颈动脉斑块和血同型半胱氨酸水平对冠心病的预测价值研究

发布时间：2018-04-14 22:29

本文选题：颈动脉斑块 + Crouse积分　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:研究颈动脉斑块和血同型半胱氨酸水平二者联合对于冠心病是否有预测价值以及颈动脉斑块Crouse积分、血浆同型半胱氨酸水平的高低与冠脉病变的严重程度之间的相关性。方法:收集山西医科大学第一医院心内科2015年7月至2016年8月拟诊为冠心病的住院患者,符合入选及排除标准者共205例。所有入选者均收集一般资料,并行化验血同型半胱氨酸、颈部血管彩超、冠状动脉造影3项检查,依据冠状动脉造影结果分为两组,病例组108例,对照组97例。分别计算颈动脉斑块、高同型半胱氨酸血症(HHcy)以及颈动脉斑块联合HHcy诊断冠心病(CHD)的灵敏度(Se)、特异度(Sp)、阳性预测值(PPV)、阴性预测值(NPV),并比较不同诊断试验的评价指标。判断颈动脉斑块Crouse积分、血同型半胱氨酸水平高低与冠脉病变严重程度的相关性。结果:1、冠心病不同危险因素之间比较,如高血压、糖尿病、血脂异常、家族史等,两组之间没有差别(P0.05);两组之间的颈动脉斑块及血Hcy水平有差别(P0.05)。2、颈动脉斑块诊断冠心病的灵敏度为82.4%,特异度为35.0%,阳性预测值为58.6%,阴性预测值为64.2%。3、HHcy诊断冠心病的灵敏度为63.0%,特异度为38.1%,阳性预测值为53.1%,阴性预测值为48.0%。4、颈动脉斑块与HHcy串联联合诊断冠心病的灵敏度为52.8%,特异度为59.8%,阳性预测值为59.4%,阴性预测值为53.2%;颈动脉斑块与HHcy并联联合诊断冠心病的灵敏度为92.6%,特异度为12.4%,阳性预测值为54.1%,阴性预测值为60.0%。5、Pearson相关性检验显示:在89例颈动脉斑块阳性的冠心病患者中,Gensini积分与Crouse积分的相关系数为0.234(P=0.027);Gensini积分与血Hcy水平的相关系数为0.250(P=0.018)。结论:1、颈动脉斑块和血同型半胱氨酸水平二者联合对冠心病有一定的预测价值,二者联合预测价值优于二者中单一因素对冠心病的预测价值。2、颈动脉斑块Crouse积分、血同型半胱氨酸水平高低与冠脉病变严重程度存在相关性。
[Abstract]:Aim: to study the predictive value of carotid plaque and serum homocysteine level in coronary artery disease (CHD) and the correlation between plasma homocysteine level and severity of coronary artery disease.Methods: 205 patients who were diagnosed as coronary heart disease from July 2015 to August 2016 in the Department of Cardiology of the first Hospital of Shanxi Medical University were collected.All the participants collected general data and examined homocysteine, color Doppler ultrasound and coronary arteriography. According to the results of coronary angiography, they were divided into two groups: 108 cases in the case group and 97 in the control group.The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque, hyperhomocysteinemia and carotid plaque combined with HHcy in the diagnosis of coronary artery disease were calculated respectively.The correlation between carotid plaque Crouse score, serum homocysteine level and severity of coronary artery lesion was evaluated.Results 1. The risk factors of coronary heart disease were compared, such as hypertension, diabetes, dyslipidemia, family history, etc.There was no difference between the two groups in Hcy levels in carotid plaque and blood. The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque were 82.4, 35.0g, 58.6 and 64.2hHHcy in diagnosing coronary heart disease, respectively, and the sensitivity of carotid plaque in diagnosing coronary heart disease was 82.4, the specificity was 35.0, the positive predictive value was 58.6 and the negative predictive value was 64.2.3HHcy in the diagnosis of coronary heart disease.Sensitivity was 63.0, specificity was 38.1, positive predictive value was 53.1, negative predictive value was 48.0. 4. The sensitivity, specificity, positive predictive value and negative predictive value of carotid plaque and HHcy were 52.8, 59.8, 59.4and 53.2, respectively.The sensitivity, specificity, positive predictive value and negative predictive value of HHcy in the diagnosis of coronary heart disease were 92.6 and 12.4, respectively. The negative predictive value was 60.0.5Pearson correlation test showed that in 89 patients with coronary heart disease with positive carotid plaque, the correlation between Gensini score and Crouse score was significant.The correlation coefficient between the Gensini integral and the blood Hcy level was 0.234 and 0.027 and the correlation coefficient was 0.250 and 0.018.Conclusion the combination of carotid plaque and serum homocysteine level has certain predictive value for coronary heart disease. The combined predictive value of the two factors is better than that of single factor in predicting coronary heart disease. The Crouse score of carotid plaque is better than that of the single factor.The level of homocysteine was correlated with the severity of coronary artery disease.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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