【作者】 李畅；

【导师】 孟晓萍；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 目的：冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease CHD)按其临床表现分为稳定性心绞痛、不稳定性心绞痛和心肌梗死,本文以冠状动脉正常者为对照,运用回顾性病例分析探讨LDL、OX-LDL在稳定性心绞痛(stable angina pectoris SAP)、不稳定性心绞痛(unstable angina pectoris UAP)和急性心肌梗死(acute myocardial infarction AMI)患者之间的关系及LDL与OX-LDL之间的联系,有助于为CHD的诊断、治疗及预防提供科学依据。方法：2008年8月至2009年8月间收住我科1个月内未服用调脂药物的300例CHD患者,其中SAP 100例、UAP 100例、AMI 100例。对照组为随机选取同期住院收住我科经冠状动脉造影检查确诊无动脉粥样硬化(atherosclerosis AS)的患者100例。上述病例均有完整的病史、基本资料和各项实验室检查结果。基本资料包括性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病病史、家族史。实验室检查内容包括LDL(采用酶比色法测定)、OX-LDL(采用ELISA法测定)数值。回顾性分析患者基本资料,LDL、OX-LDL在对照组、SAP组、UAP组和AMI组进行差异性分析,同时在对照组、SAP、UAP和AMI各组内对LDL和OX-LDL进行相关性分析。结果：1、SAP组、UAP组、AMI组与对照组相比年龄间无显著性意义(P>0.05),计数资料如性别、吸烟、饮酒、高血压、糖尿病在SAP组、UAP组、AMI组与对照组相比无显著性意义(P>0.05)。2、AMI组患者OX-LDL浓度与UAP组有显著性意义(P<0.01),LDL浓度与UAP组相比无统计学意义(P>0.05),OX-LDL浓度、LDL浓度与SAP组、对照组相比有显著性意义(P<0.01)。UAP组患者OX-LDL浓度与SAP组相比有意义(P<0.05),LDL浓度与SAP组相比无统计学有意义(P>0.05),OX-LDL浓度、LDL浓度与对照组相比有显著性意义(P<0.01)。SAP组患者LDL、OX-LDL浓度与对照组相比有显著性意义(P<0.01)。3、各组间OX-LDL浓度与LDL浓度行相关性分析后显示有相关性(r=0.2143,P<0.05)。结论：1、LDL、OX-LDL作为CHD的危险因素得到证实,与CHD的严重程度有相关性。2、CHD患者中OX-LDL浓度和LDL浓度有相关性。3、虽然OX-LDL与LDL有相关性,但在致AS过程中OX-LDL起更重要的作用,故采用ELISA方法测定OX-LDL在CHD的治疗和预防中更有意义。更多还原

【Abstract】 Backgrounds and objections:CHD refers to coronary atherosclerosis stenosis or obstruction, leading to myocardial ischemia, hypoxia caused by heart disease. AS is one of the major cause of death in Western countries. As the improved living standards of our people and eating habits change, this disease has also become the main cause of death in China. From the view of the pathogenesis of CHD, AS, whose formation process is a complex process is pathological basis. Dyslipidemia especially the elevated LDL and OX-LDL has a controlling influence over the process of AS occurrence and development. LDL which deposites in the arterial wall induces chemotaxis of chemoattractant to vascular endothelium, and then monocytes transform into macrophages under endangium. The latter can generate free radical to make LDL oxidizing to OX-LDL. OX-LDL can be unlimited taken into macrophages by phagocytosis to form foam cells which are the basis for the formation of AS. Some studies at home and abroad have shown that AS is a kind of disease which involves inflammation and immune systems. Immunogenic OX-LDL induces the body to produce specific antibodies which can form immune complexes with OX-LDL. This kind of immune complexes lead more OX-LDL being taken by macrophages and form more foam cells. All these show the importance of LDL and OX-LDL in AS. According to the clinical manifestations CHD are divided into SAP, UAP, and AMI. In this study, control group are people with normal coronary arteries. This study is to discuss the relationship between LDL, OX-LDL and SAP group, UAP group, AMI guoup and contaction of LDL and OX-LDL. The purpose is to provide a scientific basis for CHD diagnosis, treatment and prevention.Research Methods:Experimental group are 300 CHD patients without taking lipid-lowering drugs more than a month who admittde in the depatrment of cardiolysis from August 2008 to August 2009. They are divided into SAP group(100 cases)、UAP group(100 cases)、AMI(100 cases). The control group are 100 cases of patients who are randomly selected and confirmed without AS by coronary angiography in the same period in our department. Those cases has complete medical history, basic information and various laboratory test results. Basic information includs gender, age, smoking, drinking, hypertension, diabetes. Laboratory tests include levels of LDL (measured by enzyme colorimetric method) and OX-LDL (measured by ELISA method). By retrospective case analysis we study patients’basic information, the level and correlation of LDL and OX-LDL in control group, SAP group, UAP group, AMI group.Results:1 there are no significant differents between AMI group, UAP group, SAP group and control group in clinical background, such as, age, sex, smoking, alcohol consumption, hypertension, diabetes(P>0.05).2 Concentration of OX-LDL in AMI group is significant difference compared with USP group(P<0.01). Concentration of LDL in AMI group is not significant difference compared with UAP group (P>0.05). Concentration of OX-LDL and LDL in AMI group is significant difference compared with SAP group and control group(P<0.01). Concentration of OX-LDL in UAP group is significant difference compared with SAP group(P<0.05). Concentration of LDL in UAP group is not significant difference compared with SAP group(P>0.05). Concentration of OX-LDL and LDL in UAP group is significant difference compared with control group(P<0.01). Concentration of OX-LDL and LDL in SAP group is significant difference compared with control group (P<0.01).3 There is correlation between concentration of LDL and OX-LDL in CHD group (r=0.2143, P>0.05).Conclusions:1 We confirm that LDL and OX-LDL are risk factors for CHD. They associate with the severity of CHD.2 There is correlation between concentration of LDL and OX-LDL in CHD group(r=0.2143, P>0.05).3 Although OX-LDL was correlated with LDL, OX-LDL play a more important role in the process of AS. Compared with LDL, OX-LDL which is determined by using ELISA is more meaningful in the treatment and prevention of CHD.更多还原