睡眠质量对心脏X综合征患者中期预后的影响

发布时间：2018-05-17 10:04

本文选题：心脏X综合征 + 睡眠质量　；参考：《山东大学》2017年硕士论文

【摘要】：背景:心脏X综合征(CSX)主要是指有心肌缺血证据,冠状动脉造影正常或接近正常,并排除冠状动脉痉挛,瓣膜性心脏病,心肌病等其他特殊类型心脏疾病的一组症候群。目前尚无大样本人群的CSX的流行病学资料。既往小样本的临床研究显示,在具有心肌缺血症状而冠状动脉造影未见阻塞性病变的患者中,微血管疾病的发生率约为45%～60%。目前关于CSX机制的研究主要集中在微血管病变的机制、诊断和治疗上。流行病学研究发现传统危险因素(高血压病,糖尿病,吸烟等)、自主神经功能紊乱等均可以导致CSX的发生。虽然临床研究显示CSX患者长期随访主要急性冠脉事件(心源性猝死和急性心肌梗死)较低,但大部分患者仍有心绞痛症状且生存质量明显受损。反复心绞痛和再入院加重了CSX患者的经济负担和心理负担,造成社会资源的不必要的浪费。因此,发现影响CSX患者心绞痛症状发作和中远期预后的危险因素显得尤为重要。睡眠医学受到越来越多人的重视,睡眠障碍可以导致各种心血管代谢疾病(包括肥胖,高血压,糖尿病,心血管疾病等)危险增加。睡眠状态下自主神经活性的改变和呼吸调控的抑制,可导致机体神经、呼吸和血流动力学改变,对心脏事件和脑血管疾病发生具有重要意义。睡眠质量是对睡眠时长和睡眠质量的综合评价。临床研究发现睡眠质量和代谢综合征,心血管疾病密切相关。我们假设:睡眠质量可能与CSX心绞痛症状发作和预后相关。目的:本文将通过队列随访研究睡眠质量与CSX患者中期预后的关系。方法:我们从2012年5月1日至2015年12月31日在山东大学齐鲁医院心内科因冠心病可疑行冠状动脉造影的所有患者中逐一筛选出135例CSX患者。临床资料采集包括:病史采集(包括用药史、精神病史等),体格检查,实验室检查(血脂、生化等)。我们分别使用匹兹堡睡眠质量指数(PSQI)和冠状动脉TIMI血流祯数评估患者睡眠质量和冠状动脉血流情况。我们对患者实行了 4年(平均1.8年)的随访,使用连续logistic回归分析危险因素与症状的关系;Cox回归分析CSX患者再入院的预测因子;Kaplan-Meier曲线以分析睡眠质量与CSX患者再入院的关系。结果:CSX患者睡眠质量低发生率为62.5%,其中女性患者发生率为73.3%,男性患者发生率为44%。高睡眠质量组与低睡眠质量组的年龄、体重指数(BMI)、静息心率、高血压病、糖尿病、血脂异常、慢血流以及用药情况均无统计学差异。低睡眠质量组的女性患者比率高于高睡眠质量组,而吸烟率则低于高睡眠质量组。在我们的随访中,急性心肌梗死发生0例,脑梗塞1例,26名患者因反复心绞痛/急性冠脉综合征再入院。66.9%的患者仍然有心绞痛症状发生,其中2.2%患者诉心绞痛较前加重,19.1%患者诉心绞痛发作较前无明显改变。低睡眠质量组症状改善或消失的比率明显低于高睡眠质量组。排除年龄、高血压、糖尿病、高脂血症等传统心血管危险因素以及BMI和慢血流影响后,睡眠质量是患者症状变化的独立预测因子(OR 3.397;95%CI 1.652-6.978;p=0.001)。低睡眠质量的患者是高睡眠质量患者因心绞痛再入院的风险3.0倍(HR 3.094 95%CI 1.161-8.245:p=0.024)。Kaplan-Meier生存曲线显示低睡眠质量组与高睡眠质量组的再入院率存在明显差异(p=0.033)。结论:CSX患者睡眠质量低发生率较高;女性CSX患者低睡眠质量发生率明显高于男性患者。睡眠质量是CSX患者心绞痛症状变化和再入院的独立预测因子。睡眠质量量表作为一种经济,简单,实用的筛查方法对发现高危CSX患者具有重要意义。
[Abstract]:Background: cardiac X syndrome (CSX) is mainly referred to as a group of symptoms of myocardial ischemia evidence, normal coronary angiography or close to normal, and a group of other special types of heart diseases that exclude coronary artery spasm, valvular heart disease, cardiomyopathy and other special types of heart disease. There is no epidemiological data on CSX in large sample population. In patients with myocardial ischemia and coronary angiography, the incidence of microvascular disease is about 45% to 60%., and the current research on the CSX mechanism is mainly focused on the mechanism, diagnosis and treatment of microvascular lesions. Epidemiological studies have found that traditional risk factors (hypertension, diabetes, smoking, etc.) The main neurological disorders can all lead to the occurrence of CSX. Although clinical studies have shown that the major acute coronary events (sudden cardiac death and acute myocardial infarction) in CSX patients are lower in long-term follow-up, most patients still have angina symptoms and the quality of life is significantly impaired. Recurrent angina and rehospitalization aggravate the financial burden and heart of patients with CSX. It is an unnecessary waste of social resources. Therefore, it is particularly important to find the risk factors affecting the symptoms of angina and the median prognosis of CSX patients. Sleep medicine is being paid more and more attention to. Sleep disorders can lead to various cardiovascular metabolic diseases (including obesity, hypertension, diabetes, cardiovascular disease, etc.) The changes in the activity of autonomic nerves and the inhibition of respiratory regulation during sleep can lead to changes in the body's nerve, respiration and hemodynamics, which are of great significance for the occurrence of cardiac events and cerebrovascular diseases. The quality of sleep is a comprehensive evaluation of the length of sleep and the quality of sleep. Clinical studies have found the quality of sleep and metabolism. Signs, cardiovascular disease is closely related. We hypothesized that sleep quality may be associated with the onset and prognosis of CSX angina pectoris. Objective: This article will study the relationship between sleep quality and medium-term prognosis of CSX patients through a cohort. Methods: from May 1, 2012 to December 31, 2015, we were suspicious of coronary heart disease in the Department of Cardiology, Qilu Hospital, Shandong University. 135 patients with CSX were screened out of all patients undergoing coronary angiography. Clinical data collection included history collection (including history of medication, psychiatric history, etc.), physical examination, laboratory examination (blood lipid, biochemistry, etc.). We assessed the quality of sleep with the Pittsburgh sleep mass index (PSQI) and the frame of the coronary artery TIMI, respectively. The patients were followed up for 4 years (an average of 1.8 years). We used continuous logistic regression to analyze the relationship between risk factors and symptoms; Cox regression analysis of predictors of reentry in CSX patients; Kaplan-Meier curve to analyze the relationship between sleep quality and readmission in CSX patients. Results: low sleep quality in CSX patients occurred. The rate of female patients was 62.5%, and the incidence of female patients was 73.3%. The incidence of male patients was the age of 44%. high sleep quality group and low sleep quality group, body mass index (BMI), resting heart rate, hypertension, diabetes, dyslipidemia, slow blood flow and drug use. The rate of female patients in low sleep quality group was higher than that of high sleep quality. In our follow-up, 0 cases of acute myocardial infarction, 1 cases of cerebral infarction, and 26 patients with angina pectoris / acute coronary syndrome in.66.9% still had angina, of which 2.2% patients complained of severe angina pectoris, and 19.1% patients complained of angina pectoris. The rate of improvement or disappearance of the low sleep quality group was significantly lower than that in the high sleep quality group. After eliminating the traditional cardiovascular risk factors, such as age, hypertension, diabetes, hyperlipidemia, and the influence of BMI and slow blood flow, the quality of sleep was an independent predictor of the patient's symptoms (OR 3.397; 95%CI 1.652-6.978; p=0.001). The patients with high quality sleep quality were 3 times as high as the risk of angina pectoris reentry (HR 3.094 95%CI 1.161-8.245:p=0.024).Kaplan-Meier survival curve showing a significant difference in the reentry rate between the low sleep quality group and the high sleep quality group (p=0.033). Conclusion: the incidence of low sleep sleep in CSX patients was higher, and the low sleep quality of female CSX patients was low. The quality of sleep is an independent predictor of changes in angina symptoms and readmission in CSX patients. The sleep quality scale is of great significance as an economical, simple and practical screening method for the discovery of high-risk CSX patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541

【参考文献】