微循环阻力指数在心绞痛患者中的应用分析

发布时间：2018-05-22 12:38

本文选题：微循环阻力指数 + 心绞痛　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探究微循环阻力指数(indexofmicrocirculatoryresistance,IMR)在心绞痛患者中的相关影响因素,为心绞痛患者微循环受损的预防及治疗寻求敏感指标。[方法]回顾性选择2014年12月到2017年3月在云南省第二人民医院心内科住院行IMR测量病人中诊断为心绞痛的部分病例81例,先常规行冠脉造影术(coronary angiography,CAG)检查,CAG术后应用压力-温度导丝技术测量靶血管的IMR值,IMR值以25为分界值[1],将上述病例分为两组:IMR正常组(IMR25)及IMR升高组(IMR≥25),收集病例资料包括性别、年龄、身高、体重、吸烟史、饮酒史、高血压病史、糖尿病史、血脂、尿酸、肌酐、冠脉狭窄程度、瘤样扩张、TIMI 血流(thrombolysis in myocardial infarction flow,TIMI flow)。通过比较两组间各临床因素的差异,并应用统计学软件筛选导致IMR值升高的预测因素。[结果]1.应用压力-温度导丝技术测量研究对象的IMR值,手术成功率高,所有研究对象均未发生手术并发症,操作安全、简便、可重复性强、特异性高及不受心外膜循环影响。2.本研究相关性分析得出IMR升高组与IMR正常组在总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(lowdensity lipoprotein cholesterin,LDL-C)、吸烟、慢血流-无复流(slow coronary flow or no coronary reflow,SCF/NR)、糖尿病、冠脉狭窄程度中存在明显差异(P均0.05),具有统计学意义。而IMR升高组与IMR正常组在性别、年龄、体重指数(body mass index,BMI)、饮酒、高血压、尿酸、肌酐、瘤样扩张中无明显差异(P均0.05),无统计学意义。3.本研究二分类logistic回归分析中得出:最终SCF/NR、糖尿病、吸烟留在模型内,且回归系数是正值,对应的OR值1,即SCF/NR(B值=0.82、OR=2.27、P0.001)、糖尿病(B 值=0.21、OR=1.23、P=0.003)、吸烟(B 值=0.18、OR=1.06、P=0.004),结果提示SCF/NR、糖尿病、吸烟为IMR值升高的独立危险因素,即SCF/NR、糖尿病、吸烟为冠状动脉微循环受损的独立危险因素。[结论]1.微循环阻力指数的测量是一种操作简便、安全、可重复性强、特异性高的评判冠状动脉微循环的微创检查技术。2.在心绞痛患者中,冠状动脉微循环障碍与TC、TG、LDL-C、SCF/NR、吸烟、糖尿病、冠脉狭窄程度呈显著相关。3.在心绞痛患者中,SCF/NR、糖尿病、吸烟是冠状动脉微循环受损的独立危险因素。
[Abstract]:[objective] to explore the related factors of index of microcirculation resistance index (IMR) in patients with angina pectoris, and to seek sensitive indexes for the prevention and treatment of microcirculation damage in patients with angina pectoris. [methods] from December 2014 to March 2017, 81 patients with angina pectoris diagnosed as angina pectoris were selected retrospectively, who were hospitalized in Department of Cardiology, second people's Hospital of Yunnan Province. The IMR value of target vessel was measured by pressure-temperature guide wire technique after CAG operation. The IMR value was 25. The patients were divided into two groups: normal group (n = 25) and elevated IMR group (n = 25). Case data, including sex, were collected. Age, height, weight, smoking history, drinking history, history of hypertension, history of diabetes, blood lipid, uric acid, creatinine, degree of coronary artery stenosis, tumor-like dilatation of TIMI blood flow and thrombolysis in myocardial infarction flow. By comparing the differences of clinical factors between the two groups, and using statistical software to screen the predictive factors that lead to the increase of IMR value. [result] 1. The IMR value of the subjects was measured by pressure-temperature guide wire technique. The success rate of operation was high. All the subjects had no complications. The operation was safe, simple, reproducible, specific and not affected by epicardial circulation. The correlation analysis of this study showed that the IMR elevation group and the normal IMR group had total cholesterol TC, triglyceride-triglyceride lipoprotein, low density lipoprotein cholesterol low density lipoprotein in LDL-Con, smoking, slow coronary flow or no coronary refraction, diabetes mellitus, low blood flow and low coronary flow or no coronary refraction. There were significant differences in the degree of coronary stenosis (P < 0.05). However, there was no significant difference in sex, age, body mass index (BMI), alcohol consumption, hypertension, uric acid, creatinine, tumor-like dilatation between IMR elevated group and normal IMR group (P < 0.05). In this study, logistic regression analysis showed that SCF / NR, diabetes mellitus and smoking remained in the model, and the regression coefficient was positive. The corresponding OR value was 1, i.e. SCF/NR(B value was 0.82%, OR value was 2.27, P 0.001, diabetes mellitus B value was 0.21 / 0.23, and smoking B value was 0.18 ORR 1.06P ~ (0.004), the results indicated that SCF / NR, diabetes, diabetes mellitus, diabetes, Smoking was an independent risk factor for increased IMR, i.e. SCF / NR, diabetes, and smoking as an independent risk factor for coronary microcirculation damage. [conclusion] 1. The measurement of resistance index of microcirculation is a simple, safe, reproducible and specific technique to evaluate coronary microcirculation. In patients with angina pectoris, coronary microcirculation disorders were significantly correlated with TCG-TGG LDL-Cnr, smoking, diabetes, and coronary stenosis. SCF / NR, diabetes and smoking are independent risk factors for coronary microcirculation damage in patients with angina pectoris.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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