红细胞膜鞘磷脂含量对冠心病预后的预测价值

发布时间：2018-05-24 05:49

  本文选题：冠心病 + 红细胞膜鞘磷脂含量　； 参考：《安徽医科大学》2015年硕士论文

【摘要】：背景:冠心病(coronary heart disease,CHD)是指冠状动脉粥样硬化致使管腔狭窄或闭塞,导致心肌缺氧或坏死而引起的心脏疾病,是严重危害人类健康的疾病之一。急性冠脉综合征(acute coronary syndrome,ACS)是一组以冠脉粥样硬化不稳定斑块破裂或糜烂导致冠状动脉内血栓形成为主要发病基础的临床综合征,是冠心病的严重类型,越来越多的证据提示红细胞尤其是红细胞膜脂质参与了不稳定斑块的发生和发展。鞘磷脂作为红细胞膜脂质的重要组成成分之一,与动脉粥样硬化有着密切的关系,我们的前期研究发现红细胞膜鞘磷脂含量(sphingomyelin content of erythrocyte membranes,SEM)的升高与ACS有着独立的正相关性,提示SEM可能参与了不稳定斑块的形成及发展,但SEM对冠心病患者的预后是否具有预测价值目前尚无文献报道。目的:通过前瞻性随访研究,评价SEM与冠心病患者终点事件发生风险的相关性,探讨SEM对冠心病患者预后的价值。方法:选取398例经冠脉造影检查确诊为冠心病的患者,采用酶学方法测定其SEM值,并在出院后对其进行随访,随访中位数时间为990天。通过Cox回归方法和Kaplan-Meier曲线分析SEM水平对随访期间患者发生初级终点事件和次级终点事件的预测价值。结果:1.有事件发生组患者的SEM水平[114.46(72.92-145.10)ug/mg]显著性高于无事件发生组患者[82.42(30.81-117.76)ug/mg](p0.001)。2.以SEM的中位数(92.06ug/mg)为截点将患者分为两组,SEM92.06ug/mg组患者的初级终点事件的发生率高于SEM≤92.06ug/mg组患者,差异有统计学意义(p=0.001),仅全因死亡存在此显著差异(p=0.001)。SEM92.06ug/mg组患者的次级终点事件的发生率高于SEM≤92.06ug/mg组患者,差异有统计学意义(p=0.032),但在次级终点事件中再血管化治疗和心功能衰竭的差异都无统计学意义。3.Cox回归分析发现SEM对冠心病患者初级终点事件有预测价值(RR值3.287,95%CI 1.441-7.498,p=0.005),其中仅对初级终点事件中的全因死亡(RR值4.295,95%CI 1.358-13.585,p=0.013)有预测价值。而SEM对次级终点事件的发生无明显预测作用。4.Kaplan-Meier曲线显示SEM92.06ug/mg组患者的初级终点事件的发生率显著性高于SEM≤92.06ug/mg组患者(p=0.001),但其中仅全因死亡存在此显著性差异(p=0.001)。结论:SEM升高对冠心病患者初级终点事件的发生风险有一定的预测价值,且仅对初级终点事件中的全因死亡的发生有预测价值。
[Abstract]:Background: coronary heart disease (heart) is a kind of heart disease which is caused by coronary atherosclerosis, which leads to stenosis or occlusion of the lumen, hypoxia or necrosis of myocardium. It is one of the serious diseases endangering human health. Acute coronary syndrome (ACS) is a group of clinical syndrome, which is based on the rupture of unstable plaque or erosion of coronary artery, and is a serious type of coronary heart disease. More and more evidence suggests that erythrocytes, especially erythrocyte membrane lipids, are involved in the occurrence and development of unstable plaque. As an important component of erythrocyte membrane lipids, sphingomyelin content of erythrocyte membrane (SEM) is closely related to atherosclerosis. Our previous studies have found that the increase of sphingomyelin content of erythrocyte membrane sem has an independent positive correlation with ACS. It is suggested that SEM may be involved in the formation and development of unstable plaques, but whether SEM can predict the prognosis of patients with coronary heart disease has not been reported. Objective: to evaluate the relationship between SEM and the risk of end point events in patients with coronary heart disease (CHD), and to evaluate the value of SEM in the prognosis of patients with coronary heart disease (CHD). Methods: the SEM values of 398 patients with coronary artery disease diagnosed by coronary angiography were determined by enzymatic method and followed up after discharge. The median follow-up time was 990 days. Cox regression method and Kaplan-Meier curve were used to analyze the predictive value of SEM level in patients with primary and secondary endpoint events during follow-up. The result is 1: 1. The level of SEM [114.46(72.92-145.10)ug/mg] in the event-prone group was significantly higher than that in the non-event-occurring group [82.42(30.81-117.76)ug/mg] p 0.001. 2. The incidence of primary endpoint events in the SEM92.06ugr / mg group was higher than that in the SEM 鈮，

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