本文選題：冠心病　切入點：心絞痛　出處：《新鄉(xiāng)醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：背景冠心病作為發(fā)病率和致死率目前都高、病因復(fù)雜、病機至今尚未完全揭曉、對人類身心健康影響較大、防治較為困難一個心血管病,與血同型半胱氨酸、骨質(zhì)疏松的關(guān)系雖有一些研究,但關(guān)于老年冠心病心絞痛與血同型半胱氨酸、骨質(zhì)疏松關(guān)系的循證學依據(jù)至今仍十分匱乏。目的分析同型半胱氨酸、骨質(zhì)疏松之間及二者與老年冠心病心絞痛發(fā)生、嚴重程度之間的關(guān)系,為老年冠心病心絞痛的防治提供循證學依據(jù)。方法選取2015年1月至2016年12月就診于鄭州人民醫(yī)院經(jīng)冠狀動脈造影確診的70例老年冠心病心絞痛患者和70例無冠心病老年患者分別設(shè)為病例組、對照組,用Excel表格收集入組受試者的性別、年齡、煙酒史、高血壓史、糖尿病史、血同型半胱氨酸(S-腺苷水解酶法檢測)、跟骨骨密度(韓國超聲骨密度儀測定)、心絞痛嚴重程度[用加拿大心血管病學會(Canadian Cardiovascular Society,CCS)分級]和冠狀動脈狹窄程度[Gensini積分法]等資料,經(jīng)SPSS20.0統(tǒng)計軟件包用X~2檢驗、多因素Logistic模型篩選影響老年冠心病心絞痛發(fā)生的因素,用Spearman等級法分析血同型半胱氨酸、跟骨骨密度之間及二者與老年冠心病心絞痛嚴重程度之間的關(guān)系,P0.05為差異存在統(tǒng)計學意義。結(jié)果(1)X~2檢驗顯示:煙酒史、高血壓史、高同型半胱氨酸血癥、糖尿病史、骨質(zhì)疏松癥是老年冠心病心絞痛發(fā)生的可疑影響因素(P0.05);(2)多因素Logistic回歸分析顯示:高血壓史(β=0.529,OR=1.269)、高同型半胱氨酸血癥(β=2.426,OR=2.983)、骨質(zhì)疏松癥(β=1.433,OR=2.015)是老年冠心病心絞痛發(fā)生的獨立影響因素(P0.05)。(3)Spearman等級法統(tǒng)計顯示:病例組,血同型半胱氨酸與CCS分級、Gensini總積分呈正相關(guān)(rs=0.624、0.807,P0.05),跟骨骨密度與CCS分級、Gensini總積分呈負相關(guān)(rs=-0.583、-0.727,P0.05),血同型半胱氨酸與跟骨骨密度呈負相關(guān)(rs=-0.753,P0.05);對照組血同型半胱氨酸與跟骨骨密度無明顯相關(guān)性(P0.05)。結(jié)論高同型半胱氨酸血癥、骨質(zhì)疏松是老年冠心病心絞痛發(fā)生的獨立危險因素,血同型半胱氨酸、跟骨骨密度與老年冠心病心絞痛嚴重程度關(guān)系密切,且二者呈負相關(guān),臨床中需加以重視。
[Abstract]:Background Coronary heart disease, as a high morbidity and fatality rate, has complicated etiology, and the pathogenesis has not been fully revealed, which has a great impact on human physical and mental health. It is difficult to prevent and cure a cardiovascular disease with homocysteine. Although there have been some studies on the relationship between osteoporosis and angina pectoris and homocysteine in the elderly, the evidence-based basis for the relationship between osteoporosis and osteoporosis is still very scarce. The relationship between osteoporosis and the occurrence and severity of angina pectoris in elderly patients with coronary heart disease. Methods from January 2015 to December 2016, 70 elderly patients with angina pectoris diagnosed by coronary angiography and 70 patients without coronary heart disease were selected from Zhengzhou people's hospital to provide evidence-based evidence for the prevention and treatment of angina pectoris of coronary heart disease. The elderly patients were divided into two groups. In the control group, sex, age, history of alcohol and tobacco, history of hypertension, history of diabetes mellitus were collected by Excel table. Serum homocysteine S-adenosine hydrolase assay, calcaneal bone mineral density (KUSBMD), severity of angina pectoris [Canadian Cardiovascular Society CCSs] and coronary artery stenosis [Gensini integration method], and so on. The factors influencing angina pectoris in elderly patients were screened by SPSS20.0 statistical software package Xn2 test, multivariate Logistic model, and homocysteine were analyzed by Spearman grade method. The relationship between calcaneal bone mineral density and the severity of angina pectoris in elderly patients with coronary heart disease (P 0.05) was statistically significant. Results: the history of alcohol and tobacco, hypertension, hyperhomocysteinemia, diabetes mellitus, and so on. Multivariate Logistic regression analysis showed that the history of hypertension (尾 0. 529), hyperhomocysteinemia (尾 2. 426) and osteoporosis (尾 1. 433OR2.015) were independent of angina pectoris in elderly patients. The influencing factors were as follows: case group, P0.05, Spearman's grade method, P0. 05%, P 0. 05, P 0. 05, P 0. 05. There was a positive correlation between serum homocysteine and CCS grade Gensini total score, a negative correlation between calcaneal bone mineral density and CCS grade Gensini total score, a negative correlation between serum homocysteine and calcaneal bone density, a negative correlation between serum homocysteine and calcaneal bone density, and a negative correlation between serum homocysteine and calcaneal bone mineral density, and a negative correlation between serum homocysteine and calcaneal bone mineral density, and a negative correlation between serum homocysteine and calcaneal bone density, and a negative correlation between serum homocysteine and calcaneal bone density. There was no significant correlation between density and P0.05.Conclusion hyperhomocysteinemia is associated with hyperhomocysteinemia. Osteoporosis is an independent risk factor of angina pectoris in elderly patients. Homocysteine and calcaneal bone mineral density are closely related to the severity of angina pectoris in elderly patients.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4;R580

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