本文選題：冠心病 + 冠脈成形術(shù)��； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:探討脂蛋白a血漿濃度與冠心病患者行冠脈成形術(shù)后,在相關(guān)藥物干預(yù)下冠脈病變進(jìn)展是否相關(guān)性。并進(jìn)一步探討脂蛋白a與冠脈狹窄的部位以及狹窄的嚴(yán)重程度具體的相關(guān)情況。資料與方法:選擇2013年1月—2014年12月因 冠心病‖再次入院接受冠脈造影的患者。同時(shí)要求入組的患者既往有一次或以上的冠脈造影術(shù)手術(shù)史。收集再次入院和之前最近一次的冠脈造影資料。包括兩次冠脈造影時(shí)患者的基礎(chǔ)資料,實(shí)驗(yàn)室檢查資料,前次出院后的服藥資料,兩次冠脈造影的間隔時(shí)間等。通過比較兩次冠脈造影結(jié)果,將患者分為冠脈血管病變未進(jìn)展的 對照組‖和冠脈發(fā)生狹窄的 病例組‖。利用 Logistic回歸分析‖、 t檢驗(yàn)‖、 卡方檢驗(yàn)‖并通過計(jì)算 相對風(fēng)險(xiǎn)比‖等方法進(jìn)行統(tǒng)計(jì)分析。探討脂蛋白a與冠脈狹窄發(fā)生的相關(guān)性。并且進(jìn)一步在 病例組‖中行亞組分析,按脂蛋白a血漿濃度高低分組,探討脂蛋白a血漿濃度與冠脈狹窄的發(fā)生部位以及冠脈狹窄程度的相關(guān)性。結(jié)果:有200例患者符合本研究要求納入分析,其中未發(fā)生冠脈狹窄的 對照組‖共101例,發(fā)生冠脈狹窄的 病例組‖共99例。首先通過Logistic回歸分析得出:脂蛋白a、糖尿病史、男性三個(gè)因素與冠脈成形術(shù)后冠脈狹窄是相關(guān)的。且脂蛋白a濃度越高,冠脈狹窄發(fā)生率越高,脂蛋白a血漿濃度高于213.6mg/L的患者冠脈狹窄發(fā)生率為58.00%,脂蛋白a血漿濃度低于53.25mg/L的患者冠脈狹窄發(fā)生率為38%,兩組差異有統(tǒng)計(jì)學(xué)意義P=0.045。進(jìn)一步的亞組分析發(fā)現(xiàn)脂蛋白a高于213.6mg/L的患者發(fā)生 均再狹窄‖即多部位狹窄的風(fēng)險(xiǎn)是脂蛋白a低于213.6mg/L患者的3.488倍(P=0.019)。脂蛋白a高于213.6mg/L的患者發(fā)生冠脈 顯著狹窄‖的風(fēng)險(xiǎn)是脂蛋白a低于213.6mg/L患者的2.647倍(P=0.046)。結(jié)論:脂蛋白a的血漿濃度與冠脈成形術(shù)后冠脈狹窄是相關(guān)的,脂蛋白a血漿濃度越高發(fā)生冠脈狹窄的風(fēng)險(xiǎn)越大。且隨著脂蛋白a濃度升高,發(fā)生冠脈內(nèi)狹窄的部位可能越多,狹窄程度也將可能越嚴(yán)重。
[Abstract]:Aim: to investigate the correlation between plasma lipoprotein a concentration and coronary artery disease progression after coronary angioplasty in patients with coronary heart disease. Furthermore, the relationship between lipoprotein a and the location and severity of coronary stenosis was investigated. Materials and methods: patients who received coronary angiography from January 2013 to December 2014 were re-admitted to hospital for coronary artery disease. Patients in the group were also required to have one or more previous coronary angiography procedures. Coronary angiography data were collected for readmission and the most recent coronary angiography. It includes the basic data of patients during two coronary angiography, laboratory examination data, medication data after discharge from hospital, the interval between two coronary angiography and so on. By comparing the results of two coronary angiography, the patients were divided into two groups: the control group and the coronary stenosis group. By using Logistic regression analysis, t test and chi-square test, the statistical analysis was carried out by calculating the relative risk ratio. To investigate the relationship between lipoprotein a and coronary stenosis. Furthermore, the subgroup analysis was carried out in the case group. According to the plasma concentration of lipoprotein a, the relationship between the plasma concentration of lipoprotein a and the location of coronary artery stenosis and the degree of coronary stenosis was discussed. Results: there were 200 patients who met the requirements of this study, including 101 cases in the control group without coronary stenosis and 99 cases in the group of patients with coronary artery stenosis. First, Logistic regression analysis showed that lipoprotein a, diabetes history and male were associated with coronary stenosis after coronary angioplasty. The higher the concentration of lipoprotein a was, the higher the incidence of coronary stenosis was. The incidence of coronary stenosis was 58.00 in patients with higher lipoprotein a plasma concentration than that in 213.6mg/L, and 38 in patients with lower lipoprotein a plasma concentration than that in 53.25mg/L. The difference between the two groups was statistically significant (P < 0.045). Further subgroup analysis showed that patients with higher lipoprotein a than 213.6mg/L had a higher risk of restenosis, that is, multisite stenosis was 3.488 times lower than that of patients with 213.6mg/L. The risk of significant coronary stenosis in patients with lipoprotein a higher than 213.6mg/L was 2.647 times lower than that in patients with 213.6mg/L. Conclusion: the plasma concentration of lipoprotein a is associated with coronary stenosis after coronary angioplasty, and the higher the plasma concentration of lipoprotein a is, the greater the risk of coronary stenosis is. With the increase of lipoprotein a concentration, the more stenoses in the coronary artery, the more severe the stenosis may be.
【學(xué)位授予單位】：蘇州大學(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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