血小板分布宽度、中性粒细胞与淋巴细胞比值、糖化血红蛋白与冠状动脉病变程度的关系

发布时间：2018-08-01 08:34

【摘要】：背景冠心病(coronary heart disease,CHD)患者存在不同程度的冠脉血管病变,冠心病的危险因素影响着冠脉病变程度。这些年来有关于冠心病的危险因素[1]方面的相关性研究逐年增多且检测越发准确。血小板分布宽度(Platelet distribution width,PDW)、中性粒细胞与淋巴细胞比值(the ratio of neutrophils and lymphocytes,NLR)、糖化血红蛋白(Glycated hemoglobin,HbA1c)均被认为是冠心病的危险因素,它们均可独立进行检测,且逐渐成为这几年来的热门话题,其对早期预测CHD及评估冠脉病变程度的有着一定的指导意义,但是三者之间的相关性、与冠心病的关系及对冠脉病变程度评估的准确性及特异性是我们需要进一步研究和探讨的。目的探讨血小板分布宽度、中性粒细胞与淋巴细胞比值、糖化血红蛋白对冠脉血管病变程度的影响、对其进行检测的意义及临床应用价值。方法观察对象为2015年03月至2015年12月经新乡医学院第一附属医院心内二科收治的经心电图、心肌坏死标志物、冠状动脉造影术检查并结合临床表现确诊的CHD患者108例,男79例,女29例,年龄31~76岁,平均(56.67±8.76)岁;血总胆固醇(total cholesterol,TC)为(4.01±1.03)mmol·L-1,三酰甘油(triacylglycerol,TG)为(1.74±1.73)mmol·L-1,低密度脂蛋白(low density lipoprotein,LDL)为(2.35±0.90)mmol·L-1,脂蛋白a(lipoprotein a,LPa)为(0.19±0.22)mmol·L-1;其中稳定型心绞痛(stable angina pectoris,SAP)组32例,不稳定型心绞痛(unstable angima pectoris,UAP)组38例,急性心肌梗死(acute myocardial infarction,AMI)组38例。另选同期体检健康者112例为对照组,其中男78例,女44例,年龄42~69岁,平均(54.83±7.24)岁,TC为(3.81±0.99)mmol·L-1,TG为(1.55±0.70)mmol·L-1,LDL为(2.38±0.89)mmol·L-1,LPa为(0.18±0.20)mmol·L-1。所有观察对象均排除急慢性炎症性疾病、自身免疫性疾病、结缔组织病、代谢性疾病(糖尿病除外)、恶性肿瘤、严重肝肾疾病、血液病及近期服用过可影响血PDW、中性粒细胞计数、淋巴细胞计数和HbA1c药物的患者。正常对照组受试者于体检当日、CHD患者均于入院次日清晨空腹抽取肘静脉血4 mL,并测定血小板分布宽度、糖化血红蛋白及白细胞分类计数,并计算NLR。结果CHD组患者与对照组受试者年龄、性别及血脂水平比较差异无统计学意义(P0.05),具有可比性。CHD组患者的血PDW和NLR、HbA1c水平均显著高于对照组,差异有统计学意义(P0.05)。SAP组、UAP组、AMI组患者的血PDW、NLR、Hb A1c水平与对照组受试者比较均显著增高,差异有统计学意义(P0.05)。SAP组、UAP组、AMI组患者的血PDW、NLR、HbA1c水平随着冠状动脉狭窄程度的增加而有升高趋势,但UAP组患者的血PDW、NLR、HbA1c水平与SAP组比较差异无统计学意义(P0.05),AMI组患者的血PDW、NLR、HbA1c水平较SAP组和UAP组患者均显著增高,差异有统计学意义(P0.05)。SAP组、UAP组、AMI组患者的PDW、HBA1c呈显著正相关(r=0.34、0.34、0.22,P0.05);而SAP组、UAP组、AMI组患者的NLR、PDW之间无显著相关性(r=-0.21、-0.0013、-0.24,P0.05);SAP组、UAP组、AMI组患者的NLR、HBA1c之间无显著相关性(r=0.16、0.04、0.16,P0.05)。结论1.PDW、NLR、HbA1c水平与冠脉狭窄程度相关,可用来作为评价冠脉病变程度的指标。2.PDW、NLR、HbA1c的联合检测可能预测急性冠脉事件的发生。
[Abstract]:Background coronary artery disease (coronary heart disease, CHD) patients have varying degrees of coronary vascular lesions. The risk factors of coronary heart disease affect the degree of coronary artery disease. These years, the correlation of risk factors for coronary heart disease in [1] has been increased year by year and more accurate. Platelet distribution width (Platelet distribution width, PD) W), the ratio of neutrophils to lymphocytes (the ratio of neutrophils and lymphocytes, NLR), glycosylated hemoglobin (Glycated hemoglobin, HbA1c) are considered as a risk factor for coronary heart disease. They can be detected independently and gradually become a hot topic for these years. It has been used to predict the CHD and assess the degree of coronary lesions in the early stages. The relationship between the three, the relationship with the coronary heart disease and the accuracy and specificity of the assessment of the degree of coronary artery disease, we need further study and discussion. Objective to explore the effect of platelet distribution, neutrophils and lymphocyte ratio, and glycosylated hemoglobin on the degree of coronary vascular disease. The purpose of this study was to evaluate the significance and value of clinical application. Methods the subjects were 108 cases of CHD patients in two families of First Affiliated Hospital of Xinxiang Medical College from 03 months to 12 menstruation from 2015 to 2015, which were treated with electrocardiogram, myocardial necrosis markers, coronary angiography and combined with clinical manifestations in 108 cases, 79 men, 29 women, age, and flat age. The total cholesterol (total cholesterol, TC) was (4.01 + 1.03) mmol. L-1, three acyl glycerol (triacylglycerol, TG) was (1.74 + 1.73) mmol. L-1, low density lipoprotein (low density lipoprotein) was (2.35 + 0.90), and lipoprotein was (0.19 + 0.22). Gina pectoris, SAP) group 32 cases, 38 cases of unstable angina pectoris (unstable angima pectoris, UAP) group, 38 cases of acute myocardial infarction (acute myocardial infarction, AMI) group. 112 cases of healthy persons in the same period were selected as the control group, including 78 males and 44 women, age 42~69 years, average (54.83 + 7.24) years old, 3.81 + 0.99 (1.55 + 0.70). Mmol. L-1, LDL was (2.38 + 0.89) mmol. L-1, LPa was (0.18 + 0.20) mmol. L-1. all the observation subjects excluded acute and chronic inflammatory disease, autoimmune disease, connective tissue disease, metabolic disease (except diabetes), malignant tumor, severe liver and kidney disease, blood disease and recent use can affect blood PDW, neutrophils count, lymphocyte The patients in the normal control group were tested on the day of physical examination. The patients in the normal control group took 4 mL of the elbow vein blood on the early morning of the hospital on the morning of the hospital, and measured the distribution of blood platelets, glycosylated hemoglobin and the count of white blood cells, and calculated the age of the subjects in the group CHD of the CHD group and the control group, and compared the sex and blood lipid levels of the patients in the CHD group of the group CHD. There was no statistical significance (P0.05), and the blood PDW and NLR in the comparability group.CHD were significantly higher than that of the control group. The difference was statistically significant (P0.05).SAP group, UAP group, AMI group of patients with PDW, NLR, and Hb subjects were all significantly higher than those in the control group, the difference was statistically significant. The level of W, NLR, and HbA1c increased with the increase of the degree of coronary stenosis, but there was no significant difference in the level of PDW, NLR and HbA1c in the UAP group with SAP (P0.05). The level of PDW, NLR, and HbA1c in the AMI group were significantly higher than those in the group and the group. PDW, HBA1c showed significant positive correlation (r=0.34,0.34,0.22, P0.05), but there was no significant correlation between NLR and PDW in group SAP, UAP group and AMI group (r=-0.21, -0.0013, -0.24). Combined detection of.2.PDW, NLR and HbA1c as a marker for evaluating the severity of coronary artery lesions may predict the occurrence of acute coronary events.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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