volume of platelets, and eventually lead to coronary arteriosclerosis. Objective: to investigate the relationship between SH and CHD. Methods: from July 1st 2012 to July 1st 2014, 280 patients in Department of Cardiology, the first Hospital of Shanxi Medical University, were selected. All patients were diagnosed as coronary artery disease after coronary angiography, including 138 cases of CHD combined with SH2 and 142 cases of control group. The total Gensini scores of each patient were calculated, and the experimental group was further divided into three subgroups: one lesion group. The serum free thyroxine FT4, free triiodothyronine (FT3) and thyrotropin (TSH) were detected in two vessel group and three vessel group, respectively. The total Gensini score of coronary artery was calculated. Results: after controlling for sex, diabetes, smoking, hypertension and other factors, the total Gensini score was compared between the two groups: the total Gensini score of coronary artery in the experimental group was higher than that in the control group. Comparison of TSH in the subgroup: the TSH of the experimental group was higher than that of the single vessel group, and the TSH of the experimental group was significantly higher than that of the control group. There was a statistical difference between the two groups (P 0.05), and the latter was lower than that in the single vessel group (P 0.05). The TSH and MPV values in the experimental group were positively correlated with those in the control group. Correlation coefficient (r = 0.478 / 4): the level of TG in the experimental group was higher than that in the control group, the difference was statistically significant (P 0.05), the former was higher than the latter in the three vessel lesion group, the double vessel lesion group and the single vessel lesion group, the former was higher than that in the single vessel lesion group, the former was higher than that in the single vessel lesion group. ConclusionSh is one of the risk factors of coronary heart disease, which may increase the risk of CHD by affecting lipid metabolism and MPV level.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4;R581.2

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