血清纤维蛋白原及中性粒细胞—淋巴细胞比值与急性冠脉综合征的相关性研究

发布时间：2018-03-19 10:51

本文选题：纤维蛋白原　切入点：中性粒细胞-淋巴细胞比值　出处：《广西中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:急性冠脉综合征(ACS)是冠心病急性发病的临床类型。近年来许多研究已经证实了炎症在冠状动脉粥样硬化病变的发生和进展具有主要致病作用,且糖尿病患者持续高血糖状态又可显著增加血管内皮细胞的氧化应激和炎症反应,两者共同促进冠状动脉粥样硬化斑块的进展和破裂。血清纤维蛋白原(Fib)和中性粒细胞-淋巴细胞比值(NLR)不仅作为一种炎症标志物,也是心血管事件发生的预测因素。因此,本研究旨在探讨:1.外周血Fib、NLR与急性冠脉综合征的相关性,以及与冠脉病变严重程度的关联。2.外周血Fib、NLR与ACS合并糖尿病的关系,以及与冠脉病变严重程度的关联。3.血清Fib和NLR对急性冠脉综合征的预测价值。方法:1.本次研究收集2015年10月至2016年10月该时间段入院并行冠脉造影检查的230例ACS患者(其中合并糖尿病92例,不合并糖尿病138例)。同时选取疑诊为“急性冠脉综合征”但住院期间行冠脉造影术检查证实无明显冠脉狭窄的患者为对照组(58例)。并详细记录每例患者入院后的一般临床资料(年龄、性别、吸烟史、高血压史等)及相关实验室血清指标(血常规、纤维蛋白原、血脂、血糖等),并计算出中性粒细胞与淋巴细胞比值(NLR),分析血清Fib水平、NLR与ACS组和对照组间的关联以及ACS合并糖尿病与不合并糖尿病血清Fib、NLR之间的差异;2.将230例ACS患者根据冠状动脉造影结果进行冠脉病变SYNTAX评分,并按评分结果分为低危组(68例)、中危组(79例)及高危组(83例),分析血清Fib、NLR与冠脉病变SYNTAX评分组间的相关性,并比较ACS合并糖尿病组和非糖尿病ACS组不同SYNTAX评分组间血清Fib、NLR的差异;3.根据冠脉造影结果将230例ACS患者分为单支病变组(86例)、双支病变组(77例)及多支病变组(67例),分析血清Fib、NLR与冠脉病变支数间的相关性,并比较ACS合并糖尿病组和非糖尿病ACS组不同冠脉病变支数间血清Fib、NLR的差异。本次研究所有数据均应用SPSS17.0统计软件进行统计分析。结果:1.ACS组中血清Fib水平、NLR明显高于对照组,且ACS组中合并糖尿病患者血清Fib水平、NLR高于非糖尿病ACS患者。2.高危组中血清Fib水平和NLR明显高于中危组和低危组,中危组又高于低危组;同时对ACS合并糖尿病组和非糖尿病ACS组不同冠脉病变SYNTAX评分组间血清Fib水平及NLR分别进行比较,也均存在统计学差异(P0.05)。3.多支病变组中血清Fib和NLR明显高于双支病变组和单支病变组,双支病变组中血清Fib水平高于单支病变组,但NLR在双支病变组和单支病变组中差异无统计学意义(P0.05);同时对ACS合并糖尿病组和非糖尿病ACS组不同冠脉病变支数间血清Fib水平及NLR分别进行比较,也均存在统计学差异(P0.05)。4.相关性分析提示Fib及NLR与冠脉病变SYNTAX评分呈正相关性。5.多元线性逐步回归分析提示Fib和NLR是ACS患者冠脉病变严重程度的独立预测因子。6.血清Fib和NLR的ROC曲线分析提示对ACS的发生具有一定的预测价值。结论:1.ACS患者发病时血清Fib水平及NLR均显著升高,其中又以ACS合并糖尿病患者升高最显著,提示血清Fib及NLR与ACS及糖尿病的发生、发展密切相关。2.血清Fib水平及NLR与ACS患者冠脉病变SYNTAX严重程度及冠脉病变数量密切相关,可作为ACS患者冠脉病变严重程度的独立预测因子。3.血清Fib水平及NLR对ACS的早期诊断具有一定的临床价值。
[Abstract]:Objective: acute coronary syndrome (ACS) is a clinical type of coronary heart disease with acute onset. In recent years, many studies have confirmed that inflammation has a main pathogenic role in the occurrence and progression of coronary atherosclerosis, oxidative stress and inflammatory reaction in patients with diabetes mellitus and persistent hyperglycemia and increased vascular endothelial cells, both of them promote progress and rupture of coronary atherosclerotic plaque. Serum fibrinogen (Fib) and neutrophil to lymphocyte ratio (NLR) is not only a marker of inflammation, also predictive of cardiovascular events. Therefore, this study aims to investigate: 1. peripheral blood Fib, NLR associated with acute coronary syndrome, and association.2. the severity of coronary artery disease with peripheral blood Fib, the relationship between NLR and ACS patients with diabetes mellitus, and the severity of coronary artery disease with serum Fib and NLR of.3. Association The predictive value of acute coronary syndrome. Methods: 230 cases of 1. ACS patients in this study were collected from October 2015 to October 2016, the time of admission parallel coronary angiography (including 92 cases with diabetes, 138 cases without diabetes). At the same time as the "sign" selection of suspected acute coronary syndrome during hospitalization for coronary angiography examination no significant coronary artery stenosis patients as control group (58 cases). The clinical data and detailed records of each patient after admission (age, gender, smoking history, history of hypertension and related laboratory index) serum (blood, fibrinogen, blood lipid, blood sugar, etc.) and calculate the neutrophil to lymphocyte the ratio (NLR), analysis of the serum level of Fib, NLR and correlation between ACS group and control group and ACS patients with diabetes mellitus and diabetic serum Fib, the difference between NLR 2.; 230 cases of ACS patients were made according to the coronary artery The shadow SYNTAX coronary artery score according to the scoring results and divided into low risk group (68 cases), moderate risk group (79 cases) and high risk group (83 cases), SYNTAX correlation analysis of serum Fib, NLR and coronary artery lesion scores between groups, and compared ACS with diabetes group and non diabetes ACS group SYNTAX scores between the serum levels of Fib, NLR difference; 3. according to the results of coronary angiography in 230 patients with ACS were divided into single vessel group (86 cases), double vessel lesion group (77 cases) and multivessel disease group (67 cases), correlation analysis of serum Fib, NLR and coronary artery lesions between the branches, and compared ACS with diabetes group and non diabetes ACS group different coronary lesions between serum Fib, NLR difference. This research all data are used SPSS17.0 statistical software for statistical analysis. Results: the level of serum Fib in 1.ACS group, NLR was significantly higher than the control group, and ACS group with diabetes patients serum Fib level that is higher than NLR Non diabetic patients with ACS.2. high-risk group serum levels of Fib and NLR were significantly higher than those in the risk group and the low risk group, medium risk group was higher than that of low risk group; at the same time of ACS with serum Fib levels and NLR scores between the diabetic group and non-diabetic group ACS different SYNTAX coronary lesions were compared, and there were statistically significant differences (P0.05).3. multi vessel disease group serum Fib and NLR were significantly higher than that of double branch lesions group and single vessel disease group, double vessel group in the serum level of Fib was higher than that of single branch lesion group, but there was no significant NLR in double vessel group and single vessel disease group (P0.05); while the difference with ACS NLR and serum Fib levels in diabetic group and non-diabetic group ACS different coronary lesions were also compared, there were statistically significant differences (P0.05) and Fib.4. correlation analysis showed that NLR and SYNTAX score of coronary artery lesion of.5. was positively correlated to the multivariate linear stepwise regression Analysis showed that the Fib and NLR is ROC curve in patients with ACS the severity of coronary artery disease were independent predictors of.6. serum Fib and NLR analysis showed that the is of certain value in predicting the occurrence of ACS. Conclusion: 1.ACS patients with serum level of Fib and NLR were significantly increased, especially in ACS patients with diabetes increased significantly. The results showed that the serum Fib and NLR and ACS and the incidence of diabetes is closely related to the development of.2., the number of levels of serum Fib and NLR and SYNTAX ACS in patients with coronary lesion severity and coronary artery lesions are closely related, can be used as independent pre ACS patients with the severity of coronary artery disease measuring factor.3. serum levels of Fib and NLR has certain clinical value in early diagnosis of ACS.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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