非急性心肌梗死的左束支传导阻滞患者存在冠脉病变的危险因素分析

发布时间：2018-05-02 16:44

本文选题：左束支传导阻滞 + 冠脉病变　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过收集心电图提示左束支传导阻滞(LBBB)且除外急性心肌梗死患者的冠脉造影结果及高血压、糖尿病、血脂异常、高尿酸血症、吸烟史等病例数据,分析左束支传导阻滞患者同时存在或继发于冠状动脉病变的相关危险因素。从而当发现左束支传导阻滞的患者且尚未明显束支阻滞的病因时,可以指导哪些患者更应该行冠脉造影进一步检查。方法:本研究回顾性统计2014年1月-2016年12月间我院心内科住院患者,入组患者需心电图检查符合左束支传导阻滞改变,并除外急性心肌梗死患者,收集冠状动脉造影结果及病史等相关检查。将出现严重冠脉病变(至少1支冠脉血管狭窄程度大于50%)的患者共36例分为阳性组,冠状动脉无明显变化者(每支冠脉血管斑块狭窄程度小于50%)共101例分为对照组,记录年龄、高血压病、糖尿病、血脂异常、高尿酸血症、吸烟史等,再将受试者的各因素进行相对危险度分析,得出相关性因素,再行多因素相关性分析,以分析LBBB的患者冠脉病变的可能危险因素。结果:1、行单因素分析,得出性别、高血压、糖尿病、高尿酸四项无统计学意义,p值0.05,为非相关因素;年龄、血脂异常、吸烟史三项存在统计学差异,p值0.05,提示三者为左束支传导阻滞合并冠脉病变的相关因素;2、行多因素相关分析后得出结论:血脂异常无统计学意义,p值0.05,年龄、吸烟史存在统计学意义,p值0.05,提示二者为影响左束支传导阻滞合并冠脉病变的独立危险因素,且年龄每增加1岁,患病的危险性增加33.7%,有吸烟的人患病的危吸性是没有吸烟的人患病危险性的343.9%。3、计算得出疾病的初步预测公式为并求出最佳的cutoff截断值为0.595,此时的灵敏度为0.806,特异度为0.99。结论:1、年龄、高LDL、吸烟史为左束支传导阻滞合并冠脉病变的相关因素,其中年龄、吸烟史为影响患病的独立危险因素;2、初步预测左束支传导阻滞患者存在冠脉病变的公式:
[Abstract]:Objective: to collect the results of coronary angiography, hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, smoking history and so on in patients with left bundle branch block (LBBB) except acute myocardial infarction (AMI). To analyze the risk factors associated with coronary artery disease in patients with left bundle branch block. When the cause of left bundle branch block is found and no obvious cause of bundle branch block is found which patients should be further examined by coronary angiography. Methods: from January 2014 to December 2016, the patients in our hospital underwent electrocardiogram (ECG) according to the changes of left bundle branch block, except for the patients with acute myocardial infarction. The results of coronary angiography and history were collected. A total of 36 patients with severe coronary artery disease (at least one coronary artery stenosis greater than 50) were divided into positive group and 101 patients with no significant change of coronary artery (less than 50 coronary artery stenosis) were divided into control group, recording age. Hypertension, diabetes, dyslipidemia, hyperuricemia, smoking history, and so on. To analyze the possible risk factors of coronary artery disease in patients with LBBB. Results the results showed that sex, hypertension, diabetes and hyperuricemia were not significantly correlated with sex, hypertension, diabetes, hyperuricemia, age and dyslipidemia. There was a statistical difference between the three factors in smoking history (P = 0.05), which suggested that the three factors were related factors of left bundle branch block with coronary artery disease. After multivariate correlation analysis, it was concluded that there was no significant difference in blood lipids (P < 0.05). There was a statistically significant P value of 0.05 in smoking history, suggesting that both of them were independent risk factors of left bundle branch block complicated with coronary artery disease, and the age increased by 1 year. The risk of disease was increased by 33.7, and the risk of smoking was 343.99.3.The optimal cutoff cut-off value was 0.595.The sensitivity was 0.806 and the specificity was 0.99. Conclusion: age, high LDL, smoking history are related factors of left bundle branch block with coronary artery disease. Age and smoking history are independent risk factors influencing the disease. The formula of predicting coronary artery disease in patients with left bundle branch block is preliminarily predicted.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

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