脂蛋白磷脂酶A2与传统危险因素交互作用对冠心病的影响：新疆地区多民族研究

发布时间：2018-04-06 04:00

本文选题：冠心病　切入点：脂蛋白磷脂酶A2　出处：《南京医科大学》2017年硕士论文

【摘要】：目的:探讨脂蛋白相关磷脂酶A2与经典风险因子在预测冠心病(CHD)中的协同作用,并且证实Lp-PLA2用于预测冠心病冠状动脉狭窄病变的诊断价值。方法:在2011年3月至2014年7月31期间,纳入新疆伊犁哈萨克自治州友谊医院住院治疗的来自11个不同名族的911名疑似冠心病患者,以冠脉造影检查确诊或排出冠心病,根据检查结果采用Gensini评分体系评估冠心病患者病情严重程度。通过免疫比浊法测定所有研究对象血浆当中Lp-PLA2浓度。符合正态分布的数据以平均数士标准差表示,使用方差分析进行多组间差异检验。偏态数据以中位数和四分位数表示,使用Kruskal—WallisH检验(K-W检验)进行多组间差异检验。Spearman相关检验用于评估两个定量变量之间的关系。使用多元逻辑回归分析血浆Lp-PLA2浓度与冠心病严重程度之间关系,交互作用模型分析血浆Lp-PLA2与传统疾病危险因素的相互作用。结果:各民族人群血浆Lp-PLA2水平存在统计学差异(p＜0.05),其中汉族人群最低(182.25(117.63-259.03)),维吾尔族人群最高(229.56(163.11-294.58))。Spearman相关分析表明Lp-PLA2与冠心病的严重程度呈正相关(r= 0.176,p =0.000)。进行二元逻辑回归分析Lp-PLA2与其他危险因素的关系。多因素逻辑回归分析显示Lp-PLA2水平与冠心病发生显著相关(OR,1.882;95%CI,1.369-2.587,p = 0.000)。Lp-PLA2 受试者工作特征曲线下面积为 0.589(95%CI,0.549-0.629,p = 0.000)。还发现Lp-PLA2和其他危险因素之间的协同作用:年龄(SI=20.95,SIM= 2.89,4P=0.64),性别(SI= 1.15,SIM= 0.67,= 0.10),SBP(SI = SIM=1.56,AP = 0.45),HDL-C(SI=1.22,SIM=0.92,AP = 0.13),LDL-C(SI=3.47,SIM=2.00,AP = 0.62),FBG(SI=2.27,SIM= 1.37,AP =0.47)。冠心病发生归因于Lp-PLA2和年龄相互作用的比例高达64%。结论:人血浆中Lp-PLA2水平与冠心病的严重程度呈正相关,Lp-PLA2与传统疾病危险因素在预测冠心病方面有明显的正相关作用。因此,Lp-PLA2可作为预测冠心病的独立影响因素。
[Abstract]:Objective: to investigate the synergistic effect of lipoprotein associated phospholipase A 2 and classical risk factor in predicting coronary artery disease (CAD) and to confirm the diagnostic value of Lp-PLA2 in predicting coronary artery stenosis.Methods: from March 2011 to July 31, 2014, 911 patients with suspected coronary heart disease (CHD) who were admitted to the Friendship Hospital of Yili Kazak Autonomous Prefecture, Xinjiang, were diagnosed or excluded by coronary angiography.The severity of coronary heart disease was evaluated by Gensini scoring system.Lp-PLA2 levels in plasma were measured by immunoturbidimetric method.The data in accordance with the normal distribution are expressed as the mean standard deviation and the analysis of variance is used to test the differences between groups.The skewed data were expressed as median and quartile, using Kruskal-WallisH test / K-W test. Spearman correlation test was used to evaluate the relationship between the two quantitative variables.Multivariate logistic regression analysis was used to analyze the relationship between plasma Lp-PLA2 concentration and severity of coronary heart disease (CHD). The interaction between plasma Lp-PLA2 and traditional disease risk factors was analyzed by an interactive model.The relationship between Lp-PLA2 and other risk factors was analyzed by binary logistic regression analysis.Multivariate logistic regression analysis showed that the level of Lp-PLA2 was significantly correlated with the occurrence of coronary heart disease (CHD). The area under the operating characteristic curve of 0.000).Lp-PLA2 subjects was 0.549-0.629 (p = 0.000).杩樺彂鐜癓p-PLA2鍜屽叾浠栧嵄闄╁洜绱犱箣闂寸殑鍗忓悓浣滅敤:骞撮緞(SI=20.95,SIM= 2.89,4P=0.64),鎬у埆(SI= 1.15,SIM= 0.67,= 0.10),SBP(SI = SIM=1.56,AP = 0.45),HDL-C(SI=1.22,SIM=0.92,AP = 0.13),LDL-C(SI=3.47,SIM=2.00,AP = 0.62),FBG(SI=2.27,SIM= 1.37,AP =0.47).Coronary heart disease is attributed to the interaction of Lp-PLA2 and age as high as 64%.Conclusion: the level of Lp-PLA2 in human plasma is positively correlated with the severity of coronary heart disease. Lp-PLA2 has a positive correlation with traditional disease risk factors in predicting coronary heart disease.Therefore, Lp-PLA2 may be an independent predictor of coronary heart disease.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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