非ST段抬高型ACS患者外周血NLRP3及其相关因子与GRACE评分的相关性研究

发布时间：2018-03-10 15:53

  本文选题：NLRP3及其相关因子　切入点：非ST段抬高型ACS(NSTE-ACS)　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析非ST段抬高型急性冠状动脉综合征(non-ST seggment elevation acute coronary syndrome,NSTE-ACS)患者 NLRP3 及其相关因子IL-1 β、IL-18水平与全球急性冠状动脉事件注册(Global Registry ofAcute Coronary Events,GRACE)评分及危险分层的相关性,探讨NLRP3及其相关因子IL-1 β、IL-18水平是否可以对NSTE-ACS患者危险分层及住院期间发生MACE进行预测。方法选取2015年3月至2016年3月在柳州市工人医院心血管内科一病区住院的患者141例,由具有冠状动脉造影资质的专业医生对患者进行冠状动脉造影检查。其中,非ST段抬高型急性冠脉综合征患者90例,稳定性心绞痛患者(AP)24例,冠状动脉造影结果无异常者作为对照组27例。根据NSTE-ACS患者临床分型分为:不稳定性心绞痛(UA)组、非ST段抬高型心肌梗死(NSTEMI)组。按GRACE评分结果对NSTE-ACS患者分组:高危组(≥140分)、中危组(109-139分)、低危组(≤108分者)。对患者的年龄、性别、心率、血压、吸烟史、高血压病史、糖尿病史等基础性材料进行详细记录。采用酶联免疫吸附法(Enzyme Linkde Immunosorbent Assay,ELISA)测定所有患者外周血NLRP3、IL-1β、IL-18水平,记录NSTE-ACS患者住院期间MACE的发生情况。对各组间一般资料、外周血NLRP3及其相关因子IL-1 β、IL-18水平进行差异性比较。然后再对外周血NLRP3及IL-1 β、IL-18进行相关性分析。最后通过ROC曲线求出各个指标的曲线下面积及最佳截断点。分析NLRP3及其相关因子IL-1β、IL-18水平对NSTE-ACS患者危险分层及住院期间发生MACE的预测价值。结果(1)经比较,患者的临床基础资料如年龄、性别、高血压病、糖尿病患病率、血脂、心率、肌酐、用药情况等组间比较无统计学意义。(2)①NSTEMI组、UA组、AP组NLRP3及IL-1β水平显著高于对照组(P0.05)。②NSTEMI 组 NLRP3、IL-1 β 水平显著高于 UA 组和 AP 组(P0.05)。③NSTEMI组IL-18水平显著高于UA组和对照组(P0.05);UA组、AP组、对照组组间IL-18水平无明显差别(P0.05)。(3)①高危组、中危组、低危组NLRP3、IL-1β、hsCRP水平及白细胞计数显著高于对照组(P0.05)。②高危组、中危组NLRP3、IL-1β、hsCRP水平及白细胞计数显著高于低危组(P0.05)。③高危组NLRP3、IL-1β、hsCRP水平及白细胞计数显著高于中危组(P0.05)。④高危组IL-18水平显著高于中危组、低危组、对照组(P0.05)。⑤中危组、低危组、对照组组间IL-18水平无明显差别(P0.05)。⑥高危组NLRP3、IL-1β、IL-18水平显著高于中危、低危及对照组,提示NLRP3、IL-1β、IL-18水平有助于高危患者的识别。(4)相关性分析结果显示,NLRP3及IL-1 β、IL-18水平与GRACE评分的相关系数分别为 0.599,0.590,0.281,P0.05,提示 NLRP3 及 IL-1β、IL-18 水平与GRACE评分呈良好的相关性。(5)ROC曲线求得NLRP3及其相关因子IL-1 β、IL-18对NSTE-ACS患者住院期间发生MACE的曲线下面积分别为0.921、0.762、0.692。最佳截断点分别为 133.77pg/mL、7.83ng/mL、15.07ng/mL。结论相比较于IL-Iβ及IL-18,外周血NLRP3水平的检测与GRACE评分对NSTE-ACS患者危险分层及住院期间发生MACE的预测有比较好价值,外周血NLRP3有可能成为NSTE-ACS患者预后判断的重要血清标记物。
[Abstract]:Objective to analyze the non ST elevation acute coronary syndrome (non-ST seggment elevation acute coronary syndrome, NSTE-ACS) in patients with NLRP3 and its related factors of IL-1 beta, IL-18 level and the global registry of acute coronary events (Global Registry ofAcute Coronary Events, GRACE) correlation score and risk stratification, discuss NLRP3 and its related factors of IL-1 beta, IL-18 whether the level of risk stratification of NSTE-ACS patients during hospitalization and incidence of MACE were predicted. Methods 141 cases from March 2015 to March 2016 in a hospital of Liuzhou Worker's Hospital Department of Cardiology disease patients, for patients with coronary artery angiography with coronary angiography by qualified professional doctor. Among them, non ST elevation acute coronary syndrome in 90 cases patients, patients with stable angina pectoris (AP) in 24 cases, no abnormal results of coronary angiography as control Group of 27 cases. According to the clinical NSTE-ACS patients were divided into unstable angina pectoris (UA) group, non ST elevation myocardial infarction (NSTEMI) group according to the GRACE score of NSTE-ACS patients were divided into two groups: high risk group (more than 140), medium risk group (109-139), low risk group (less than or equal to 108). The patient's age, gender, heart rate, blood pressure, smoking history, hypertension history, diabetes history and other basic materials were recorded. Using enzyme-linked immunosorbent assay (Enzyme Linkde Immunosorbent Assay, ELISA) were measured in all patients with peripheral blood NLRP3, IL-1 beta, IL-18 level, NSTE-ACS records of hospitalized patients during MACE. The general data between groups, peripheral blood NLRP3 and related cytokine of IL-1, IL-18 levels were compared. Then the peripheral blood NLRP3 and IL-1 beta, IL-18 correlation analysis. Finally, through the ROC curve area under the curve of each index and the best section 鏂�鐐�.鍒嗘瀽NLRP3鍙婂叾鐩稿叧鍥犲瓙IL-1尾,IL-18姘村钩瀵筃STE-ACS鎮ｈ，

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