| BackgroundGRACE risk score is one of the most commonly used to risk stratification of acute coronary syndrome(acs) method, called the global registration of acute coronary events in the field of senile coronary heart disease clinical research.GRACE risk score, including a number of indicators, such as in patients with myocardial biochemical markers in patients from the heart of the hospital began to stop such conditions.For many years, however, a large number of clinical practice research has consistently shown that GRACE score is applied to the clinical evaluation, there are some problems.Such as on some index selection issues affect the pathological mechanism, lack of corresponding indicator, cannot reflect the hemodynamic changes in patients with. Existing indicators for clinical condition cannot be integrated generalization in this case, and clinical assessment of patients with ACS was limited.This topic research based on the clinical medicine based on the existing technology, consulting, collecting the authority of the relevant research materials, further discussion may be involved in the risk of cardiovascular events related to the serum inflammatory factors, MMP- 9, UA, Cys- C and other indicators.To study the changes in the levels of different types in elderly patients with coronary heart disease(CHD) and the correlation with GRACE score, and then for the analysis of the clinical diagnosis and prognosis of senile coronary heart disease, etc to provide certain reference basis. ObjectivesTo investigate different types of elderly patients with coronary heart disease(CHD) serum levels of inflammatory cytokines, MMP- 9, UA, Cys- C level changes, establish to follow sexual contact with GRACE scoring mechanism, to further explore the serum UA level in elderly patients with coronary heart disease(CHD) and its changes on the basis of the practical research. Methods(1) the clinical practice research topic, in order to more accurately reflect the hs- CRP, IL- 6, TNF alpha, MMP- 9, UA, Cys- C level change and cardiovascular risk in elderly patients with coronary heart disease event correlation, so from our hospital cardiovascular division during June 2013- December 2015 among elderly patients with coronary heart disease were randomly selected from the 117 cases, 117 cases of coronary heart disease as the research object.The inclusion of 117 patients with coronary heart disease(CHD), in the hospital for diagnosis and treatment, all into the group of patients with the clinical data collecting and sorting.And 117 cases of elderly patients with coronary heart disease(CHD) in the implementation of routine blood, liver and kidney function, myocardial enzymes, such as inspection, inspection results, and calculate every GRACE rating of elderly patients with coronary heart disease(CHD).The selected 117 cases of patients with clinical practice research object, in the via selective coronary angiography, coronary CTA, laboratory examination, test results of test group according to different patients.Divided into three groups, AMI group(35 cases), UAP group(39 cases), SAP group(43 cases).In addition, also includes the control group, 40 cases in my hospital were accepted the research object of physical examination.(2)117 cases of elderly patients with coronary heart disease(CHD) from the date of admission, extract the patients serum specimens were within 24 h, all using enzyme-linked immunosorbent method to detect each group of serum inflammatory factors level.For patients with MMP- 9, UA, Cys- C level change and expression, adopt the Hitachi 7060 automatic biochemical analyzer.(3) according to the relevant inspection, will be included in the 117 cases of elderly patients with coronary heart disease(CHD) is divided into three groups with GRACE 8 factors scoring index as a benchmark.Selected 117 cases of elderly patients with coronary heart disease can be divided into three groups according to the GRACE scoring method, including the high-risk group, moderate and low risk group.In hierarchical standards, calculate score > 140 patients, classified as high risk groups, calculate score between 109-140 points, delimit in dangerous group, calculate score < 109 patients, delimit low-risk group.Further discussion analysis correlation of three groups of patients with UA level and GRACE score according to the survey results. Results(1) each object of study of serum inflammatory factors related index after testing and comparing available, each of the hs- CRP, IL- 6, TNF alpha levels, compares between two groups, there were significant statistical differences, tested all P < 0.05. Healthy controls of each index of the lowest levels, followed by SAP group and AMI group the testing index, the highest level followed by UAP group. Groups of subjects in the serum levels of MMP- 9, after testing and comparison between groups of serum level of MMP- 9 levels, compares between two groups, there were significant statistical differences, tested all P < 0.05. Healthy controls of each index of the lowest levels, followed by SAP group and AMI group the testing index, the highest level followed by UAP group. Each object of study of serum UA level after testing and comparing available, each level of serum UA level detection, compares between two groups, there were significant statistical differences, tested all P < 0.05. Healthy controls of each index of the lowest levels, followed by SAP group and AMI group the testing index, the highest level followed by UAP group. Each object of study of serum Cys- C level after testing and comparison, between groups of serum Cys- C levels, compares between two groups, there were significantly statistical difference, tested all P < 0.05. Healthy controls of each index of the lowest levels, followed by SAP group and AMI group the testing index, the highest level followed by UAP group.(2) in patients with ACS were implemented GRACE risk score, and set criteria, according to the grading result test group. Criteria for: for low-risk group under 108 points, 109 ~ 140 divided into moderate groups, more than 140 points in high-risk groups. According to the above standard, low-risk groups to the high-risk group of 23 cases respectively, 30 cases, 21 cases. Could be divided into different subtypes in patients with ACS, including UA group, and STEMI and NSTEMI group, each group corresponds to the number of 39 cases, 13 cases, 22 cases respectively, could be divided into different subtypes in patients with ACS, including UA group, and STEMI and NSTEMI group, after testing different subtypes grouping the patient's level of serum UA and comparison, the available groups of serum UA levels, compares between two groups, there were significant statistical differences, tested all P < 0.05. High-risk groups of measurements, the highest level, followed by in the intermediate risk category had a low-risk group detection had the lowest levels.(3) the level of serum UA and GRACE score there is a close relationship between, and present a positive correlation(r = 0.752, P < 0.05). Conclusions1It participate in the process of the elderly patients with coronary heart disease of serum inflammatory factors, MMP-9, UA, Cys-C. 2 serum inflammatory factors, MMP-9, UA, Cys-C concentrations can be used to assess the severity of coronary heart disease in elderly patients. 3 the serum UA and GRACE score showed a linear positive correlation, which could be used in the prognosis of patients with ACS. |
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