冠心病患者HDL、UA与血管内皮功能的关系及三者与冠脉病变程度的相关性分析

发布时间：2018-04-14 10:30

本文选题：冠心病 + HDL　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨冠心病(coronary heart disease,CHD)患者高密度脂蛋白(high-density lipoprotein,HDL)、血尿酸(uric acid,UA)与血管内皮功能的关系及三者与冠脉病变程度的相关性。方法选取2014年4月至2015年10月在河南省人民医院心内科就诊的疑似CHD患者243人,所有患者均进行冠脉造影,其中冠脉造影阳性者146例为冠心病组,冠脉造影阴性者97例为非冠心病组,以上患者均用Endo-PAT2000仪器进行血管内皮功能检查,经计算机校正得出RHI(反应性充血指数reactive hyperemia index)。比较2组一般资料、血脂水平、肝功能、肾功能、UA及RHI间的差异;依RHI正常与否运用二分类Logistic回归分析血管内皮功能即RHI的影响因素;运用Pearson相关分析探讨了冠心病组HDL、UA与RHI之间的关系;再将冠心病组患者依冠状动脉病变程度分为单支病变组(37例)、双支病变组(48例)与三支病变组(61例)3个亚组,运用方差分析分别比较各亚组间HDL、UA及RHI的差异。结果1.冠心病组HDL、血管内皮功能评估指数-RHI低于非冠心病组,差异有统计学意义[(0.99±0.21)mmol/L比(1.08±0.24)mmol/L、(1.6±0.3)比(1.8±0.5)](P0.05)。但冠心病组UA水平高于非冠心病组,差异有统计学意义[(325.07±79.87)umol/l比(321.52±85.50)umol/l](P0.01)。2.两组总体人群中RHI与UA水平相关(比值比=0.802,P=0.045)。非冠心病组患者中RHI与高血压相关(比值比=0.979,P=0.005)。冠心病组患者中,RHI与HDL、UA的相关性有统计学意义(比值比分别为5.132、0.901,P值分别为0.043、0.004),且HDL与RHI呈明显线性正相关(r=0.470,P0.001),UA水平与RHI呈线性负相关(r=-0.202,P=0.014)。3.冠心病组患者中单支病变组、双支病变组及三支病变组HDL水平分别为(1.16±0.35)、(1.01±0.25)、(1.02±0.20),组间差异有统计学意义(P=0.014),其中单支病变组与双支病变组、单支病变组与三支病变组HDL差异有统计学意义(P0.05)。4.冠心病组患者中单支病变组、双支病变组及三支病变组UA水平分别为[(248.84±57.73)、(331.81±56.63)、(360.97±76.70)],组间差异有统计学意义(P0.01),两两比较各组UA水平差异仍有统计学意义(P0.05)。5.冠心病组患者中单支病变组、双支病变组及三支病变组RHI水平分别为[(1.52±0.23)、(1.44±0.19)、(1.40±0.19)],组间差异有统计学意义(P=0.025),其中单支病变组与三支病变组RHI差异有统计学意义(P=0.007)。结论1.在冠心病患者中HDL为血管内皮功能正常的保护因素,且HDL与血管内皮功能呈线性正相关;而UA为血管内皮功能正常的危险因素,且UA水平与血管内皮功能呈负相关。提示提高HDL与降低UA可能会对血管内皮功能有改善作用。2.随着冠脉病变程度的加重,RHI逐渐下降,而UA逐渐升高。提示UA、血管内皮功能与冠脉病变程度相关,它们可以预测冠状动脉病变程度。
[Abstract]:Objective to investigate the relationship between high density lipoprotein (HDL) and vascular endothelial function in patients with coronary heart disease (heart) and the relationship between these three factors and the severity of coronary artery disease.Methods A total of 243 suspected CHD patients from April 2014 to October 2015 in Henan Provincial people's Hospital were selected. All the patients underwent coronary angiography. Among them, 146 cases were positive for coronary artery disease.97 patients with negative coronary arteriography were non-coronary heart disease group. All the patients were examined with Endo-PAT2000 instrument for vascular endothelial function. The RHI (reactive hyperemia index reactive hyperemia index) was obtained by computer correction.The differences of blood lipid level, liver function, renal function, UA and RHI were compared between the two groups, and the influencing factors of vascular endothelial function (RHI) were analyzed by two-classification Logistic regression analysis according to whether RHI was normal or not.Pearson correlation analysis was used to study the relationship between RHI and RHI in coronary heart disease group. According to the degree of coronary artery disease, the patients in coronary heart disease group were divided into three subgroups: single vessel lesion group (37 cases), double vessel lesion group (48 cases) and three vessel disease group (61 cases).Analysis of variance was used to compare the differences of HDLLA UA and RHI among subgroups.Result 1.The vascular endothelial function assessment index (RHI) in coronary heart disease group was lower than that in non-coronary heart disease group, and the difference was statistically significant [0.99 卤0.24 mmol / L 1.08 卤0.24 mmol / L = 1.6 卤0.3 vs 1.8 卤0.5].However, the level of UA in coronary heart disease group was higher than that in non-coronary heart disease group, and the difference was statistically significant [325.07 卤79.87)umol/l vs 321.52 卤85.50)umol/l] P 0.01g 路2.There was a correlation between RHI and UA levels in the two groups (the ratio was 0.802, P < 0.045).RHI was associated with hypertension in patients with non coronary heart disease (ratio: 0.979g P < 0.005).In coronary heart disease group, the correlation between HDL and HDLU UA was statistically significant (the ratio ratio was 5.132 卤0.901g / r = 0.043 卤0.004, P = 0.043 卤0.004, respectively), and there was a significant linear positive correlation between HDL and RHI. There was a linear negative correlation between RHI and RHI (r = -0.202, P = 0.014, n = 3).The HDL levels of single vessel disease group, double vessel lesion group and three vessel lesion group were 1.16 卤0.35, 1.01 卤0.25, 1.02 卤0.20, respectively. There was significant difference in HDL between single vessel lesion group and double vessel lesion group, single vessel lesion group and three vessel lesion group.The levels of UA in single vessel group, double vessel lesion group and three vessel lesion group were respectively [248.84 卤57.73andil] (331.81 卤56.63) (360.97 卤76.70). There was significant difference between the two groups (P 0.01), and there was still significant difference in UA level between two groups (P 0.05).The RHI levels of single vessel disease group, double vessel lesion group and three vessel lesion group were 1.52 卤0.23 卤0.19 卤1.40 卤0.19 respectively, and there was significant difference in RHI between the single vessel lesion group and the three vessel lesion group (P 0.007).Conclusion 1.In patients with coronary heart disease, HDL was the protective factor of normal vascular endothelial function, and HDL was positively correlated with vascular endothelial function, while UA was the risk factor of normal vascular endothelial function, and the level of UA was negatively correlated with vascular endothelial function.It is suggested that increasing HDL and decreasing UA may improve vascular endothelial function. 2. 2.With the severity of coronary artery lesion, RHI decreased and UA gradually increased.The results suggest that the vascular endothelial function is related to the severity of coronary artery lesion, and they can predict the severity of coronary artery lesion.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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