PNN50与冠状动脉慢血流现象相关性研究

发布时间：2018-04-16 23:31

本文选题：冠状动脉慢血流现象 + TIMI血流计帧法　；参考：《郑州大学》2016年硕士论文

【摘要】：背景随着冠状动脉造影的普及,越来越多的冠状动脉病变现象被发现,冠状动脉慢血流现象就是其中之一,冠状动脉慢血流现象是指冠状动脉没有明显的狭窄病变却发生造影剂灌注延迟的现象。国内外对此现象发病率报道不一,Hawkins等发现5.5%怀疑冠心病的患者存在SCF,有报道称因胸痛进行冠脉造影的患者约7%存在冠状动脉慢血流现象。目前认为冠状动脉慢血流现象的发病机制与冠状动脉血管内皮功能不良、血液粘滞度、冠状动脉硬化、微血管病变、神经体液改变等密切相关,且发现其与冠心病的危险因素有重叠部分,部分患者可能会出现严重的心血管事件甚至是猝死。目前更多的关于慢血流的研究多集中于血生化和血管内皮功能不良,而对血管自主神经调节障碍导致血管舒张障碍却较少关注。动态心电图作为心血管内科常见的重要辅助检查之一,不仅能发现患者是否存在各种心律失常现象,更重要的是能有效反映患者的心率变异性情况,评价心脏迷走神经和交感神经的紧张性、均衡性及其对心血管活动的影响。PNN50是动态心电图检查中反映心率变异性的重要指标,是指相邻窦性R-R间期差值50ms所占百分比,主要反映迷走神经张力水平。本研究通过这一检测指标来评测冠状动脉慢血流患者的神经张力变化,分析其与冠状动脉慢血流的相关性。目的探讨PNN50与冠状动脉慢血流现象发生的相关性。方法连续入选2014年1月~2016年2月河南省郑州大学第一附属医院心内科行CAG显示冠状动脉无明显狭窄及瘤样扩张者300人。根据TIMI帧数法分为两组,慢血流组123人(男性57人,年龄54.7±9.02岁)和正常血流组177人(男性86人,年龄53.62±8.91岁),两组患者均进行24小时动态心电图检测,分析两组心率变异性指标PNN50差异,利用Logistic回归分析得出冠状动脉慢血流现象发生的影响因素。结果数据分析结果显示两组患者在性别、年龄、合并疾病如高血压、糖尿病等一般资料的比较上差异无统计学意义(P0.05)。其中慢血流组的红细胞压积(40.7±3.8 vs.37.3±3.3,P0.05)、C反应蛋白水平(11.35±4.73 vs.4.66±3.20,P0.05)高于冠状动脉正常组,PNN50(14.2±7.3 vs.22.8.±6.2,P0.05)低于冠脉正常组,差异有统计学意义(P0.05),Logistic分析结果表明,红细胞压积、C反应蛋白是影响冠状动脉慢血流的危险因素,PNN50是冠状动脉慢血流的保护因素。结论PNN50下降是冠脉慢血流现象发生的独立危险因素。
[Abstract]:Background with the popularity of coronary angiography, more and more coronary artery lesions have been discovered, among which the slow flow of coronary artery is one of them.Slow flow of coronary artery is a phenomenon of delayed perfusion of contrast media without obvious stenosis of coronary artery.Hawkins et al found that 5.5% of the patients suspected of coronary heart disease had SCF, and about 7% of the patients who underwent coronary angiography due to chest pain had the phenomenon of slow flow of coronary artery.At present, it is believed that the pathogenesis of coronary slow flow phenomenon is closely related to coronary artery endothelial dysfunction, blood viscosity, coronary artery sclerosis, microvascular disease, neurohumoral changes, etc.It was found that it overlapped with the risk factors of coronary heart disease, and some patients might have severe cardiovascular events or even sudden death.At present, more studies on slow blood flow focus on blood biochemistry and vascular endothelial dysfunction, while less attention is paid to vascular vasodilation due to autonomic nervous dysfunction.As one of the most important auxiliary examinations in cardiovascular medicine, ambulatory electrocardiogram can not only find out whether there are any arrhythmia in patients, but also reflect the heart rate variability of patients.Evaluation of cardiac vagus nerve and sympathetic nerve tension, equilibrium and its effect on cardiovascular activity. PNN50 is an important indicator of heart rate variability in dynamic electrocardiogram examination, which refers to the percentage of adjacent sinus R-R interval difference (50ms).It mainly reflects the level of vagus nerve tension.In this study, we evaluated the changes of nerve tension in patients with slow coronary artery flow and analyzed its correlation with slow flow of coronary artery.Objective to investigate the correlation between PNN50 and slow flow of coronary artery.Methods from January 2014 to February 2016, 300 consecutive patients with coronary artery stenosis and tumor-like dilatation were selected for CAG examination in Department of Cardiology, first affiliated Hospital of Zhengzhou University, Henan Province.According to the TIMI frame count method, 123 patients in the slow flow group (57 males, aged 54.7 卤9.02 years) and 177 patients in the normal blood flow group (86 males, 53.62 卤8.91 years old) were divided into two groups.The difference of heart rate variability (PNN50) between the two groups was analyzed and the influencing factors of coronary slow flow were obtained by Logistic regression analysis.Results the data analysis showed that there was no significant difference in sex, age, complicated diseases such as hypertension and diabetes between the two groups (P 0.05).The hematocrit in the slow flow group (40.7 卤3.8 vs.37.3 卤3.3 vs.37.3 卤3.3 vs.4.66 卤3.05 vs.4.66 卤3.20 vs.4.66 卤3.20 vs.4.66 P 0.05) was significantly higher than that in the normal coronary artery group (14.2 卤7.3 vs.22.8. 卤6.2 vs.37.3, P 0.05), and the difference was statistically significant (P 0.05).Hematocrit C reactive protein (CRP) is a risk factor for the slow flow of coronary artery. PNN50 is the protective factor of slow flow of coronary artery.Conclusion the decrease of PNN50 is an independent risk factor for the occurrence of slow coronary flow.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4

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