糖尿病肾病患者血小板形态与急性冠脉综合征发生及严重程度相关性分析

发布时间：2018-04-12 08:02

  本文选题：糖尿病肾病 + 血小板形态　； 参考：《首都医科大学》2017年硕士论文

【摘要】：目的随着糖尿病肾病患者寿命延长,糖尿病肾病患者并发心血管疾病比例升高,更多死于心血管疾病,尤其是冠脉疾病,而非肾功能不全及尿毒症本身。如何在糖尿病肾病人群中早期识别冠脉疾病风险显得尤为重要。本研究旨在探讨糖尿病肾病患者血小板形态指标与急性冠脉综合征(ACS)发生及严重程度之间的相关性,进而评估血小板形态指标是否可作为评估急性冠脉综合征(ACS)发生、发展的简易指标。方法纳入2011年1月至2015年12月于首都医科大学附属北京安贞医院就诊的糖尿病肾病患者439例,其中合并急性冠脉综合症患者219例为ACS组,未合并急性冠脉综合症患者220例为对照组。ACS组中190例患者根据冠脉造影光盘结果进行SYNTAX评分,并根据评分结果分为低评分组(101例)、中评分组(50例)及高评分组(39例)。收集全部入选患者的性别、年龄、是否合并高血压、是否合并高脂血症、是否存在吸烟史、红细胞计数、血红蛋白、血小板计数、尿素、肌酐、尿酸、高密度脂蛋白、低密度脂蛋白、超敏C反应蛋白、红细胞沉降率等基线资料。入选的患者均在入院后空腹采用真空采血管留取外周静脉血,并采用全自动血细胞分析仪检测血小板平均体积(MPV)、血小板分布宽度(PDW)、大血小板比率(P-LCR)等血小板形态相关参数。ACS组患者根据冠脉造影结果进行Gensini评分。对数据进行统计分析分析血小板形态指标与冠脉病变严重程度相关性。结果与对照组相比,ACS组三项血小板形态指标明显升高(P均0.05)。Logistic回归分析提示PDW可作为ACS发生的影响因素(OR 1.399(1.031-1.898),P0.05)。MPV、PDW、P-LCR指标随着冠脉病变支数增加而增高(P0.05)。线性相关分析结果显示,MPV、PDW、P-LCR均与Gensini评分呈正相关,相关系数分别为:0.694、0.697、0.673(P均0.05)。多元线性回归分析提示血小板形态指标对冠脉Gensini评分存在独立影响(标准化回归系数为:0.723,P0.01)。SYNTAX评分患者中,高评分组在MPV、PDW、P-LCR均明显高于中、低评分组[(12.6±0.8)fL比(11.6±0.6)、(10.7±0.8)fL,(17.4±2.4)%比(14.6±1.6)%、(12.8±1.7)%,(45±6)%比(38±5)%、(31±7)%],差异有统计学意义(P0.05)。Logistic回归分析提示血小板形态指标(MPV、PDW及P-LCR,比值比=6.154,95%置信区间:3.260~11.618,P=0.001)为高SYNTAX评分的危险因素。Spearman相关分析显示MPV(rs=0.723,P0.001)、PDW(rs=0.708,P0.001)、P-LCR(rs=0.727,P0.001)均与冠状动脉SYNTAX评分呈正相关。多元线性回归分析结果提示血小板形态指标、尿素对冠状动脉SYNTAX评分存在独立影响,标准化回归系数依次为0.799(P0.001)和0.136(P=0.016)。结论血小板形态指标与冠脉病变程度存在正相关性,对冠状动脉病变程度可能存在预测意义,并且可作为糖尿病肾病患者合并发生急性冠脉综合征的评估指标。
[Abstract]:Objective with the prolongation of life span of diabetic nephropathy, the proportion of diabetic nephropathy complicated with cardiovascular disease increased, and more died of cardiovascular disease, especially coronary artery disease, rather than renal insufficiency and uremia itself.It is very important to identify the risk of coronary artery disease in diabetic nephropathy population.The purpose of this study was to investigate the correlation between platelet morphology and the incidence and severity of acute coronary syndrome (ACS) in patients with diabetic nephropathy, and to evaluate whether platelet morphology can be used as an assessment of the occurrence of acute coronary syndrome (ACS).A simple indicator of developmentMethods from January 2011 to December 2015, 439 patients with diabetic nephropathy were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University, including 219 patients with acute coronary syndrome (ACS) as ACS group.220 patients without acute coronary syndrome (ACS) were divided into low score group (101 cases) and high score group (39 cases) and high score group (39 cases).Gender, age, hypertension, hyperlipidemia, smoking history, red blood cell count, hemoglobin, platelet count, urea, creatinine, uric acid, high density lipoprotein were collected.Baseline data of low density lipoprotein, hypersensitive C reactive protein and erythrocyte sedimentation rate.After admission, all patients were treated with vacuum blood vessels on an empty stomach to collect peripheral venous blood.The mean platelet volume (MPV), platelet distribution width (PDW) and large platelet ratio (P-LCR) were measured by automatic blood cell analyzer (ACS). The patients in ACS group were evaluated with Gensini according to the results of coronary angiography.The correlation between platelet morphology and severity of coronary artery disease was analyzed statistically.Results compared with the control group, compared with the control group, the three indexes of platelet morphology were significantly increased P and 0.05).Logistic regression analysis showed that PDW could be used as an influential factor for the occurrence of ACS (OR 1.399) 1.031-1.898P0.05N. MPVG PDWP- LCR increased with the increase of the number of coronary artery lesion branches.The results of linear correlation analysis showed that there was a positive correlation between the P-LCR and the Gensini score, and the correlation coefficients were respectively 0. 05%, 0. 694 ~ 0. 697 and 0. 673% (P = 0. 05).Multiple linear regression analysis showed that platelet morphology had an independent effect on coronary Gensini score (standardized regression coefficient was 0. 723 P 0. 01%. SYNTAX score). The high score group was significantly higher than that of middle group.浣庤瘎鍒嗙粍[(12.6卤0.8)fL姣，

本文编号：1738874