本文關(guān)鍵詞：對特發(fā)性擴(kuò)張型心肌病患者心血管事件的預(yù)測指標(biāo)的探索　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 特發(fā)性擴(kuò)張型心肌病 心肌重構(gòu) 心血管事件 左心室射血分?jǐn)?shù) 心功能

【摘要】：目的:探索能預(yù)測特發(fā)性擴(kuò)張型心肌病患者心血管事件風(fēng)險的指標(biāo),同時探索心肌重構(gòu)指標(biāo)、心功能及射血分?jǐn)?shù)之間的相關(guān)關(guān)系,了解本院對特發(fā)性擴(kuò)張型心肌病患者的診療情況。方法:1、收集入選的59例特發(fā)性擴(kuò)張型心肌病患者(39名男性,20名女性,平均年齡59.66±14.77歲)的臨床資料,如心功能NYHA分級、左室射血分?jǐn)?shù)、左室舒張末期直徑、治療情況等,計算T值(T=左室舒張末期直徑/體表面積),并對其存在的心血管事件進(jìn)行Q評分。通過分析心功能分級、左室射血分?jǐn)?shù)、左室舒張末期直徑和T值這四個指標(biāo)之間的相關(guān)關(guān)系,推導(dǎo)出它們可能存在的聯(lián)系。通過分析Q評分與上述各指標(biāo)的相關(guān)關(guān)系,推導(dǎo)出能預(yù)測心血管事件風(fēng)險的指標(biāo)。2、分別根據(jù)心功能、左室射血分?jǐn)?shù)、左室舒張末期直徑、T值的差別將入選患者進(jìn)行人為分組,比較各個預(yù)測指標(biāo)下不同組別間各類心血管事件的風(fēng)險是否存在差異。結(jié)果:1、入選患者的T值與LVEDD呈正相關(guān)關(guān)系(p0.05);這兩個指標(biāo)以及心功能分別與LVEF呈負(fù)相關(guān)關(guān)系(p0.05),T值與LVEF的相關(guān)系數(shù)高于LVEDD或心功能與LVEF的相關(guān)系數(shù)。2、Q評分及室性心律失常Q評分分別與T值、心功能(NYHA分級)呈正相關(guān)關(guān)系(p0.05),與LVEF呈負(fù)相關(guān)關(guān)系(p0.05),與LVEDD不呈相關(guān)關(guān)系(p0.05)。各個指標(biāo)與Q評分的相關(guān)系數(shù)從大到小排列分別為LVEF、心功能(NYHA分級)、T值;各個指標(biāo)與室性心律失常Q評分的系數(shù)從大到小排列分別為心功能(NYHA分級)、LVEF、T值。在一定范圍內(nèi)Q評分及室性心律失常Q評分較高者LVEDD通常較大(p0.05)。3、比較各個指標(biāo)(心功能(NYHA分級)、LVEF、T值、LVEDD)不同分組間各類心血管事件的發(fā)生頻率,可以看到不同心功能組別間發(fā)生漿膜腔積液的概率、不同LVEF組別間發(fā)生瓣膜病變及左束支傳導(dǎo)阻滯的概率、不同T值組別間發(fā)生血壓90/60mmHg及瓣膜病變的概率、不同LVEDD組別間發(fā)生室上性心律失常的概率均存在差異(p0.05)。結(jié)論:1.LVEF越低,T值或LVEDD越大、心功能越差;T值或LVEDD和心功能之間無必然聯(lián)系。2.T值可以作為左心室重構(gòu)指標(biāo),在一定程度上能代替甚至優(yōu)于LVEDD。3.T值、心功能(NYHA分級)、LVEF與IDCM患者心血管事件的風(fēng)險相關(guān),即左心室重構(gòu)越嚴(yán)重、心功能NYHA分級越高、左室收縮功能越差,心血管事件風(fēng)險越高。LVEDD在一足范圍內(nèi)也能預(yù)測心血管事件的風(fēng)險。4.不同指標(biāo)能預(yù)測不同類別心血管事件的風(fēng)險。
[Abstract]:Objective: to explore the predictors of cardiovascular event risk in idiopathic dilated cardiomyopathy (IDMC), and to explore the correlation among myocardial remodeling index, cardiac function and ejection fraction in patients with idiopathic dilated cardiomyopathy. Methods to investigate the diagnosis and treatment of idiopathic dilated cardiomyopathy in our hospital. Methods 59 patients with idiopathic dilated cardiomyopathy were selected. The mean age was 59.66 鹵14.77 years old), such as NYHA classification of cardiac function, left ventricular ejection fraction, left ventricular end-diastolic diameter, treatment, etc. T = left ventricular end-diastolic diameter / body surface area was calculated, and its cardiovascular events were evaluated by Q score. The left ventricular ejection fraction (LVEF) was analyzed by analyzing the cardiac function grade and the left ventricular ejection fraction (LVEF). The correlation between left ventricular end-diastolic diameter and T value and their possible relationship were deduced. The correlation between Q score and the above indexes was analyzed. According to cardiac function, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED) T value, the patients will be selected for artificial grouping according to their cardiac function, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED). The risk of various cardiovascular events among different groups was compared under different predictors. Results the T value of the selected patients had a positive correlation with LVEDD (p 0.05). There was a negative correlation between these two indexes and LVEF, respectively. The correlation coefficient between the two indexes and LVEF was higher than that of LVEDD or the correlation coefficient between cardiac function and LVEF. 2. Q score and Q score of ventricular arrhythmia were positively correlated with T and cardiac function (P 0.05), and negatively correlated with LVEF (p 0.05). There was no correlation between LVEF and LVEDD. The correlation coefficient between each index and Q score was LVEF. The parameters and Q scores of ventricular arrhythmias ranged from large to small in the order of cardiac function NYHA grade and LVEF. T value. In a certain range of Q score and Q score of ventricular arrhythmia, LVEDD was usually larger than that of P0.05. 3, and each index (cardiac function NYHA grade) was compared. The frequency of various kinds of cardiovascular events among different groups of T value LVEDDs can see the probability of serous cavity effusion among different cardiac function groups. The probability of valve lesion and left bundle branch block among different LVEF groups, blood pressure 90 / 60 mmHg and valvular disease probability among different T value groups. There were significant differences in the probability of supraventricular arrhythmias among different LVEDD groups. Conclusion: 1. The lower the T value or the greater the LVEDD, the worse the cardiac function. T or LVEDD is not associated with cardiac function. 2. T can be used as an index of left ventricular remodeling, which can replace or even outperform LVEDD.3.T to some extent. NYHA classification was associated with the risk of cardiovascular events in patients with IDCM, that is, the more severe left ventricular remodeling, the higher the NYHA grade of cardiac function and the worse left ventricular systolic function. The higher the risk of cardiovascular events. LVEDD can also predict the risk of cardiovascular events within one foot. 4. Different indicators can predict the risk of different types of cardiovascular events.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.2

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