超敏CRP和NSTEMI冠脉病变严重程度及预后的相关性研究
发布时间：2018-10-12 12:26
【摘要】：背景和目的随着生活质量的提升,人们越来越关注健康,急性冠脉综合征逐渐变为其关注的焦点。急性冠脉综合征主要包括急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死以及不稳定型心绞痛。超敏CRP是一种快速、简便的生化检验指标。国内外对于超敏CRP与急性ST段抬高型心肌梗死以及不稳定型心绞痛之间的关系研究报道较多,对于超敏CRP与急性非ST抬高型心肌梗死之间的关系研究报道较少。急性非ST段抬高型心肌梗死的患者多以中老年为主,病情较为复杂,影响因素众多。目前临床上常用于评价急性非ST段抬高型心肌梗死的病情及预后情况的方法有GRACE评分和TIMI评分等,但这些评价方法步骤繁琐、涉及冠心病危险因素较多、耗时较长,而超敏CRP作为一种简便、快速的生化检验指标,具有巨大的优势。本文着重探究急性非ST型抬高型的心肌梗死病人的超敏CRP水平和冠脉病变之间严重程度的关系,以及探讨超敏CRP能否预测急性非ST心肌梗死患者的预后。方法从大连医科大学附属一院二部病例查阅系统和NSTEMI数据库中连续选取了 2014年01月01日至2015年12月31日住院的急性非ST段抬高型心肌梗死患者共522例,其中行冠脉造影的共287例,而抽血化验超敏CRP并行冠脉造影的共164例,这164例患者作为纳入本次研究的对象。记录所有患者的临床资料,如性别、年龄、既往史(高血压、糖尿病、脑血管疾病等)、超敏CRP、血脂、左室射血分数等。然后相关人员对这些病人进行了随访,记录是否发生MACCE事件及生存时间。MACCE主要包括了全因性死亡、再发性心肌梗死、再发性心绞痛、需住院的治疗的不稳定性心绞痛以及心功能衰竭。随访截止日期为2016年12月31日。结果根据所有病人的大体情况,依据hs-CRP水平分为两组,高hs-CRP组(大于3.Omg/L)和低hs-CRP组(小于等于3.Omg/L)。其中高hs-CRP组79例,低hs-CRP组85例。根据冠脉造影结果,为了便于量化分析比较冠脉病变严重程度,引入新Gensini评分,将整体冠脉狭窄程度转化为具体直观数值。新Gensini评分[3]:对冠状动脉8个主要节段进行狭窄评分,无异常发现为0分;狭窄范围在1%-49%为1分;50%-74%为2分;75%-99%为3分;100%闭塞为4分。结果发现高hs-CRP组和低hs-CRP组比较新Gensini评分有统计学意义(p0.05)。另外根据随访患者有无发生MACCE事件,分为MACCE组和无MACCE组,MACCE组患者31例,无MACCE组129例,失访4例。未发生MACCE事件组的患者超敏CRP水平4.08±3.69mg/L明显低于MACCE事件组的患者6.66± 1.91mg/L。通过单因素和多因素的COX回归分析表明,超敏CRP是NSTEMI患者未来MACCE事件的独立预测因素[RR=1.126,95%CI(1.052,1.205),P=0.001]。Kaplan-Meier 生存曲线表明随着超敏 CRP水平的不断升高,NSTEMI患者的无事件生存率明显降低(log—rank x2=9.339,P=0.002)。结论1.超敏CRP水平与NSTEMI患者的冠脉病变严重程度有关,研究证实CRP浓度越高,提示NSTEMI患者冠脉病变程度越重;2.超敏CRP可以预测NSTEMI患者的不良预后,研究证实CRP浓度越高,提示NSTEMI患者的预后越差。
[Abstract]:BACKGROUND & OBJECTIVE: With the improvement of quality of life, people pay more and more attention to health, and acute coronary syndrome gradually becomes the focus of its attention. Acute coronary syndromes mainly include acute ST-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction, and unstable angina. Hypersensitive CRP is a fast and simple biochemical test index. The relationship between hypersensitive CRP and acute ST-segment elevation myocardial infarction (AMI) and unstable angina pectoris was more and more reported at home and abroad, and the relationship between hypersensitive CRP and acute non-ST-elevation myocardial infarction was reported less. Patients with acute non-ST-segment elevation myocardial infarction were mostly middle-aged and elderly, with complex condition and many influencing factors. At present, the methods for evaluating the condition and prognosis of acute non-ST-segment elevation myocardial infarction include GRACE score and TIMI score, but these methods are complicated, involving more risk factors of coronary heart disease, longer time consumption, and hypersensitive CRP as a simple and convenient method. The rapid biochemical test index has great advantages. This paper focuses on the relationship between the hypersensitivity CRP level and the severity of acute non-ST elevation myocardial infarction patients, and discusses whether the hypersensitive CRP can predict the prognosis of patients with acute non-ST myocardial infarction. Methods A total of 522 patients with acute non-ST-segment elevation myocardial infarction hospitalized from Jan. 01, 2014 to December 31, 2015 were selected from the case review system and the NSTEMI database from the Affiliated Hospital of Dalian Medical University, including 287 cases of coronary angiography. A total of 164 cases of hypersensitive CRP parallel coronary angiography were used to test 164 patients as subjects for inclusion in the study. Record clinical data of all patients, such as sex, age, past history (hypertension, diabetes, cerebrovascular disease, etc.), hypersensitive CRP, blood lipid, left ventricular ejection fraction, etc. The patients were then followed up and documented for MACE events and survival time. MACE mainly includes all-cause death, recurrent myocardial infarction, recurrent angina, unstable angina pectoris requiring hospitalization, and heart failure. Follow-up cutoff date was December 31, 2016. Results According to the general condition of all patients, the hs-CRP level was divided into two groups: high hs-CRP group (greater than 3. Omg/ L) and low hs-CRP group (less than or equal to 3. Omg/ L). Among them, 79 cases were high hs-CRP group and 85 cases were low hs-CRP group. Based on the results of coronary angiography, in order to facilitate quantitative analysis and compare the severity of coronary lesions, a new Gaini score was introduced to translate the degree of overall coronary stenosis into a specific visual value. New Gaini score[3]: stenosis scores were performed on 8 major segments of the coronary artery, no anomalies noted as 0 points; stenosis ranged from 1% to 49% for 1 point; 50% to 74% for 2 points; 75% to 99% for 3 points; 100% occlusion was 4 points. The results showed that there was a statistically significant difference between the high hs-CRP group and the low hs-CRP group (P0.05). In addition, according to the presence or absence of MACE event in the follow-up patients, there were 31 patients with MACE group, 129 without MACE group, 129 without MACE group, and 4 cases lost to follow-up. Patients who did not have a MACE event group had a significantly lower CRP level of 4.08 Mt. 3.69mg/ L significantly lower than that of the MACE event group 6.66 mg/ L. A single factor and multivariate COX regression analysis indicated that hypersensitive CRP was an independent predictor of future MACE events in NSTEMI patients[RR = 1. 126, 95% CI (1. 052, 1. 205), P = 0. 001]. Kaplan-Meier survival curves show a significant decrease in the non-event survival rate of NSTEMI patients as the level of hypersensitive CRP increases (log = 0.93x2 = 9. 339, P = 0. 002). Conclusion 1. The higher CRP level was associated with the severity of coronary lesions in NSTEMI patients, and the higher the CRP concentration was demonstrated, the greater the degree of coronary lesions in NSTEMI patients; 2. Hypersensitive CRP can predict the poor prognosis of NSTEMI patients, and the higher CRP concentration results in the poorer prognosis of NSTEMI patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
，
本文编号：2266109
[Abstract]:BACKGROUND & OBJECTIVE: With the improvement of quality of life, people pay more and more attention to health, and acute coronary syndrome gradually becomes the focus of its attention. Acute coronary syndromes mainly include acute ST-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction, and unstable angina. Hypersensitive CRP is a fast and simple biochemical test index. The relationship between hypersensitive CRP and acute ST-segment elevation myocardial infarction (AMI) and unstable angina pectoris was more and more reported at home and abroad, and the relationship between hypersensitive CRP and acute non-ST-elevation myocardial infarction was reported less. Patients with acute non-ST-segment elevation myocardial infarction were mostly middle-aged and elderly, with complex condition and many influencing factors. At present, the methods for evaluating the condition and prognosis of acute non-ST-segment elevation myocardial infarction include GRACE score and TIMI score, but these methods are complicated, involving more risk factors of coronary heart disease, longer time consumption, and hypersensitive CRP as a simple and convenient method. The rapid biochemical test index has great advantages. This paper focuses on the relationship between the hypersensitivity CRP level and the severity of acute non-ST elevation myocardial infarction patients, and discusses whether the hypersensitive CRP can predict the prognosis of patients with acute non-ST myocardial infarction. Methods A total of 522 patients with acute non-ST-segment elevation myocardial infarction hospitalized from Jan. 01, 2014 to December 31, 2015 were selected from the case review system and the NSTEMI database from the Affiliated Hospital of Dalian Medical University, including 287 cases of coronary angiography. A total of 164 cases of hypersensitive CRP parallel coronary angiography were used to test 164 patients as subjects for inclusion in the study. Record clinical data of all patients, such as sex, age, past history (hypertension, diabetes, cerebrovascular disease, etc.), hypersensitive CRP, blood lipid, left ventricular ejection fraction, etc. The patients were then followed up and documented for MACE events and survival time. MACE mainly includes all-cause death, recurrent myocardial infarction, recurrent angina, unstable angina pectoris requiring hospitalization, and heart failure. Follow-up cutoff date was December 31, 2016. Results According to the general condition of all patients, the hs-CRP level was divided into two groups: high hs-CRP group (greater than 3. Omg/ L) and low hs-CRP group (less than or equal to 3. Omg/ L). Among them, 79 cases were high hs-CRP group and 85 cases were low hs-CRP group. Based on the results of coronary angiography, in order to facilitate quantitative analysis and compare the severity of coronary lesions, a new Gaini score was introduced to translate the degree of overall coronary stenosis into a specific visual value. New Gaini score[3]: stenosis scores were performed on 8 major segments of the coronary artery, no anomalies noted as 0 points; stenosis ranged from 1% to 49% for 1 point; 50% to 74% for 2 points; 75% to 99% for 3 points; 100% occlusion was 4 points. The results showed that there was a statistically significant difference between the high hs-CRP group and the low hs-CRP group (P0.05). In addition, according to the presence or absence of MACE event in the follow-up patients, there were 31 patients with MACE group, 129 without MACE group, 129 without MACE group, and 4 cases lost to follow-up. Patients who did not have a MACE event group had a significantly lower CRP level of 4.08 Mt. 3.69mg/ L significantly lower than that of the MACE event group 6.66 mg/ L. A single factor and multivariate COX regression analysis indicated that hypersensitive CRP was an independent predictor of future MACE events in NSTEMI patients[RR = 1. 126, 95% CI (1. 052, 1. 205), P = 0. 001]. Kaplan-Meier survival curves show a significant decrease in the non-event survival rate of NSTEMI patients as the level of hypersensitive CRP increases (log = 0.93x2 = 9. 339, P = 0. 002). Conclusion 1. The higher CRP level was associated with the severity of coronary lesions in NSTEMI patients, and the higher the CRP concentration was demonstrated, the greater the degree of coronary lesions in NSTEMI patients; 2. Hypersensitive CRP can predict the poor prognosis of NSTEMI patients, and the higher CRP concentration results in the poorer prognosis of NSTEMI patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
，
本文编号：2266109
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