本文選題：前蛋白轉(zhuǎn)化酶枯草溶菌素9 + 急性心肌梗死　； 參考：《石河子大學》2017年碩士論文

【摘要】：目的:觀察前蛋白轉(zhuǎn)化酶枯草溶菌素9(PCSK9)在急性心肌梗死合并2型糖尿病患者中的水平,并探討其與血糖控制水平、炎癥反應(yīng)之間的關(guān)系。方法:選取急性心肌梗死合并2型糖尿病患者100例,同期住院的單純急性心肌梗死患者61例,慢性穩(wěn)定性冠心病患者70例。急性心肌梗死的診斷標準符合2011年ESC“急性心肌梗死診斷和治療指南”中的相關(guān)診斷標準;糖尿病的診斷標準符合2013年ADA糖尿病醫(yī)學診療標準。收集患者的臨床基本資料,并嚴格按照中華醫(yī)學會心血管病學分會制定的《經(jīng)皮冠狀動脈介入治療指南(2012)》對入選患者行冠脈造影檢查,并采用Gensini積分系統(tǒng)對患者冠狀動脈的狹窄程度給予定量評價;各組入選患者入院后第二天空腹采取靜脈血,采用貝克曼AU5800全自動生化分析儀測定患者高敏C反應(yīng)蛋白(Hs-CRP)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、甘油三酯(TG)、總膽固醇(TC)水平;采用BIO-RAD公司D-10全自動糖化血紅蛋白分析儀檢測患者糖化血紅蛋白(HbA1c);采用酶聯(lián)免疫吸附試驗(ELISA)檢測患者血清PCSK9水平;并將血清PCSK9水平與反映血糖控制水平的HbA1c以及炎癥指標Hs-CRP之間進行相關(guān)性分析。結(jié)果:急性心肌梗死合并2型糖尿病組、單純急性心肌梗死組、慢性穩(wěn)定性冠心病組三組患者在年齡、性別、吸煙史、高血壓病史、甘油三酯、總膽固醇、高密度脂蛋白、低密度脂蛋白等各方面的比較差異均無統(tǒng)計學意義(P0.05),三組間空腹血糖水平比較差異有統(tǒng)計學意義(P0.05);急性心肌梗死合并糖尿病組、單純急性心肌梗死組血清PCSK9、HbA1c、Hs-CRP水平均較慢性穩(wěn)定性冠心病組高,且急性心肌梗死合并糖尿病組三者水平均較單純急性心肌梗死組高(P0.05);在急性心肌梗死合并糖尿病組中,血清PCSK9水平與Hs-CRP、Gensini評分呈正相關(guān)(r分別為0.526、0.287,P均0.05),與HbA1c、空腹血糖水平無相關(guān)性(r分別為0.067、0.118,P0.05)。結(jié)論:1、急性心肌梗死合并糖尿病患者血清PCSK9水平較高,提示PCSK9可能參與了促冠脈斑塊的不穩(wěn)定性及糖代謝紊亂的過程。2、血清PCSK9在急性心肌梗死合并糖尿病患者中與冠狀動脈Gensini評分、hs-CRP存在正相關(guān)關(guān)系,提示檢測PCSK9有助于協(xié)助判斷患者冠脈病變的嚴重程度。
[Abstract]:Aim: to observe the level of proprotein converting enzyme lysogenin 9 (PCSK9) in patients with acute myocardial infarction (AMI) complicated with type 2 diabetes mellitus (T2DM), and to explore the relationship between PCSK9 and blood glucose control level and inflammatory response. Methods: 100 patients with acute myocardial infarction complicated with type 2 diabetes mellitus, 61 patients with simple acute myocardial infarction and 70 patients with chronic stable coronary heart disease were selected. The diagnostic criteria for acute myocardial infarction are in accordance with the relevant diagnostic criteria in the ESC guidelines for the diagnosis and treatment of Acute Myocardial Infarction in 2011, and the diagnostic criteria for diabetes are in line with the 2013 ADA Diabetes Medical criteria. Collect the basic clinical data of the patients, and strictly follow the guidelines for percutaneous coronary intervention made by the Chinese Medical Association's Cardiovascular Association Branch (2012), and perform coronary angiography examination on the selected patients. The degree of coronary artery stenosis was evaluated quantitatively by Gensini integral system, and the venous blood was taken on an empty stomach on the second day after admission. The levels of Gao Min C-reactive protein (Hs-CRP), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG) and total cholesterol (TC) were measured by Beckmann AU5800 automatic biochemical analyzer. HbA1cU was detected by D-10 automatic glycosylated hemoglobin analyzer of BIO-RAD Company, and serum PCSK9 level was detected by enzyme linked immunosorbent assay (Elisa). The correlation between serum PCSK9 level, HbA1c, which reflects the level of blood glucose control, and Hs-CRP, an inflammatory index, was analyzed. Results: age, sex, smoking history, history of hypertension, triglyceride, total cholesterol, high density lipoprotein (HDL) in patients with acute myocardial infarction complicated with type 2 diabetes mellitus, simple acute myocardial infarction and chronic stable coronary heart disease were studied. There was no significant difference in all aspects of low density lipoprotein (LDL), but there was significant difference in fasting blood glucose level among the three groups (P 0.05), and there was no significant difference in acute myocardial infarction (AMI) complicated with diabetes mellitus group (P 0.05). The serum levels of PCSK9 HbA1chs-CRP in patients with AMI were higher than those in patients with chronic stable coronary heart disease, and the levels of Hs-CRP in patients with acute myocardial infarction complicated with diabetes were higher than those in patients with acute myocardial infarction and diabetes mellitus. The positive correlation between serum PCSK9 level and Hs-CRP Gensini score was 0. 526 鹵0. 287 (P < 0. 05), and there was no correlation between serum PCSK9 level and HBA _ (1) (P < 0. 05). Conclusion the serum PCSK9 level in patients with acute myocardial infarction and diabetes mellitus is higher than that in control group. The results suggest that PCSK9 may be involved in the process of coronary plaque instability and glucose metabolism disorder. There is a positive correlation between serum PCSK9 and coronary Gensini score in patients with acute myocardial infarction and diabetes mellitus. The results suggest that the detection of PCSK9 is helpful in judging the severity of coronary artery disease.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22;R587.1

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