GRACE危险评分与拟诊非ST段抬高急性冠脉综合征患者冠脉病变程度的关联研究

发布时间：2018-04-18 11:19

本文选题：GRACE评分 + 非ST段抬高急性冠脉综合征　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:分析GRACE评分(the Global Registry of Acute Coronary score,GRACE)与冠脉病变程度之间的相关性,后者可用Gensini评分表示,探讨GRACE评分在拟诊非ST段抬高急性冠脉综合征(NSTE-ACS)患者冠脉病变狭窄严重程度的评估方面的价值,为此类患者的临床治疗决策提供依据。方法:收集2014年9月至2015年1月在山西医科大学第一医院心内科住院期间的非ST段抬高急性冠脉综合征(NSTE-ACS)患者102例,入院后常规检查血生化、心机标志物、血压、心电图、心脏彩色多普勒超声、腹部彩色多普勒超声等,根据检查结果及患者的基本资料计算出GRACE危险评分,依据GRACE评分系统将患者分为低危组(n=63,61.8%)、中危组(n=30,29.4%)及高危组(n=9,8.8%)。所有的患者在入院期间均于3天内行冠脉造影术,术中根据冠脉病变部位及狭窄程度计算Gensini评分用于代表冠脉病变程度,统计分析使用SPSS17.0软件。结果:1.低危组Gensini评分为0(0,10),中危组为5.3(0,20.6),高危组为38.5(12.3,57.8),Kruskal-Wallis H检验分析表明三组比较差异具有显著性(p0.001),Nemenyi法两两比较表明高危组与低危组相比,差异具有显著性(p0.005),与中危组相比,差异仍具有显著性(p0.005)。2.Spearman相关分析表明GRACE评分与Gensini评分具有相关性(r=0.334,p0.001)。3.正常血管、单支、双支及三支血管病变患者分别占42.2%(43例)、25.5%(26例)、16.7%(17例)、15.7%(16例)。三支病变或左主干病变患者在低危组占12.7%,中危组占13.3%,在高危组占55.6%(p0.001),高危组与低危组相比,差异具有显著性(p0.001)。4.25例患者患有糖尿病(24.5%),其中8例冠脉血管正常(32%),7例患者有左主干或三支病变(28%),本研究的小组分析表明,糖尿病与非糖尿病患者Gensini评分相比,差异无显著性(10.5(0,43.5)vs 3(0,12),p=0.074)。结论:研究显示GRACE评分在拟诊NSTE-ACS患者冠脉病变程度的评估方面有重要价值。GRACE评分高危的患者有更严重的冠脉病变,因此在第一个24小时,对于这些患者的早期干预非常重要。
[Abstract]:Objective: to analyze the correlation between the Global Registry of Acute Coronary score and the severity of coronary artery lesion, which can be expressed by Gensini score.To investigate the value of GRACE score in evaluating the severity of coronary stenosis in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSS).Methods: from September 2014 to January 2015, 102 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSS) who were hospitalized in Department of Cardiology, first Hospital of Shanxi Medical University were collected. Blood biochemistry, cardiac markers, blood pressure, electrocardiogram (ECG) were examined routinely after admission.Cardiac color Doppler ultrasound and abdominal color Doppler ultrasound were used to calculate the GRACE risk score according to the examination results and the basic data of the patients. According to the GRACE scoring system, the patients were divided into two groups: the low risk group (63.38%) and the middle risk group (30 ~ (29. 4)) and the high risk group (9 ~ 8.8%).All the patients underwent coronary angiography within 3 days during admission. The Gensini score was calculated according to the location of coronary artery lesion and the degree of stenosis during the operation. The SPSS17.0 software was used for statistical analysis.The result is 1: 1.The Gensini score of low risk group was 0 ~ 0 ~ 10 ~ (th), that of middle risk group was 5. 3 / 0 ~ 20. 6%, and that of high risk group was 38. 5 / 12. 3 / 3 ~ 57. 8% Kruskal-Wallis H test analysis showed that there was a significant difference between the three groups by p0. 001 and Nemenyi method, which indicated that there was significant difference between high risk group and low risk group (P 0. 005, P 0. 005).Spearman correlation analysis showed that there was a correlation between GRACE score and Gensini score.43 cases of normal vessel, single vessel, double vessel and three vessel disease accounted for 43 cases and 26 cases were involved in 16 cases.In the low risk group, the middle risk group accounted for 13.3%, the high risk group accounted for 55.6% P 0.001, the high risk group was compared with the low risk group, and the patients with three vessel disease or left main trunk disease accounted for 12.7%, 13.3% and 55.6% respectively, compared with the low risk group.The difference was significant (P 0.001) .4.25 patients had diabetes mellitus 24.555, among which 8 patients with normal coronary vessels had left main trunk or three-vessel lesions. The group analysis of this study showed that there was no significant difference in Gensini score between diabetic patients and non-diabetic patients. There was no significant difference in Gensini score between diabetes mellitus patients and non-diabetic patients (n = 8, n = 8, n = 8, n = 32, n = 7), there was no significant difference in Gensini score between diabetic patients and non-diabetic patients (n = 7, n = 7).Conclusion: GRACE score has important value in evaluating the degree of coronary artery lesion in patients with NSTE-ACS. Grace score has more serious coronary artery disease in high-risk patients, so early intervention is very important for these patients at the first 24 hours.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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