發(fā)布時(shí)間：2018-04-09 04:09

  本文選題：急性冠脈綜合征　切入點(diǎn)：纖維蛋白原　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：急性冠脈綜合征臨床表現(xiàn)各異,冠狀動(dòng)脈狹窄嚴(yán)重程度不一,血流動(dòng)力學(xué)變化差異大,病死率高,預(yù)后存在明顯差異。血清纖維蛋白原作為心血管事件的一個(gè)預(yù)測因素,與冠心病的發(fā)生、發(fā)展相關(guān)。本研究目的為探究纖維蛋白原與急性冠脈綜合征的發(fā)生、發(fā)展及危險(xiǎn)嚴(yán)重程度的關(guān)系。方法：納入符合急性冠脈綜合征(ACS)診斷標(biāo)準(zhǔn)的患者共692例,擬診“冠心病”但后冠狀動(dòng)脈造影顯示冠狀動(dòng)脈光滑無斑塊或狹窄患者作為對照組99例。對患者的一般情況(如年齡、性別、吸煙史、吸煙史、高血壓史等)進(jìn)行詳細(xì)記錄。同時(shí)測定血清纖維蛋白原(FIB)水平、血脂、血糖及其他血清學(xué)指標(biāo).所有患者均完善心電圖、冠脈造影檢查,冠脈狹窄程度以gensini評分評價(jià),急性冠脈綜合癥危險(xiǎn)程度以grace評分評價(jià)。分析不同急性冠脈綜合征類型、冠脈病變支數(shù)、gensini評分及grace評分組間血清纖維蛋白原(FIB)水平,探討血清纖維蛋白原與急性冠脈綜合征的發(fā)生、發(fā)展、冠脈嚴(yán)重程度及危險(xiǎn)程度的相關(guān)性。結(jié)果：1、STEMI組血清纖維蛋白原水平明顯高于NST-ACS組及正常組,NST-ACS組血清FIB水平又明顯高于正常組。2、血清纖維蛋白原水平與冠脈病變支數(shù)有關(guān),冠脈多支病變組雙支病變組單支病變組正常組。3、與低gensini評分組患者相比,高gensini評分組血清纖維蛋白原水平明顯增高,隨著gensini評分的增加,血清FIB水平逐漸增高。4、隨著grace評分的增高,血清纖維蛋白原水平顯著升高。5、相關(guān)分析提示,血清纖維蛋白原與grace評分及gensini評分呈正相關(guān)性。6、多因素logistic回歸分析示,血清纖維蛋白原是急性冠脈綜合征危險(xiǎn)程度加重的獨(dú)立因素(P0.05)。7、血清纖維蛋白原診斷急性冠脈綜合征的ROC曲線下面積為0.876,提示纖維蛋白原對預(yù)測急性冠脈綜合征的發(fā)生有一定價(jià)值,以FIB水平4.15g/l為標(biāo)準(zhǔn),從統(tǒng)計(jì)學(xué)意義上講診斷冠心病的敏感性、特異性分別為80.1%、79.9%。結(jié)論：1、血清纖維蛋白原水平能反映冠脈病變嚴(yán)重程度及急性冠脈綜合征的危險(xiǎn)程度；2、血清纖維蛋白原與急性冠狀動(dòng)脈綜合征的發(fā)生、發(fā)展密切相關(guān),是急性冠脈綜合征危險(xiǎn)程度加重的獨(dú)立因素。3、血清纖維蛋白原可用于預(yù)測急性冠脈綜合征的發(fā)生風(fēng)險(xiǎn)。4、聯(lián)合運(yùn)用血清纖維蛋白原水平可能對ACS的早期危險(xiǎn)分層、預(yù)后評估及診療方案的選擇有重要臨床參考價(jià)值。
[Abstract]:Objective: acute coronary syndrome (ACS) is characterized by different clinical manifestations, different severity of coronary stenosis, great difference in hemodynamics, high mortality and significant difference in prognosis.As a predictor of cardiovascular events, serum fibrinogen is associated with the occurrence and development of coronary heart disease.The aim of this study was to investigate the relationship between fibrinogen and the occurrence, development and risk severity of acute coronary syndrome (ACS).Methods: a total of 692 patients with acute coronary syndrome (ACS) were included in this study. 99 patients with coronary artery disease were diagnosed as "coronary artery disease", but the patients with smooth coronary artery without plaque or stenosis were selected as the control group.The patient's general information (such as age, sex, smoking history, smoking history, hypertension history, etc.) was recorded in detail.At the same time, serum fibrinogen FIBs, blood lipids, blood glucose and other serological indexes were measured.All patients had improved ECG, coronary angiography, coronary stenosis was evaluated by gensini score, and acute coronary syndrome risk was evaluated by grace score.The types of acute coronary syndrome (ACS), the levels of serum fibrinogen (FB) and the levels of serum fibrinogen (FB) in patients with acute coronary syndrome (ACS) were analyzed, and the occurrence and development of acute coronary syndrome (ACS) were discussed.Correlation between severity and risk of coronary artery.Results the level of serum fibrinogen in group 1 was significantly higher than that in group NST-ACS and group NST-ACS, and the level of serum fibrinogen was significantly higher than that in group 2. The level of serum fibrinogen was related to the number of coronary artery lesion branches.Compared with the low gensini score group, the serum fibrinogen level in the high gensini score group was significantly higher than that in the single vessel lesion group, and the level of fibrinogen in the high gensini score group increased with the increase of gensini score.The serum FIB level increased gradually. With the increase of grace score, the serum fibrinogen level increased significantly. The correlation analysis indicated that the serum fibrinogen level was positively correlated with the grace score and gensini score. The multivariate logistic regression analysis showed that the serum fibrinogen level was significantly higher than that in the control group.Serum fibrinogen is an independent factor for exacerbating the risk of acute coronary syndrome (ACS). The area under the ROC curve of serum fibrinogen for diagnosis of acute coronary syndrome is 0.876, suggesting that fibrinogen can predict acute coronary syndrome.It has some value.According to the standard of FIB level 4.15g/l, the sensitivity of diagnosis of coronary heart disease was 80.1% and 79.9% respectively.Conclusion the level of serum fibrinogen can reflect the severity of coronary artery disease and the risk of acute coronary syndrome. Serum fibrinogen is closely related to the occurrence and development of acute coronary syndrome.Serum fibrinogen can be used to predict the risk of acute coronary syndrome. Combined use of serum fibrinogen may be an early risk stratification of ACS.The evaluation of prognosis and the choice of diagnosis and treatment plan have important clinical reference value.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4

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