老年冠心病患者血尿酸对冠状动脉狭窄程度的影响
发布时间：2018-09-17 09:04
【摘要】：背景改革开放近几十年来我国经济建设取得了举世瞩目的成就,广大人民群众的物质文化生活水平得到了极大的提高,青少年及中老年人的饮食与生活教之以前也发生了巨大变化,高脂、高糖及高蛋白的饮食和锻炼的缺乏,工作和社会压力的增加使得我国居民的心血管疾病的发病率逐年攀升。我国已慢慢步入老年化国家行列,老年心血管疾病患病率远高于青年人且病情重、合并症多、死亡率高,是我国目前所面临的严重的社会和公共卫生问题。冠心病是心血管疾病的主要疾病之一,也是引起心脏性猝死(SCD)的主要原因,严重影响患者的工作和生活,增加患者的精神和经济负担。尿酸与冠心病的关系一直是多年来的研究热点,其水平的增高不但与痛风的患病关系密切,而且随着临床与基础研究的不断深入发现,尿酸还与冠心病的患病密切相关。研究发现尿酸既可通过对冠心病的传统危险因素的影响又可通过对冠状动脉的直接作用影响冠心病的发生和发展。目前国内外的研究多集中于尿酸对于冠状动脉总体病变程度的影响,但关于老年冠心病患者血清尿酸水平对于左主干、前降支、右冠状动脉、回旋支是否具有不同的影响的研究较少引起广大医务工作者的重视。本研究拟通过对老年冠心病患者的血清尿酸水平对冠状动脉狭窄程度的影响,探讨尿酸对冠状动脉不同分支狭窄程度的影响,为心血管病的预防与治疗提供一定的临床依据。目的探讨老年冠心病患者尿酸对冠状动脉狭窄程度的影响。方法选择老年冠心病患者137例,根据尿酸水平将所有对象分位第1分位组(141-279mmol/L)34例、第2分位组(279.5-418mmol/L)35例、第3分位组(418.5-557mmol/L)34例、第4分位组(557.5-692mmol/L)34例。所有受试者均行冠状动脉造影,采用Gensini积分系统评价狭窄程度。结果4分位组冠状动脉总体及右冠状动脉Gensini积分显著高于1分位组[(60.15±8.78)分vs(53.73±6.04)分,(12.03±3.12)分vs(6.44±1.52)分,P0.05]。4分位组左回旋支Gensini积分显著高于3分位组及2分位组[(14.32±3.70)分vs(10.97±4.13)分,(10.60±3.18)]分,P0.05。3分位组左回旋支Gensini积分明显低于1分位组[(10.97±4.13)分vs(15.58±3.85)分,P0.05]。3分位组右冠状动脉Gensini积分明显高于1分位组[(12.00±2.35)分vs(6.44±1.52)分,P0.05]。3分位组右冠状动脉Gensini积分高于2分位组[(12.00±2.35)分vs(10.20±2.91)分,P0.05]。2分位组右冠状动脉Gensini积分明显高于1分位组(P0.05)。2分位组左回旋支Gensini积分明显低于1分位组[(10.60±3.18)分vs(15.58±3.85)分,P0.05]。血清尿酸水平与右冠状动脉Gensini积分相关系数为0.385、与冠状动脉总体病变Gensini积分相关系数为0.305,均呈显著正相关,P均0.05;尿酸与高密度脂蛋白胆固醇水平呈负相关,相关系数为-0.196,P0.05;尿酸与收缩压、舒张压、甘油三脂及空腹血糖水平呈正相关,相关系数分别为0.157、0.155、0.189及0.267,P均0.05。多元线性回归分析结果显示,尿酸为右冠状动脉和冠状动脉总体病变的独立危险因素。结论右冠状动脉病变Gensini积分、回旋支病变Gensini积分、冠状动脉总体病变Gensini积分与老年冠心病患者血清尿酸水平密切相关。
[Abstract]:Background China's economic construction has made remarkable achievements in recent decades of reform and opening up. The material and cultural living standards of the broad masses of the people have been greatly improved. Great changes have taken place in the diet and life education of young people and middle-aged and old people before, including the lack of diet and exercise with high fat, sugar and protein, work and society. The incidence of cardiovascular disease in the elderly is much higher than that in the young. The incidence of cardiovascular disease in the elderly is much higher than that in the young. There are many complications and high mortality. It is a serious social and public health problem in China. Sudden cardiac death (SCD) is one of the main causes of heart disease, which seriously affects the work and life of patients and increases their mental and economic burden. It has been found that uric acid can influence the occurrence and development of coronary heart disease through both the influence of traditional risk factors and the direct effect of coronary artery. The study of whether serum uric acid levels have different effects on left main coronary artery, anterior descending coronary artery, right coronary artery and circumflex coronary artery in elderly patients with coronary heart disease has received less attention from medical workers. Objective To investigate the effect of uric acid on the severity of coronary artery stenosis in elderly patients with coronary heart disease.Methods 137 elderly patients with coronary heart disease were selected and divided into the first group (141-279 mmol/L) and the second group (34 cases) according to the level of uric acid. Group A (279.5-418 mmol/L), Grade 3 (418.5-557 mmol/L), Grade 4 (557.5-692 mmol/L) and Grade 3 (34). All subjects underwent coronary angiography, and the degree of stenosis was assessed by Gensini score system. Results The total coronary artery score and the Gensini score of right coronary artery in Grade 4 group were significantly higher than that in Grade 1 group [(60.15+8.78) vs (53.73+6.0). 4) score, (12.03 + 3.12) vs (6.44 + 1.52), P 0.05].Gensini score of left circumflex branch in 4-position group was significantly higher than that of 3-position group and 2-position group [(14.32 + 3.70) vs (10.97 + 4.13), (10.60 + 3.18)] score, P 0.05.3-position group was significantly lower than that of 1-position group [(10.97 + 4.13) vs (15.58 + 3.85), P 0.05]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (6.44 (+ 1.52), P 0.05)]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (10.20 (+ 2.91), P 0.05)]. Gensini score of the right coronary artery in the two-position group was significantly higher than that in the one-position group (P 0.05). Gensini score of the left circumflex branch in the two-position group The correlation coefficient between serum uric acid and Gensini integral of right coronary artery was 0.385, and that between serum uric acid and total coronary artery lesion was 0.305 (P 0.05). Uric acid was negatively correlated with high density lipoprotein cholesterol (P 0.196, P 0.05). The correlation coefficients were 0.157, 0.155, 0.189 and 0.267, respectively, P were 0.05. Multivariate linear regression analysis showed that uric acid was an independent risk factor for right coronary artery and coronary artery lesions. The integral Gensini score of coronary artery disease is closely related to serum uric acid level in elderly patients with coronary heart disease.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
[Abstract]:Background China's economic construction has made remarkable achievements in recent decades of reform and opening up. The material and cultural living standards of the broad masses of the people have been greatly improved. Great changes have taken place in the diet and life education of young people and middle-aged and old people before, including the lack of diet and exercise with high fat, sugar and protein, work and society. The incidence of cardiovascular disease in the elderly is much higher than that in the young. The incidence of cardiovascular disease in the elderly is much higher than that in the young. There are many complications and high mortality. It is a serious social and public health problem in China. Sudden cardiac death (SCD) is one of the main causes of heart disease, which seriously affects the work and life of patients and increases their mental and economic burden. It has been found that uric acid can influence the occurrence and development of coronary heart disease through both the influence of traditional risk factors and the direct effect of coronary artery. The study of whether serum uric acid levels have different effects on left main coronary artery, anterior descending coronary artery, right coronary artery and circumflex coronary artery in elderly patients with coronary heart disease has received less attention from medical workers. Objective To investigate the effect of uric acid on the severity of coronary artery stenosis in elderly patients with coronary heart disease.Methods 137 elderly patients with coronary heart disease were selected and divided into the first group (141-279 mmol/L) and the second group (34 cases) according to the level of uric acid. Group A (279.5-418 mmol/L), Grade 3 (418.5-557 mmol/L), Grade 4 (557.5-692 mmol/L) and Grade 3 (34). All subjects underwent coronary angiography, and the degree of stenosis was assessed by Gensini score system. Results The total coronary artery score and the Gensini score of right coronary artery in Grade 4 group were significantly higher than that in Grade 1 group [(60.15+8.78) vs (53.73+6.0). 4) score, (12.03 + 3.12) vs (6.44 + 1.52), P 0.05].Gensini score of left circumflex branch in 4-position group was significantly higher than that of 3-position group and 2-position group [(14.32 + 3.70) vs (10.97 + 4.13), (10.60 + 3.18)] score, P 0.05.3-position group was significantly lower than that of 1-position group [(10.97 + 4.13) vs (15.58 + 3.85), P 0.05]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (6.44 (+ 1.52), P 0.05)]. Gensini score of the right coronary artery in the three-position group was significantly higher than that in the two-position group [(12.00 (+ 2.35) vs (10.20 (+ 2.91), P 0.05)]. Gensini score of the right coronary artery in the two-position group was significantly higher than that in the one-position group (P 0.05). Gensini score of the left circumflex branch in the two-position group The correlation coefficient between serum uric acid and Gensini integral of right coronary artery was 0.385, and that between serum uric acid and total coronary artery lesion was 0.305 (P 0.05). Uric acid was negatively correlated with high density lipoprotein cholesterol (P 0.196, P 0.05). The correlation coefficients were 0.157, 0.155, 0.189 and 0.267, respectively, P were 0.05. Multivariate linear regression analysis showed that uric acid was an independent risk factor for right coronary artery and coronary artery lesions. The integral Gensini score of coronary artery disease is closely related to serum uric acid level in elderly patients with coronary heart disease.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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相关期刊论文 前5条
1 陈伟伟;高润霖;刘力生;朱曼璐;王文;王拥军;吴兆苏;李惠君;郑哲;蒋立新;胡盛寿;;《中国心血管病报告2014》概要[J];中国循环杂志;2015年07期
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