脂蛋白a血浆浓度与冠脉成形术后冠脉狭窄的相关性研究

发布时间：2018-05-12 19:43

本文选题：冠心病 + 冠脉成形术　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:探讨脂蛋白a血浆浓度与冠心病患者行冠脉成形术后,在相关药物干预下冠脉病变进展是否相关性。并进一步探讨脂蛋白a与冠脉狭窄的部位以及狭窄的严重程度具体的相关情况。资料与方法:选择2013年1月—2014年12月因冠心病‖再次入院接受冠脉造影的患者。同时要求入组的患者既往有一次或以上的冠脉造影术手术史。收集再次入院和之前最近一次的冠脉造影资料。包括两次冠脉造影时患者的基础资料,实验室检查资料,前次出院后的服药资料,两次冠脉造影的间隔时间等。通过比较两次冠脉造影结果,将患者分为冠脉血管病变未进展的对照组‖和冠脉发生狭窄的病例组‖。利用 Logistic回归分析‖、 t检验‖、卡方检验‖并通过计算相对风险比‖等方法进行统计分析。探讨脂蛋白a与冠脉狭窄发生的相关性。并且进一步在病例组‖中行亚组分析,按脂蛋白a血浆浓度高低分组,探讨脂蛋白a血浆浓度与冠脉狭窄的发生部位以及冠脉狭窄程度的相关性。结果:有200例患者符合本研究要求纳入分析,其中未发生冠脉狭窄的对照组‖共101例,发生冠脉狭窄的病例组‖共99例。首先通过Logistic回归分析得出:脂蛋白a、糖尿病史、男性三个因素与冠脉成形术后冠脉狭窄是相关的。且脂蛋白a浓度越高,冠脉狭窄发生率越高,脂蛋白a血浆浓度高于213.6mg/L的患者冠脉狭窄发生率为58.00%,脂蛋白a血浆浓度低于53.25mg/L的患者冠脉狭窄发生率为38%,两组差异有统计学意义P=0.045。进一步的亚组分析发现脂蛋白a高于213.6mg/L的患者发生均再狭窄‖即多部位狭窄的风险是脂蛋白a低于213.6mg/L患者的3.488倍(P=0.019)。脂蛋白a高于213.6mg/L的患者发生冠脉显著狭窄‖的风险是脂蛋白a低于213.6mg/L患者的2.647倍(P=0.046)。结论:脂蛋白a的血浆浓度与冠脉成形术后冠脉狭窄是相关的,脂蛋白a血浆浓度越高发生冠脉狭窄的风险越大。且随着脂蛋白a浓度升高,发生冠脉内狭窄的部位可能越多,狭窄程度也将可能越严重。
[Abstract]:Aim: to investigate the correlation between plasma lipoprotein a concentration and coronary artery disease progression after coronary angioplasty in patients with coronary heart disease. Furthermore, the relationship between lipoprotein a and the location and severity of coronary stenosis was investigated. Materials and methods: patients who received coronary angiography from January 2013 to December 2014 were re-admitted to hospital for coronary artery disease. Patients in the group were also required to have one or more previous coronary angiography procedures. Coronary angiography data were collected for readmission and the most recent coronary angiography. It includes the basic data of patients during two coronary angiography, laboratory examination data, medication data after discharge from hospital, the interval between two coronary angiography and so on. By comparing the results of two coronary angiography, the patients were divided into two groups: the control group and the coronary stenosis group. By using Logistic regression analysis, t test and chi-square test, the statistical analysis was carried out by calculating the relative risk ratio. To investigate the relationship between lipoprotein a and coronary stenosis. Furthermore, the subgroup analysis was carried out in the case group. According to the plasma concentration of lipoprotein a, the relationship between the plasma concentration of lipoprotein a and the location of coronary artery stenosis and the degree of coronary stenosis was discussed. Results: there were 200 patients who met the requirements of this study, including 101 cases in the control group without coronary stenosis and 99 cases in the group of patients with coronary artery stenosis. First, Logistic regression analysis showed that lipoprotein a, diabetes history and male were associated with coronary stenosis after coronary angioplasty. The higher the concentration of lipoprotein a was, the higher the incidence of coronary stenosis was. The incidence of coronary stenosis was 58.00 in patients with higher lipoprotein a plasma concentration than that in 213.6mg/L, and 38 in patients with lower lipoprotein a plasma concentration than that in 53.25mg/L. The difference between the two groups was statistically significant (P < 0.045). Further subgroup analysis showed that patients with higher lipoprotein a than 213.6mg/L had a higher risk of restenosis, that is, multisite stenosis was 3.488 times lower than that of patients with 213.6mg/L. The risk of significant coronary stenosis in patients with lipoprotein a higher than 213.6mg/L was 2.647 times lower than that in patients with 213.6mg/L. Conclusion: the plasma concentration of lipoprotein a is associated with coronary stenosis after coronary angioplasty, and the higher the plasma concentration of lipoprotein a is, the greater the risk of coronary stenosis is. With the increase of lipoprotein a concentration, the more stenoses in the coronary artery, the more severe the stenosis may be.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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