探讨血清尿酸与不稳定心绞痛冠脉病变程度及远期不良事件的关联性

发布时间：2018-04-23 14:47

本文选题：尿酸 + 不稳定型心绞痛　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:探讨血清尿酸与不稳定心绞痛患者冠状动脉病变程度相关性及其预测心血管不良事件的可能性。方法:选取入住我科病人270例(根据其主诉症状暂拟为不稳定型心绞痛),男性138例,女性132例,根据经皮冠状动脉造影术和患者主诉症状及心肌坏死标志物结果分为不稳定型心绞痛组188例和对照组82例。收集病例的临床资料(性别,年龄,高血压病史,糖尿病史,吸烟史);实验室检查数据(生化常规,血常规,凝血功能);冠状动脉造影术结果(计算Gensini积分),比较不同组间血清尿酸水平与冠状动脉病变程度的相关性;通过通信设备及门诊收集完成对不稳定型心绞痛组病人术后6个月起2年期内是否发生心血管不良心血管事件(包括反复发作的不稳定性心绞痛、新发心肌梗死、缺血性心律失常、脑血管事件、心源性猝死、充血性心力衰竭)跟踪随访收集工作,通过非条件多因素二元Logistic回归模型分析血清尿酸水平是否为预测心血管不良事件的独立预测因子。结果:1.不稳定型心绞痛组的男性比例、平均年龄及高血压病患病率、糖尿病患病率、吸烟史均高于对照组;不稳定型心绞痛组患者尿酸水平及低密度脂蛋白水平明显高于对照组(333.07±65.95vs284.02±68.29,P=0.001;2.73±0.85vs2.47±0.84,P=0.024),高密度脂蛋白(HDL)水平则低于对照组(1.03±0.26vs1.21±0.36,P=0.001)。2.双支病变组尿酸水平高于单支病变组和对照组(326.89±48.99vs299.75±60.24,P=0.008;326.89±48.99vs284.02±68.29,P=0.001),多支病变组尿酸水平高于双支病变组和单支病变组及对照组(365.35±62.55vs326.89±48.99,P=0.001;365.35±62.55vs299.75±60.24,P0.001;365.35±62.55vs284.02±68.29,P0.001)。3.尿酸与Gensini积分呈正相关(r=0.548,P0.001),高密度脂蛋白与Gensini积分呈负相关(r=-0.088,P=0.043),低密度脂蛋白与Gensini积分呈正相关(r=0.046,P=0.001)。4.预测不稳定型心绞痛患者心血管不良事件的因子为尿酸(OR=4.431,95%CI1.003-1.017,P0.001)和高密度脂蛋白(OR=0.869,95%CI 0.125-1.353,P=0.022)。5.尿酸水平与年龄呈正相关(r=0.265,P=0.0.041),尿酸水平与肌酐水平呈正相关(r=1.476,P=0.023)。6.不同尿酸水平组心血管不良事件发生率存在差异(57.14%vs60.86%vs62.22%vs65.96%,P0.001),发生反复发作的不稳定性心绞痛的概率存在显著差异(34.69%vs36.96%vs39.13%vs40.43%,P0.001),发生充血性心力衰竭的概率存在差异(18.37%vs19.57%vs20.02%vs21.27%,P=0.042),且随着尿酸水平提高其全部心血管不良事件、发生不稳定性心绞痛、充血性心力衰竭的概率增大。结论:1.不稳定型心绞痛患者尿酸水平明显高于对照组,高血清尿酸水平是不稳定型心绞痛的危险因素之一。2.血清尿酸水平与冠状动脉病变程度存在相关性,其水平随冠状动脉病变程度增加而升高。3.血清尿酸水平与不稳定型心绞痛患者远期心血管不良事件的发生呈正相关,尿酸升高可以作为不稳定型心绞痛患者远期预后不良的预测因子之一。
[Abstract]:Objective: to investigate the correlation between serum uric acid and coronary artery disease in patients with unstable angina pectoris and the possibility of predicting adverse cardiovascular events. Methods: a total of 270 patients (138 males and 132 females) with unstable angina pectoris according to their main complaints were selected. According to the results of percutaneous coronary angiography, main complaint symptoms and myocardial necrosis markers, 188 cases of unstable angina pectoris group and 82 cases of control group were divided into two groups. Collect clinical data (sex, age, history of hypertension, history of diabetes, history of smoking), laboratory data (biochemical routine, blood routine), Results of coronary angiography (Gensini score was calculated to compare the correlation between serum uric acid level and severity of coronary artery disease in different groups). Whether cardiovascular adverse cardiovascular events (including recurrent unstable angina pectoris, new myocardial infarction) occurred in 2 years from 6 months after operation in patients with unstable angina pectoris were completed by means of communication equipment and outpatient collection. Ischemic arrhythmias, cerebrovascular events, sudden cardiac death, congestive heart failure) follow up and collect, To analyze whether serum uric acid level is an independent predictor of cardiovascular adverse events by non conditional multivariate Logistic regression model. The result is 1: 1. The proportion of men, average age, prevalence of hypertension, diabetes mellitus and smoking history in unstable angina pectoris group were higher than those in control group. The levels of uric acid and low density lipoprotein in patients with unstable angina pectoris were significantly higher than those in the control group (333.07 卤68.29P0. 001and 2. 73 卤0. 84 0.85vs2.47 卤0. 84), while the levels of high density lipoprotein (HDL) were lower than those in the control group (1. 03 卤0.26vs1.21 卤0. 36). The level of uric acid in the double vessel lesion group was higher than that in the single vessel lesion group and the control group (326.89 卤60.24 48.99vs299.75 卤326.89 卤68.29). The uric acid level in the multi-vessel lesion group was higher than that in the double vessel lesion group and the single vessel lesion group and the control group. The level of uric acid was 365.35 卤62.55vs299.75 卤60.24 P 0.001 卤365.35 卤62.55vs284.02 卤68.29P 1. There was a positive correlation between uric acid and Gensini score, a negative correlation between high density lipoprotein and Gensini score, a positive correlation between low density lipoprotein and Gensini score, a negative correlation between HDL and Gensini score, and a positive correlation between low density lipoprotein and Gensini score. The risk factors for predicting cardiovascular adverse events in patients with unstable angina pectoris were as follows: uric acid ORL 4.431 / 95 CI 1.003-1.017 P0.001) and high density lipoprotein (HDL) 0.86995 CI 0.125-1.353Pai 0.0222.5.The risk factors for predicting cardiovascular adverse events in patients with unstable angina pectoris were as follows: 4.431% CI 1.003-1.017 P0.001). There was a positive correlation between uric acid level and age, and a positive correlation between uric acid level and creatinine level, and a positive correlation between uric acid level and creatinine level. There were significant differences in the incidence of cardiovascular adverse events in different uric acid groups (57.14 vs 60.86 and 52.22 vs 65.96), and there were significant differences in the probability of recurrent unstable angina pectoris (34.69 vs 36.96 vs 39.13 vs 40.43). There were significant differences in the probability of congestive heart failure (18.37 vs 19.57 vs 20.02 vs 21.27) and with the uric acid level (P 0.042). To improve all adverse cardiovascular events, Unstable angina pectoris increases the probability of congestive heart failure. Conclusion 1. The level of uric acid in patients with unstable angina pectoris was significantly higher than that in the control group, and high serum uric acid level was one of the risk factors of unstable angina pectoris. The level of serum uric acid was correlated with the severity of coronary artery lesion, and the level of uric acid increased with the increase of coronary artery lesion. The level of serum uric acid was positively correlated with the occurrence of long-term cardiovascular adverse events in patients with unstable angina pectoris. Elevated uric acid may be one of the predictors of poor long-term prognosis in patients with unstable angina pectoris.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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