HIV感染患者冠脉斑块、狭窄程度的评估及其影响因素的判断

发布时间：2018-06-30 20:06

本文选题：HIV + 冠脉CTA　；参考：《郑州大学》2017年硕士论文

【摘要】：第一部分 HIV感染患者冠脉斑块和狭窄程度的评估研究目的:本研究通过观察HIV感染患者和HIV非感染患者冠脉CTA的表现,分析二者冠脉斑块组成和管腔狭窄程度的异同点。材料与方法:收集2016年1月至2017年1月有症状的HIV感染患者21例和HIV非感染患者32例进行冠脉CTA检查,纳入标准:心肺肝肾功能良好,无碘对比剂过敏史,无心脏手术史,排除标准:重度心肺肝肾功能不全,神志不清不能配合检查,对碘对比剂过敏,有心脏手术史。结果:21名HIV感染患者和32名HIV非感染患者进行了冠脉CTA检查,按照15段分法,总共分别有297段和453段。HIV感染患者和HIV非感染患者的年龄分别为50.9±9.6和54.3±8.9,差异没有明显统计学意义。HIV感染患者和HIV非感染患者有斑块的比例分别为15.6%和10.6%,p值为0.048,人均有斑块的段数分别为2.2和1.5,差异具有统计学意义。HIV感染患者和HIV非感染患者发生软斑块的比例分别为8.8%和4.0%,p值为0.006,人均有软斑块的段数分别为1.2和0.6,差异有统计学意义。而HIV感染患者和HIV非感染患者发生混合斑块的可能性之间没有明显差别。以个体为研究对象,HIV感染患者和HIV非感染患者发生软斑块的比例都较钙化斑块和混合斑块高。对斑块的位置分析,发现HIV感染患者和HIV非感染患者斑块位于冠脉近段的比例分别为71.7%和72.6%,差异无统计学意义。HIV感染患者和HIV非感染患者发生明显管腔狭窄(狭窄程度≥50%)的比例分别为7/21(33.3%)和2/32(6.3%),p值为0.028,二者之间的差异有统计学意义。在这7名有明显管腔狭窄的患者中,发生明显狭窄的比例为9/21(47.6%),其中右冠、左前降支和左回旋支发生管腔明显狭窄的比例分别是1/9(11.1%)、6/9(66.7%)、和2/9(22.2%)。管腔有明显狭窄的HIV感染患者和管腔没有明显狭窄的HIV感染患者发生不同性质斑块的比例相似,差异无统计学意义。在这7名管腔有明显狭窄的HIV感染患者中,所有人都至少有2段冠脉有斑块,而在其余14名HIV感染患者中,至少有2段冠脉有斑块的患者占35.7%,p值为0.006,差异有统计学意义。结论:HIV感染患者冠脉发生斑块的可能性较HIV非感染患者高,尤其是软斑块,而发生混合斑块的可能性没有明显差别。HIV感染患者冠脉发生中重度狭窄的可能性较HIV非感染患者高。第二部分 HIV感染患者冠脉斑块影响因素的研究研究目的:通过对HIV感染患者斑块的影响因素分析,判断对斑块影响较大的相关因素,从而进行早期干预和及时治疗。材料与方法:收集HIV感染患者21例,进行冠脉CTA检查,统计患者的基本信息和相关实验室检查结果,根据CTA结果将HIV感染患者分为无斑块组和有斑块组。结果:HIV感染患者中无斑块组较有斑块组有着更高的CD4+T细胞检查时(p=0.002)。CD4+T细胞检查时和斑块的数量明显呈负相关(r=-0.66,p=0.001),而年龄、性别、BMI、高血压、糖尿病、吸烟、低密度脂蛋白、高密度脂蛋白、甘油三酯、总胆固醇、抗病毒治疗时间、CD4+T细胞最低点和斑块的数量之间没有相关性。结论:在HIV感染患者中,无斑块组较有斑块组有着更高的CD4+T细胞检查时(p=0.002),CD4+T细胞检查时和冠脉粥样硬化斑块的增多呈负相关。而其他相关因素在这个实验中没有看到相关性,需要大样本实验的进一步研究。
[Abstract]:Part 1 Evaluation of coronary plaque and stenosis in patients with HIV infection. Objective: to analyze the similarities and differences of coronary plaque composition and stenosis degree between two patients with HIV infection and HIV non infected patients. Materials and methods: 21 patients with symptomatic HIV infection from January 2016 to January 2017 were collected and analyzed. HIV non infected patients with 32 cases of coronary CTA examination, included standard: good heart and lung liver and kidney function, no iodine contrast agent allergy history, no history of cardiac surgery, exclusion criteria: severe cardiopulmonary liver and kidney insufficiency, unconsciousness can not cooperate with examination, iodine contrast agent allergy, heart dirty hand history. Results 21 HIV infected patients and 32 HIV non infected patients entered. The coronary CTA examination was performed. According to the 15 segment method, the age of 297 and 453.HIV infected patients and HIV non infected patients were 50.9 + 9.6 and 54.3 + 8.9 respectively. There was no significant difference between.HIV and HIV non infected patients for 15.6% and 10.6%, and the p value was 0.048. The difference was 2.2 and 1.5, the difference was statistically significant in.HIV and HIV non infected patients, the proportion of soft plaques was 8.8% and 4%, P was 0.006, and the number of soft plaques per capita was 1.2 and 0.6, respectively. There was no significant difference between the possibility of mixed plaques in HIV infected patients and HIV non infected patients. The proportion of HIV infected patients and HIV non infected patients was higher than calcified plaques and mixed plaques. The position analysis of the plaque found that the proportion of HIV infected patients and HIV non infected patients in the proximal coronary segments were 71.7% and 72.6%, respectively, and there was no statistically significant difference in.HIV and HIV non infection patients. The proportion of obvious lumen stenosis (degree of stenosis more than 50%) in infected patients was 7/21 (33.3%) and 2/32 (6.3%), and the value of P was 0.028. The difference between the two were statistically significant. In the 7 patients with obvious lumen stenosis, the proportion of obvious stenosis was 9/21 (47.6%), and the right coronal, left anterior descending and left circumflex branch had obvious narrowing of the lumen. The narrow proportions were 1/9 (11.1%), 6/9 (66.7%), and 2/9 (22.2%). The proportions of different nature plaques in patients with obvious stenosis of HIV infection and that of HIV infected with no stenosis of the lumen were similar, and the difference was not statistically significant. In these 7 patients with clear stenosis of the lumen, all of them had at least 2 segments of coronary plaque. In the remaining 14 patients with HIV infection, at least 2 patients with coronary plaque were 35.7%, and the p value was 0.006. The difference was statistically significant. Conclusion: the possibility of coronary atherosclerotic plaque in patients with HIV infection is higher than that of non infected HIV patients, especially in soft plaque, and the possibility of mixed plaque is not significantly different from the incidence of coronary artery in patients with.HIV infection. The possibility of severe stenosis is higher than that of HIV non infected patients. Research on the influencing factors of coronary plaque in second part of HIV infected patients: by analyzing the influencing factors of plaque in patients with HIV infection, judging the relative factors that have great influence on the plaque, so as to make early intervention and time treatment. Materials and methods: collect HIV infected patients 21 CTA examination of coronary artery, the basic information of the patients and the results of the related laboratory examination, the patients with HIV infection were divided into no plaque group and plaque group according to the CTA results. Results: there was a higher CD4+T cell examination in the non plaque group of the patients with HIV infection (p= 0.002) when the.CD4+T cell examination and the number of plaques were obviously negative. Correlation (r=-0.66, p=0.001), and no correlation between age, sex, BMI, hypertension, diabetes, smoking, LDL, HDL, triglycerides, total cholesterol, antiviral treatment time, the lowest point of CD4+T cell and the number of plaques. Conclusion: in HIV infected patients, there is a higher CD4+T thinner in the plaque group than in the plaque group. There was a negative correlation between cell examination (p=0.002), CD4+T cell examination and the increase of atherosclerotic plaque in the coronary artery. Other related factors did not see the correlation in this experiment, and further study of large sample experiments was needed.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.91;R816.2

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