血清视黄醇结合蛋白4水平与冠状动脉病变程度的关系及其预后价值

发布时间：2018-03-02 03:34

  本文关键词： 视黄醇结合蛋白4 同型半胱氨酸 超敏C反应蛋白 冠心病　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：【目的】探讨血清视黄醇结合蛋白4(RBP4)在冠心病患者冠脉病变程度及其预后中的临床意义。【方法】对收住我科,拟诊冠心病患者行冠状动脉造影术210例。明确诊断为冠心病者160例,其中急性心肌梗死组69例,不稳定型心绞痛组35例,稳定型心绞痛组56例,余造影结果正常者50例作为对照组。再根据冠脉造影结果将冠心病者分为单支病变组40例,双支病变组63例、多支病变组57例;按照Gensini积分分为轻度病变组36例、中度病变组46例、重度病变组44例、极重度病变组34例。所有入选患者集中检测血清RBP4、HCY及Hs-CRP。分析RBP4水平与冠状动脉病变程度的相关性;对急性冠脉综合征患者门诊或电话随访6个月,分析比较血清RBP4水平变化与主要不良心血管事件(MACE)发生率的相关性。【结果】1.与对照组比较AMI组、UAP组、SAP组血清RBP4、HCY、Hs-CRP水平显著增高(P0.01)。2.AMI组、UAP组血清RBP4、HCY、Hs-CRP水平明显高于SAP组(P0.05);血清RBP4水平在AMI组和UAP组间差异无统计学意义(P0.05)。3.单支病变组、双支病变组、多支病变组血清RBP4、HCY、Hs-CRP水平明显高于对照组(P0.05),随着冠状动脉病变支数的增多,血清RBP4、HCY、Hs-CRP水平也明显增高,各组间差异有统计学意义(P0.05)。4.轻度病变组、中度病变组、重度病变组、极重度病变组血清RBP4水平逐渐升高,各组间比较有明显差异,有统计学意义(P0.05)。5.ACS以血清RBP4中位数值(28mg/L)为依据,血清RBP4≥28mg/L的ACS患者随访中MACE的发生率(46%)明显高于RBP4水平28mg/L的患者(8%)。6.冠心病患者血清RBP4水平与冠脉Gensini评分、HCY、Hs-CRP、LDL-C呈正相关(r=0.859,P0.01;r=0.491,P0.05;r=0.671,P0.01;r=0.229,P0.05),与HDL-C呈负相关(r=-0.293,P0.05)。【结论】1.血清RBP4水平在冠心病组明显高于对照组,AMI组、UAP组血清RBP4水平明显高于SAP组,提示RBP4可能成为冠心病独立危险因素。2.冠脉病变支数越多,血清RBP4水平越高,且与Gensini积分呈正相关,提示血清RBP4水平可反应冠状动脉病变程度。3.血清RBP4水平可以作为评价冠心病患者病变严重程度及预后的参考指标之一。
[Abstract]:[objective] to investigate the clinical significance of serum retinol binding protein 4 (RBP4) in the severity of coronary artery disease and its prognosis in patients with coronary heart disease. A total of 210 patients were diagnosed as coronary artery disease (CHD), including 69 patients with acute myocardial infarction, 35 patients with unstable angina pectoris and 56 patients with stable angina pectoris. According to the results of coronary angiography, the patients were divided into single vessel disease group (40 cases), double vessel disease group (63 cases), multivessel disease group (57 cases) and mild lesion group (36 cases) according to Gensini score. There were 46 cases in moderate lesion group, 44 cases in severe lesion group and 34 cases in very severe lesion group. The serum RBP4HCY and Hs-CRP were detected in all patients. The correlation between the level of RBP4 and the severity of coronary artery disease was analyzed. Patients with acute coronary syndrome were followed up by telephone or outpatient for 6 months. The correlation between the changes of serum RBP4 level and the incidence of major adverse cardiovascular events was analyzed. [results] 1.Compared with the control group, the level of serum RBP4HCYHs-CRP in the AMI group was significantly higher than that in the SAP group. 2. The level of serum RBP4HCYHs-CRP in the UAP group was significantly higher than that in the SAP group. There was no significant difference in serum RBP4 level between AMI group and UAP group. The level of serum RBP4HCYAHs-CRP in patients with double-vessel disease was significantly higher than that in control group (P 0.05). With the increase of the number of coronary artery lesion branches, the level of serum RBP4HCYHs-CRP was also significantly increased. The difference between the two groups was statistically significant (P 0.05). The serum RBP4 level increased gradually in the patients with severe and very severe lesions, and there was significant difference among the groups. There was a significant difference between the two groups. 5. ACS was based on the median value of serum RBP4 (28mg / L). The incidence of MACE in patients with ACS with RBP4 鈮，

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