血清碱性磷酸酶水平与冠状动脉粥样硬化性心脏病的相关性分析

发布时间：2018-04-28 12:18

本文选题：冠心病 + 血清碱性磷酸酶　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:回顾性分析血清碱性磷酸酶(ALP)水平与冠心病(CHD)的相关性,及其对CHD进行危险分层的价值。方法:采集因胸痛、胸闷住院并行冠状动脉造影检查的研究对象314例,收集他们的年龄、性别、血压等一般资料及肝功能、肾功能、血脂、血糖等实验室生化检查资料。根据冠状动脉造影结果确诊CHD221例,其中稳定型心绞痛(SAP)62例、不稳定型心绞痛(UAP)89例和急性心肌梗死(AMI)70例。CHD组中,ALP升高者51例,ALP正常者170例。据Gensini评分记录冠状动脉狭窄程度,Gensini40为严重狭窄组,有151例。据Rentrop分级评价冠状动脉侧支循环(CCC)情况,Rentrop 0-1级为冠状动脉侧支循环受损,有112例。并随访半年,记录CHD组主要心血管不良事件(MACCE)的发生情况。回顾性分析ALP水平与CHD的临床分型、冠脉病变程度、冠脉侧支循环及发生MACCE的相关性,并分析ALP与其他传统指标的关联,探讨ALP水平与CHD的相关性。结果:1.ALP浓度升高者共为59例,检出率为18.79%。其中CHD组51例,异常率为23.08%;非CHD组8例,异常率为8.6%。前者明显高于后者,差异有统计学意义,x2值为4.738,P0.05。ALP升高者中男性50例,检出率84.7%;女性9例,检出率15.3%。差异无统计学意义,P0.05。2.CHD组在男性、年龄、吸烟、高血压、血糖、总胆固醇、甘油三酯、低密度脂蛋白、C反应蛋白、ALP水平均高于非CHD组,CHD组高密度脂蛋白水平低于非CHD组,仅年龄、高血压、血糖、C-反应蛋白、高密度脂蛋白、ALP水平差别有统计学意义。多变量logistic回归分析结果表明ALP水平升高是CHD的独立影响因素(OR1.027,95%CI 1.013-1.040,P0.05)。3.ALP水平在冠状动脉严重狭窄组(101.3±50.6U/L)非严重狭窄组(78.0±38.8U/L),差异有统计学意义,P0.05。采用多变量logistic回归分析结果表明ALP水平升高是冠状动脉狭窄的独立影响因素(OR1.013,95%CI 1.103-1.023,P0.05)。4.ALP水平在多支血管病变组(80.80±29.37U/L)双支血管病变组(76.53±18.15U/L)单支血管病变组(73.95±23.15U/L),差别无统计学意义,P0.05。5.ALP水平在SAP组(78.08±50.05U/L)、UAP组(80.08±48.80U/L)、AMI组(79.80±50.30U/L)无明显差异。6.CHD组中有112例(51%)观察到CCC受损。ALP水平和CCC受损分级之间有相关性,高ALP水平与CCC受损相关(65%vs 51%,p=0.03)7.单变量回归分析表明,糖尿病、高血压、年龄和ALP水平是影响CHD发生MACCE的因素。多变量logistic回归分析结果表明ALP水平升高是CHD发生MACCE的独立影响因素(OR1.112,95%CI 1.203-1.623,P0.05)。8.ALP水平与冠脉狭窄积分、高血压、C-反应蛋白呈正相关,r值分别是0.452、0.166、0.387。结论:1.血清ALP水平与CHD呈正相关,它可能是CHD的独立危险因素。2.ALP水平还与冠状动脉狭窄程度相关,可能是反映冠状动脉病情严重程度的一个指标。3.ALP水平可用与评估CCC是否受损。4.ALP升高可作为CHD发生MACCE的危险因素之一。5.ALP水平与C-反应蛋白呈线性正相关。
[Abstract]:Objective: to retrospectively analyze the correlation between serum alkaline phosphatase (ALP) level and coronary heart disease (CHD), and the value of risk stratification in CHD. Methods: 314 patients with chest pain and chest tightness were examined by coronary angiography, and their age, sex, blood pressure, liver function, renal function, blood lipid, blood sugar and other laboratory biochemical data were collected. According to the results of coronary angiography, there were 62 cases of stable angina pectoris, 89 cases of unstable angina pectoris and 70 cases of acute myocardial infarction AMI. According to Gensini score, coronary artery stenosis was recorded as severe stenosis group (151 cases). According to the Rentrop classification, the CCCs of coronary collateral circulation were evaluated. Rentrop 0-1 grade was damaged in the collateral circulation of coronary artery, there were 112 cases. The incidence of major adverse cardiovascular events (MAC) in CHD group was recorded after half a year follow-up. The correlation between ALP level and clinical type of CHD, severity of coronary artery disease, collateral circulation of coronary artery and occurrence of MACCE was analyzed retrospectively. The correlation between ALP and other traditional indexes was analyzed, and the correlation between ALP level and CHD was discussed. Results: 1. The ALP concentration was increased in 59 cases, and the detection rate was 18.79%. The abnormal rate was 23.08 in CHD group and 8.6 in non- group. The former was significantly higher than the latter, and the difference was statistically significant (P 0.05. 05.ALP 4.738g) in 50 males (84.7%) and 9 females (15.3%). There was no significant difference in the levels of CHD, age, smoking, hypertension, blood glucose, total cholesterol, triglyceride, low density lipoprotein C-reactive protein (LDL-C) in CHD group compared with that in non-CHD group. There were significant differences in ALP levels among hypertension, glucose C-reactive protein and high density lipoprotein. The results of multivariate logistic regression analysis showed that the increase of ALP level was an independent factor of CHD. The CI 1.013-1.040 P0.05U 路3.ALP level was significantly higher in the coronary artery stenosis group (101.3 卤50.6 UL / L) than in the non-severe stenosis group (78.0 卤38.8 UL / L, P 0.05). Multivariate logistic regression analysis showed that elevated ALP level was an independent influencing factor for coronary artery stenosis (CI 1.103-1.023 P0.05N .4.ALP level was 80.80 卤29.37U / L in multivessel disease group) and 76.53 卤18.15U / L group in single vessel disease group (73.95 卤23.15U / L), there was no significant difference. There was no significant difference in P0.05.ALP level between SAP group (78.08 卤50.05U / L) and SAP group (80.08 卤48.80U / L + 58.80U / L). High ALP level is associated with CCC damage. Univariate regression analysis showed that diabetes, hypertension, age and ALP levels were the factors influencing MACCE in CHD. Multivariate logistic regression analysis showed that the increase of ALP level was the independent influencing factor of MACCE in CHD. The correlation between the level of ALP and coronary stenosis score was 0.203 ~ 1.623 (P < 0.05), and the positive correlation value of C-reactive protein in hypertension was 0.452n0.166n 0.387, respectively. Conclusion 1. Serum ALP level was positively correlated with CHD, which may be an independent risk factor for CHD. 2. ALP level was also correlated with coronary artery stenosis. ALP level may be a marker of severity of coronary artery disease. 3. ALP level can be used to evaluate whether CCC is damaged or not. 4. ALP elevation may be one of the risk factors for MACCE in CHD. 5. ALP level is linearly correlated with C- reactive protein.
【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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