血瘀证积分联合红细胞分布宽度对冠心病及冠脉病变程度的预测价值研究

发布时间：2018-04-11 06:20

本文选题：血瘀证积分 + 红细胞分布宽度　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：本研究拟收集接受CAG术的血瘀证患者,CAG结果使用Gensini计分评估,分析血瘀程度、RDW值与CHD及冠状动脉病变程度的关系,并探讨血瘀证积分联合RDW对CHD的预测价值。方法：根据纳入标准、排除标准选择广州中医药大学第一附属医院心内科自2015年10月至2016年2月中医证型为血瘀证并接受了CAG,术的住院患者共202例。其中冠脉造影示冠状动脉正常或冠状动脉异常但未及冠心病诊断标准的患者96例,为非冠心病组；确诊冠心病患者106例,为冠心病组。收集病人的一般资料包含性别、年龄、既往史、是否吸烟及饮酒等临床资料；检测RDW-CV、RBC、HGB、MCV、HCT、WBC、GRA、 Mon、hs-CRP、Glu、TBIL、UA、CRE、TC、TG、HDL-C、LDL-C等化验指标；行血瘀证积分；行CAG术并根据结果行Gensini积分。使用SPSS 19.0统计软件进行数据分析。两组间计量资料以t(t’)检验或独立样本非参数检验进行比较,两组间计数资料比较采用x2检验；相关性分析采用Spearman分析；Gensini积分影响因素采用逐步回归分析；冠心病危险因素分析用logistic回归分析；利用受试者工作特征(receiver operating characterist, ROC)曲线下面积分析血瘀证积分、RDW-CV及血瘀证积分联合RDW-CV对冠心病的预测价值。以P0.05为差异有统计学意义。结果：单因素检验结果示,冠心病组与非冠心病组间性别、年龄、吸烟史、RDW-CV、RBC、 NCV、WBC、GRA、Mon、hs-CRP、CRE、HDL-C、LDL-C、血瘀证积分水平均具有显著性差异(P0.05)。而高血压病史、高脂血症病史、糖尿病病史、TBIL、UA、TC、TG、 HbAlc、Glu水平均不具有统计学意义。进一步进行Spearman相关性分析,RDW-CV及血瘀证积分均与炎性指标hs-CRP、GRA、Mon成正相关(P0.05),而与WBC均不存在相关性。血瘀证积分及RDW-CV与Gensini积分成正相关(r分别为0.545和0.542,P均0.001)。拟合回归方程,R2线性分别为0.256、0.124,表明两者分别与Gensini积分成正相关,即随着血瘀证积分及RDW-CV水平的升高,冠状动脉病变程度也随之加重。以中位数为节点分为两组,大于中位数组确诊冠心病的患者比例约为低于中位数组的2.5倍。两组间冠心病、血管病变支数(双、三支)及Gensini积分差异均有统计学意义(P0.05)。两组间(血瘀证积分)单支血管病变有显著差异性。逐步回归分析示血瘀证积分、RDW-CV、男性、GRA、MCV、TG及糖尿病与Gensini积分呈线性回归关系(R=0.719,R2=0.516,调整R2=0.496,回归方程方差分析F=25.759,P0.001),血瘀证积分、RDW-CV与Gensini积分仍成正相关。多因素logistic回归分析结果显示RDW-CV与血瘀程度是冠心病的独立影响及预测因素,Exp(B)分别为2.011和1.157。绘制ROC曲线,血瘀证积分ROC曲线下面积为0.783,95%CI：0.673-0.814,P0.001,最佳临界点值为19.50,诊断冠心病的敏感性为67.9%,特异性为79.2%；RDW-CV曲线下面积为0.743,95%CI：0.720-0.846,P0.001,最佳临界点值为13.25%,诊断冠心病的敏感性为66.0%,特异性为76.0%；二者联合曲线下面积为0.808,最佳临界点值的诊断敏感性达92.5%,说明两者联合有助于对冠心病高危人群的筛查。结论：1.血瘀证积分与RDW-CV值呈正相关,即随血瘀程度加重,RDW-CV值也随之上升。2.血瘀程度越重、RDW-CV值越高,Gensini积分则越高。3.血瘀证积分、RDW-CV水平可作为冠心病风险的独立预测指标。4.血瘀证积分联合RDW-CV有助于对冠心病高危人群的筛查。
[Abstract]:Objective: This study received CAG surgery in patients with blood stasis syndrome, CAG results using the Gensini score evaluation, analysis of the degree of blood stasis, RDW value and the severity of CHD and coronary artery disease, and to investigate the value of blood stasis syndrome combined with RDW on the prediction of CHD. Methods: according to the inclusion criteria, exclusion criteria to choose the Department of Cardiology the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2015 to February 2016 for the TCM Syndromes of blood stasis and accepted CAG surgery inpatients were 202 cases. The coronary angiography showed normal coronary arteries or coronary artery anomalies but not the standard diagnosis of coronary heart disease in 96 patients with non coronary heart disease group; 106 patients were diagnosed as coronary heart disease, coronary heart disease group. The patient's general information gathering including gender, age, medical history, smoking and drinking and other clinical data; detection of RDW-CV, RBC, HGB, MCV, HCT, WBC, GRA, Mon, hs-CRP, Glu, TBIL, UA, CRE, TC, TG, HDL-C LDL-C, the test index; for the blood stasis score; CAG was performed according to the results of Gensini integral. Using SPSS 19 statistical software to analyze the data. The measurement data between the two groups with t (T) test or nonparametric test for independent samples were compared between the two groups of count data were compared with X2 test; the correlation analysis Spearman analysis; Gensini integral influence factors by stepwise regression analysis; regression analysis of risk factors of coronary heart disease by logistic; using the receiver operating characteristic (receiver operating, characterist, ROC) of blood stasis syndrome in the area under the curve, the value of RDW-CV and the blood stasis score combined with RDW-CV in prediction of coronary heart disease with P0.05. The difference was statistically significant. Single factor test results showed that CHD group and non CHD group sex, age, smoking history, RDW-CV, RBC, NCV, WBC, GRA, Mon, hs-CRP, CRE, HDL-C, LDL-C, blood stasis For the integral level has significant difference (P0.05). The history of hypertension, hyperlipidemia history, history of diabetes, TBIL, UA, TC, TG, HbAlc, Glu levels were not statistically significant. The Spearman correlation analysis, RDW-CV and the blood stasis score and inflammatory indexes of hs-CRP, GRA, Mon positive correlation (P0.05), and there was no correlation between WBC and RDW-CV. The blood stasis score and Gensini score was positively correlated (r = 0.545 and 0.542, P 0.001). The regression equation, the linear R2 0.256,0.124 respectively, indicating that both were positively correlated with Gensini score, namely with the increase of blood stasis syndrome the level of RDW-CV and the severity of coronary artery disease also will increase. The median of nodes are divided into two groups, more than the median array of diagnosed coronary artery disease ratio is about 2.5 times lower than the median array. Between the two groups of coronary heart disease, the number of vascular lesions (double, three) and Gens Ini score differences were statistically significant (P0.05). Among the two groups (blood stasis syndrome) significant differences in single vessel disease. Stepwise regression analysis showed that blood stasis score, RDW-CV, GRA, MCV, male, TG and diabetes and Gensini integral linear regression (R=0.719, R2= 0.516, R2=0.496 adjustment, regression equation analysis of variance and F=25.759, P0.001), blood stasis syndrome, RDW-CV and Gensini integral is still a positive correlation. Logistic regression analysis showed that RDW-CV and the degree of blood stasis is an independent influence and predictive factors of coronary heart disease, Exp (B) 2.011 and 1.157. respectively the ROC curve, the area under the ROC curve of blood stasis score is 0.783,95%CI:0.673-0.814, P0.001 the best critical point, was 19.50, sensitivity in the diagnosis of coronary heart disease was 67.9%, specificity was 79.2%; the area under the RDW-CV curve of 0.743,95%CI:0.720-0.846, P0.001, best critical point value is 13.25%, the diagnosis of coronary heart disease The sensitivity was 66%, specificity was 76%; the two combined area under the curve was 0.808, the diagnostic sensitivity of the best critical point of 92.5%, that combination is conducive to screening the high-risk coronary heart disease. Conclusion: 1. blood stasis syndrome integral and the RDW-CV values were positively correlated with the severity of blood stasis, the RDW-CV value also increased.2. blood stasis degree is heavier, the higher the RDW-CV value, the higher the Gensini score.3. score of blood stasis, RDW-CV can be used as an independent predictor of coronary heart disease risk.4. score of blood stasis combined with RDW-CV is helpful in screening for high-risk coronary heart disease.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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