本文選題：先天性心臟病 + 肺動(dòng)脈高壓��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的: 研究先天性心臟�。–HD）合并肺動(dòng)脈高壓（PH）患兒血清心肌型脂肪酸結(jié)合蛋白（H-FABP）的變化及其與肺動(dòng)脈收縮壓（PASP）的相關(guān)性，探討H-FABP對(duì)于診斷CHD合并PH的臨床意義。 方法: 1、CHD確診及PASP測(cè)定，患兒應(yīng)用頻譜多普勒超聲心動(dòng)圖檢查，確診CHD并明確其類(lèi)型，并測(cè)出三尖瓣返流的最高流速，依據(jù)簡(jiǎn)化的Bernoulli方程（即ΔP=4V2，V表示最大返流速度）求出右心室與右心房之間的壓力差。右室流出道若無(wú)梗阻，，PASP則與右心室收縮壓（RVSP）相似，即：PASP=RVSP=右房壓力（RAP）+三尖瓣跨瓣壓力差（ΔP）。其中右房的壓力值估計(jì)為10mmHg（1mmHg=0.133kPa），即PASP=4V2+10。PH判斷標(biāo)準(zhǔn)：SPAP30mmHg為肺動(dòng)脈壓正常，30mmHg SPAP50mmHg為輕度肺動(dòng)脈高壓；50mmHg SPAP70mmHg為中度肺動(dòng)脈高壓；70mmHg為重度肺動(dòng)脈高壓。 2、H-FABP的測(cè)定，所有受檢者均于清晨空腹抽取靜脈血2mL，注入含促凝劑的采血管中，靜置2h后以3000r/min離心10min，分離血清放入EP管，分別標(biāo)記，并放于-70℃的冰箱中保存。待標(biāo)本收齊后統(tǒng)一采用雙抗體夾心(ABC-ELISA）檢測(cè)H-FABP，ABC-ELISA試劑盒由上海西塘生物科技有限公司提供，操作嚴(yán)格按照試劑說(shuō)明。 3、統(tǒng)計(jì)學(xué)方法，所有指標(biāo)均進(jìn)行正態(tài)性檢驗(yàn)，采用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理，采用均數(shù)±標(biāo)準(zhǔn)差（x s）進(jìn)行定量資料描述，采用單因素方差分析進(jìn)行組間均數(shù)比較，兩兩比較采用LSD-t檢驗(yàn)，檢驗(yàn)水準(zhǔn)α=0.05。相關(guān)分析用Pearson相關(guān)。P 0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果: 1、各組血清H-FABP檢測(cè)結(jié)果，正常組、先心無(wú)肺高壓組、先心伴輕度肺高壓組、先心伴中度肺高壓組、先心伴重度肺高壓組血清H-FABP分別為（1.24±1.06、2.46±1.17、4.19±1.52、11.55±1.83、14.41±1.64）μg/L，5組間比較差異有統(tǒng)計(jì)學(xué)意義(F=267.981，p0.05)，兩兩比較發(fā)現(xiàn)，CHD各組患兒H-FABP較正常對(duì)照組水平升高（P 0.05）；CHD合并不同程度PH組患兒血清H-FABP高于CHD無(wú)PH組（P 0.05）；CHD合并不同程度PH中，血清H-FABP含量輕度PH組最低，重度PH組最高（P 0.05）。 2、CHD患兒血清H-FABP與肺動(dòng)脈壓力相關(guān)性，66例CHD患兒血清H-FABP與PASP呈正相關(guān)（γ=0.952，P 0.05），CHD并PH輕、中、重各組患兒血清H-FABP與PASP呈正相關(guān)，即CHD患兒隨肺動(dòng)脈壓力的升高，血清H-FABP的含量不斷升高。 結(jié)論: CHD患兒早期雖未形成肺動(dòng)脈高壓，但已存在一定心肌損害，血清H-FABP升高。當(dāng)合并PH時(shí)，心肌損害明顯加重，血清H-FABP明顯升高，且隨肺動(dòng)脈壓力程度的加重而升高，對(duì)于CHD合并PH患兒病情評(píng)估有一定指導(dǎo)意義。
[Abstract]:Objective: To study the changes of serum myocardial fatty acid binding protein (H-FABP) in children with congenital heart disease (CHD) and pulmonary hypertension (PH) and its correlation with pulmonary artery systolic pressure (PASP), and to explore the clinical significance of H-FABP in the diagnosis of CHD with PH. Methods: 1the diagnosis of CHD and the determination of PASP. The CHD was diagnosed and its type was determined by spectrum Doppler echocardiography, and the maximum velocity of tricuspid regurgitation was measured. The pressure difference between the right ventricle and the right atrium was calculated by the simplified Bernoulli equation (that is, 螖 Pe 4V 2V denotes the maximum reflux velocity). If right ventricular outflow tract is not obstructed, it is similar to right ventricular systolic blood pressure (RVSP), that is, the tricuspid valve pressure difference (螖 P) of the right ventricular outflow tract (RVSP = right atrial pressure trap) is similar to that of right ventricular systolic pressure (RVSP). The pressure of the right atrium was estimated to be 10 mm Hg1 mm Hgn 0.133 KPA, that is, the normal pulmonary artery pressure was 30 mm Hg and the normal pulmonary artery pressure was 30 mm Hg in the PASP=4V2 10.PH judgment standard. The normal pulmonary artery pressure was 30 mm Hg in the right atrium and the mild pulmonary hypertension was 50 mmHg SPAP70mmHg was the moderate pulmonary hypertension and 70 mmHg was the severe pulmonary hypertension. 2the determination of H-FABP showed that the venous blood samples were taken from all the subjects in the morning, and then injected into the blood vessels containing coagulant. The blood serum was centrifuged with 3000r/min for 10 min, then the serum was labeled and stored in the refrigerator at -70 鈩

本文編號(hào)：1849307