n-3PUFAS对稳定型心绞痛患者Lp-PLA2、LDL及脂蛋白a的影响

发布时间：2018-05-14 22:13

本文选题：冠状动脉疾病 + 脂肪酸类　；参考：《青岛大学》2017年硕士论文

【摘要】：目的通过回顾性和前瞻性随访调查相结合的研究方法,研究Omerga-3多不饱和脂肪酸(n-3PUFAS)对稳定型心绞痛患者脂蛋白磷脂酶A2(Lp-PLA2)、低密度脂蛋白(LDL)和脂蛋白a水平的影响,为Omerga-3多不饱和脂肪酸治疗稳定型心绞痛提供临床依据。方法回顾性研究对青岛大学医学院附属医院心血管内科2014年1月至2015年1月收录的全部稳定型心绞痛患者的出院病例于本院“联众系统”进行检索,共纳入了214例患者,排除不符合纳入要求的和失访的患者,实际随访人数为150人,随访内容包括患者一般信息,冠心病危险因素(年龄、性别、体重指数、高血压、糖尿病、血脂异常、吸烟史)、目前药物治疗情况、出院后1年内鱼油使用情况。随访终止时间为2015年6月30日,根据患者鱼油使用情况将患者分为鱼油组和常规组,其中鱼油组为36人,常规组114人。门诊或电话通知随访患者返院检测Lp-PLA2及脂蛋白a,初步观察n-3PUFAS对Lp-PLA2及脂蛋白a水平的影响。前瞻性研究选取青岛大学附属医院心内科80名经冠状动脉造影诊断为稳定型心绞痛的患者,随机分为对照组和试验组,每组各40例。所有纳入的对象均根据情况给予规范化的抗冠心病治疗,包括阿司匹林抗血小板、瑞舒伐他汀降血脂、降压、β受体阻滞剂。试验组的病人在规范抗冠心病治疗的基础上给予n-3PUFAS胶囊1g/日(汤臣倍健牌鱼油软胶囊),对照组在规律抗冠心病治疗的基础上给予相同剂量的安慰剂(大豆油胶囊),疗程为3个月,干预前后采集空腹静脉血检测Lp-PLA2、LDL及脂蛋白a等的水平,根据西雅图心绞痛量表(SAQ)赋分方法比较两组患者在使用不同治疗方法出院后1年内心绞痛发作情况,评价n-3PUFAS治疗冠心病稳定性心绞痛患者的临床疗效。结果回顾性研究:1、共纳入150例临床诊断为稳定性心绞痛的患者,鱼油组34例,常规组114例。两组之间在年龄、性别、体重指数、吸烟史、高血压史、糖尿病史等方面没有统计学差异(P均0.05)。2、鱼油组的血浆Lp-PLA2水平较非鱼油组明显降低,差异有统计学意义(t=1.627,P0.05)。而脂蛋白a两组之间无明显统计学差别(t=0.153,P0.05)。前瞻性研究:1、干预前两组患者的基线资料及血清学指标组间无差异(P0.05)。2、治疗后,试验组中Lp-PLA2水平明显下降(t=3.825,P0.05),对照组Lp-PLA2水平也明显下降(t=2.115,P0.05),差异有统计学意义。3、试验组治疗前后Lp-PLA2的差值比对照组治疗前后Lp-PLA2差值明显增加(t=2.813,P0.05)。试验组治疗前后LDL的差值比对照组治疗前后的差值也明显增加(t=2.813,P0.05)。试验组、对照组脂蛋白a治疗前后及两组治疗前后差值的比较均无统计学意义。4、西雅图心绞痛量表评定积分比较:躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意度方面,治疗后试验组积分明显高于对照组(t值分别为2.455,3.216,2.984,3.001,P均0.05);在疾病认识程度方面,两组比较无明显差异,但试验组的积分较对照组有升高趋势(t=1.132,P0.05)。5、安全性方面:两组未记录到明显不良反应,治疗前后血分析、肝肾功能、尿常规、大便常规均无明显异常。结论n-3PUFAS能降低稳定型心绞痛患者的Lp-PLA2、LDL水平,但对脂蛋白a的水平无明显影响。
[Abstract]:Objective to study the effect of Omerga-3 polyunsaturated fatty acid (n-3PUFAS) on the level of lipoprotein phospholipase A2 (Lp-PLA2), low density lipoprotein (LDL) and lipoprotein a in patients with stable angina, and to provide a clinical basis for the treatment of stable angina pectoris by Omerga-3 polyunsaturated fatty acid (Omerga-3). Methods a retrospective study was carried out to retrieve all the patients discharged from the Department of cardiovascular medicine of the Affiliated Hospital of Qiingdao University Medical College from January 2014 to January 2015. 214 patients were included in the hospital. The patients were excluded from the required and lost patients. The follow-up number was 150, and the follow-up was followed up. The contents included general information of patients, risk factors of coronary heart disease (age, sex, body mass index, hypertension, diabetes, dyslipidemia, smoking history), current drug treatment, and the use of fish oil within 1 years after discharge. The end of follow-up was June 30, 2015. The patients were divided into fish oil group and routine group according to the use of fish oil. 36 people in the oil group and 114 people in the routine group. Lp-PLA2 and lipoprotein a were detected by outpatient or telephone follow-up. The effect of n-3PUFAS on the level of Lp-PLA2 and lipoprotein a was preliminarily observed. 80 patients in Department of Cardiology of the Affiliated Hospital of Qiingdao University were randomly divided into the control group and the control group, and the patients were randomly divided into the control group and the control group. The experimental group, 40 cases in each group. All the subjects were given standardized anti CHD treatment according to the situation, including aspirin antiplatelet, rosuvastatin lowering blood lipid, depressor, beta blocker. The patients in the test group were given n-3PUFAS capsule 1g/ day on the basis of standardizing anti coronary heart disease treatment (Tomson health brand fish oil soft capsule), The group was given the same dose of placebo (soybean oil capsule) on the basis of regular anti coronary heart disease treatment. The treatment course was 3 months. The level of Lp-PLA2, LDL and lipoprotein a were collected before and after the intervention. The two groups of patients were compared with the Seattle angina scale (SAQ) for 1 years after the discharge of different treatments. The clinical effect of n-3PUFAS on angina pectoris patients was evaluated. Results 1, 150 cases were included in the clinical diagnosis of stable angina pectoris, 34 cases of fish oil group and 114 cases in routine group. There was no statistics between the two groups in age, sex, weight index, smoking history, hypertension history, diabetes history and so on. The study difference (P 0.05).2, the plasma Lp-PLA2 level of fish oil group was significantly lower than that of non fish oil group, the difference was statistically significant (t=1.627, P0.05), but there was no significant difference between the two groups of lipoprotein (t=0.153, P0.05). 1, there was no difference between the base line data and the serological index group (P0.05).2 in the two groups before intervention (P0.05), after treatment, test The level of Lp-PLA2 in the group was significantly decreased (t=3.825, P0.05), and the level of Lp-PLA2 in the control group was also significantly decreased (t=2.115, P0.05), and the difference was statistically significant.3. The difference value of Lp-PLA2 before and after treatment in the test group was significantly higher than that of the control group before and after treatment (t=2.813, P0.05). The difference between the LDL in the experimental group before and after treatment was also better than that before and after the treatment of the control group. Significantly increased (t=2.813, P0.05). The test group, the comparison group before and after treatment of lipoprotein A and the difference between the two groups before and after treatment were not statistically significant.4, Seattle angina scale evaluation score: the degree of physical activity restriction, angina stable state, angina pectoris condition, treatment satisfaction, after treatment, the test group scores were significantly higher than the scores. The control group (t value was 2.455,3.216,2.984,3.001, P was 0.05), and there was no significant difference between the two groups in the degree of disease recognition, but the score of the test group was higher than that of the control group (t=1.132, P0.05).5, the safety of the two groups did not record the obvious adverse reactions, the blood analysis, the liver and kidney function, the urine routine, and the routine stool were not clear before and after the treatment. Conclusion n-3PUFAS can reduce the level of Lp-PLA2 and LDL in patients with stable angina pectoris, but has no significant effect on the level of lipoprotein a.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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