外周血细胞与冠状动脉慢血流的相关性研究

发布时间：2018-03-20 01:40

本文选题：冠状动脉慢血流　切入点：炎症　出处：《郑州大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景冠状动脉慢血流(slow coronary flow,SCF)最初由Tambe等[1]首先发现并报道,根据Mohammad等[2]最新统计数据在行冠状动脉造影的患者中6.6%存在SCF现象。SCF患者可表现为不明原因的胸部不适、稳定型心绞痛、急性冠状动脉综合症、恶性心律失常以及猝死等[3-4],鉴于SCF发生率增加和临床表现多样性其日益受到关注。尽管关于SCF的研究已很多,但其具体病理生理机制仍不明确,所以对于SCF的治疗暂无明确指南推荐,仅根据临床症状给予对应治疗。综合目前研究SCF可能的发生机制主要为内皮功能受损[5-6]、微血管功能失调[7]、炎症反应[8]以及动脉粥样硬化早期改变[9]。内皮细胞受损导致血管活性物质分泌紊乱,引发微血管舒缩失调,同时内皮细胞损伤也是血管壁动脉粥样硬化的关键环节;微血管是血流阻力的主要来源,微血管病变可致血流阻力增加及大血管充血状态,这时血细胞可发生叠连和聚集,血液粘度增加一方面使血流阻力进一步增加,另一方面可致白细胞向血管壁粘附,导致内皮细胞炎症状态,出现内皮细胞损伤,从而诱发血管壁病理性改变;炎症反应可首先致内皮损伤修复失衡,出现内膜增厚及平滑肌增殖等病理性变化,从而发生血管重构,血流阻力随之增加。可见SCF是这些因素相互作用的结果,而非单一因素引起。外周血细胞包括白细胞、红细胞及血小板,白细胞是炎症反应的主要参与者,并可释放多种炎性因子加速炎症反应;红细胞的免疫粘附作用可致红细胞之间以及红细胞与血小板之间出现粘附,进而导致微血管栓塞、血流阻力增加;血小板除其主要的凝血和止血作用外,尚有保护血管内皮、参与内皮修复、防止动脉粥样硬化的作用,但血小板的过度激活可致血栓形成,引起血管栓塞。基于上述外周血细胞功能,并结合目前有关研究,推测外周血细胞某些成分可能在一定程度上参与了SCF的病理生理过程。因此本研究通过对比SCF组与正常组外周血细胞各项指标,旨在明确外周血细胞中各项指标与SCF的关系,以期为临床诊断提供依据。目的探讨外周血细胞中的各项指标与冠状动脉慢血流的相关性方法以郑州大学第一附属医院心内科经冠状动脉造影检查证实狭窄40%的195例患者为研究对象,其中SCF组99例(男性52例,女性47例),正常血流(normal coronary flow,NCF)组96例(男性45例,女性51例),SCF定义为图像采集速度30帧/s时,造影剂通过至少1支冠状动脉的帧数27帧[10],记录患者基本临床资料并在入院次日早晨抽取空腹肘静脉血进行血常规、血脂、血糖、尿酸、尿素及肌酐测定,计算中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),采用SPSS17.0统计软件对两组数据进行统计学分析。结果1.两组患者基线资料相比无统计学差异(P0.05);2.SCF组白细胞计数、中性粒细胞计数、红细胞分布宽度(red cell distribution width,RDW)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、平均血小板体积(mean platelet volume,MPV)、尿酸(UA)及NLR均显著高于NCF组(6.76±1.31 vs.6.32±1.39,P=0.024;4.24±1.12 vs.3.79±1.16,P=0.007;13.47±1.93 vs.12.88±1.90,P=0.034;2.20±0.69 vs.2.01±0.61,P=0.041;9.04±1.11vs.8.55±1.42,P=0.008;287.55±67.46 vs.262.26±80.46,P=0.018;2.45±0.80 vs.2.06±0.70,P0.001),差异有统计学意义(P0.05);3.Pearson相关分析显示NLR与hs-CRP呈显著正相关,r=0.871,P0.001;4.二元Logistic回归分析显示增高的NLR(OR=1.885,95%CI:1.254-2.835,P=0.002)及MPV(OR=1.381,95%CI:1.085-1.757,P=0.009)可能是发生SCF的独立危险因素;5.ROC曲线表明NLR(AUC=0.635,敏感性为59.6%,特异性为61.5%)及MPV(AUC=0.612,敏感性为80.8%,特异性为46.9%)对SCF的发生具有重要预测价值。结论1.白细胞、中性粒细胞、hs-CRP及UA参与了SCF的病理生理过程;2.NLR与血清hs-CRP水平正相关,其可作为炎症状态的标志物,增高的NLR及hs-CRP提示SCF可能是一种炎症状态;3.NLR及MPV可能是发生SCF的独立危险因素,其可作为临床无创性预测SCF的重要指标。
[Abstract]:The background of slow coronary flow (slow coronary, flow, SCF) initially by the Tambe [1] first discovered and reported 6.6%, according to the latest statistics Mohammad [2] undergoing coronary angiography in patients with SCF in patients with.SCF showed unexplained chest discomfort, stable angina, acute coronary syndrome, malignant arrhythmia and sudden death of [3-4], whereas SCF increased incidence and clinical manifestations of diversity of its growing concern. Although there have been a lot of research on SCF, but the specific pathophysiological mechanism is still not clear, so for SCF treatment no clear guidelines, only to give the corresponding therapy according to the clinical symptoms. At present a comprehensive study of SCF the mechanism mainly is endothelial dysfunction and microvascular dysfunction of [5-6], [7], [8] and inflammatory reaction in early atherosclerotic changes [9]. endothelial cell damage leads to vasoactive The material secretion disorder, caused by micro vasomotor disorders, and the key link of endothelial cell injury is vascular atherosclerosis; microvascular blood flow resistance is the main source of the micro vascular lesions increased resistance to flow and vascular hyperemia, then blood cells can produce overlapping and aggregation, increased blood viscosity, the blood flow resistance on one hand to further increase, on the other hand can cause white blood cells to vascular endothelial cell adhesion, leading to inflammation, endothelial cell injury, and induce vascular pathological change; the inflammatory response can be induced in the first skin damage repair imbalance, endometrial thickening and proliferation of vascular smooth muscle cells and other pathological changes, resulting in vascular remodeling, blood flow resistance increased SCF. Visible is the interaction result of all these factors, rather than a single factor. Peripheral blood cells including white blood cells, red blood cells and blood platelets, white blood cells Is the main participants of the inflammatory response and the release of various inflammatory factors accelerate inflammation; adhesion between erythrocyte immune adhesion function can cause the red blood cells and red blood cells and platelets, leading to microvascular embolization, blood flow resistance increased; in addition to the platelet coagulation and hemostasis, and protect vascular endothelium, participate in endothelial repair, prevent atherosclerosis, but can cause excessive activation of platelet thrombosis caused by vascular embolization. The peripheral blood cell function based on, combined with the current relevant research, push test some components of peripheral blood cells may participate in the pathophysiological process of SCF to a certain extent. Therefore the research and the normal group compared with the SCF group in peripheral blood cells of the index, the correlation between SCF aims to make clear in the peripheral blood cells, in order to provide the basis for clinical diagnosis. Objective to investigate The method of correlation in the peripheral blood cells index and coronary slow flow in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University underwent coronary angiography and 195 cases of stenosis was confirmed in 40% of the patients as the research object, including 99 cases of SCF group (52 males, 47 females), normal blood flow (normal coronary flow, NCF) 96 patients (45 cases, male 51 cases of female), SCF is defined as the image acquisition speed of 30 frames /s, contrast agent through at least 1 coronary artery. 27 frames [10], record the basic clinical data of patients and blood routine in the hospital the next morning fasting venous blood lipid, blood glucose, uric acid, urea and creatinine determination the calculation, neutrophil to lymphocyte ratio (neutrophil to lymphocyte ratio, NLR), using SPSS17.0 statistical software for statistical analysis of data of the two groups. Results 1. patients of the two groups at baseline compared no significant difference (P0.05); 2.SC F group of white blood cell count, neutrophil count, red cell distribution width (red cell distribution width, RDW), high sensitive C reactive protein (high sensitivity C-reactive protein, hs-CRP), mean platelet volume (mean platelet, volume, MPV), uric acid (UA) and NLR were significantly higher than that of group NCF (6.76 + 1.31 vs.6.32 + 1.39, P=0.024; 4.24 + 1.12 vs.3.79 + 1.16, P=0.007; 13.47 + 1.93 vs.12.88 + 1.90, P=0.034; 2.20 + 0.69 vs.2.01 + 0.61, P=0.041; 9.04 + 1.11vs.8.55 + 1.42, P=0.008; 287.55 + 67.46 vs.262.26 + 80.46, P=0.018; 2.45 + 0.80 vs.2.06 + 0.70, P0.001), the difference was statistically significant (P0.05) 3.Pearson; correlation analysis showed a significant positive correlation between NLR and hs-CRP, r=0.871, P0.001; 4. two yuan Logistic regression analysis showed that the increased NLR (OR=1.885,95%CI:1.254-2.835, P=0.002) and MPV (OR=1.381,95%CI:1.085-1.757, P=0.009) may be an independent risk of SCF Factor; 5.ROC curves show that NLR (AUC=0.635, the sensitivity was 59.6%, specificity was 61.5% (AUC=0.612) and MPV, the sensitivity was 80.8%, specificity 46.9%) is important for the predictive value of SCF. Conclusion: 1. white blood cells, neutrophils, hs-CRP and UA are involved in the pathophysiology of SCF is related to 2.NLR; and the level of serum hs-CRP, which may be used as a marker of inflammation, NLR and increased hs-CRP may indicate that SCF is an inflammatory condition; 3.NLR and MPV may be the independent risk factors of SCF, it can be used as a noninvasive prediction of SCF important index.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

【共引文献】