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  本文選題：胸腔積液　切入點：心力衰竭　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:胸腔積液是一種常見臨床疾病,任何導(dǎo)致胸膜腔內(nèi)液體形成過快或吸收過緩的疾病都可產(chǎn)生胸腔積液。NT-proBNP是一種血管活性多肽,心力衰竭時心室壁因壓力負(fù)荷增大受到物理牽拉由腦鈉肽(B-type natriuretic peptide,BNP)裂解產(chǎn)生,可直接由血漿透過血管壁進入胸膜腔,使胸腔積液中NT-proBNP含量增高,本文旨在研究其在診斷心衰性胸腔積液中的診斷價值,以期望能夠找到敏感性高,特異性強,準(zhǔn)確性高的有效分子診斷標(biāo)記物。方法:選取2014年11月至2015年10月因胸腔積液就診我院的住院患者,根據(jù)患者的臨床病理特點及相關(guān)檢查化驗結(jié)果,將患者分為心力衰竭性胸腔積液組和非心力衰竭性胸腔積液組。應(yīng)用膠體金免疫層析法檢測心力衰竭性胸腔積液患者和非心力衰竭性胸腔積液患者血漿和胸腔積液中的NT-proBNP含量,通過SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析。結(jié)果:心衰患者血漿和胸腔積液中NT-proBNP平均含量分別為13725pg/ml和12309pg/ml,顯著高于非心衰患者血漿和胸腔積液中NT-proBNP平均含量,分別為1094pg/ml和974pg/ml,其差異有顯著的統(tǒng)計學(xué)意義(P0.001)。胸腔積液患者血漿中NT-proBNP含量和胸腔積液中NT-proBNP含量呈明顯的線性正相關(guān),Spearman等級相關(guān)系數(shù)為0.961。血漿和胸腔積液中NT-proBNP含量的ROC曲線下面積均為0.97,以血漿中NT-proBNP含量大于4000ng/L為診斷界值時,其在診斷心力衰竭時的敏感性、特異性、陽性似然比、陰性似然比及準(zhǔn)確性分別為89%(73%-96%)、92%(82%-96%)、82%(65%-94%)、94%(87%-97%)和90%(83%-94%),以胸腔積液中NT-proBNP含量大于4000ng/L為診斷界值時,其在診斷心力衰竭時的敏感性、特異性、陽性似然比、陰性似然比及準(zhǔn)確性分別為91%(74%-97%)、92%(83%-97%)、81%(66%-93%)、96%(86%-99%)、91%(84%-96%)。結(jié)論:胸腔積液和血漿中NT-proBNP在心力衰竭患者中明顯高于非心力衰竭患者。胸腔積液中的NT-proBNP含量與血漿中的NT-proBNP含量呈明顯正相關(guān)。胸腔積液中NT-proBNP判斷心力衰竭所致胸腔積液敏感性高,特異性強,準(zhǔn)確性高。
[Abstract]:Objective: pleural effusion is a common clinical disease. Any disease that causes pleural fluid to form too fast or slow to absorb can produce pleural effusion. NT-proBNP is a vasoactive polypeptide. In congestive heart failure, the ventricular wall is physically pulled by physical pull from the brain natriuretic peptide B-type natriuretic peptideBNPs, which can enter the pleural cavity directly through the blood vessel wall from the plasma and increase the content of NT-proBNP in the pleural effusion. The purpose of this study was to study its diagnostic value in the diagnosis of pleural effusion due to heart failure, in order to find a highly sensitive and specific pleural effusion. Methods: from November 2014 to October 2015, the inpatients with pleural effusion were selected according to the clinicopathological characteristics of the patients and the results of relevant examinations and laboratory tests. Patients were divided into heart failure pleural effusion group and non-heart failure pleural effusion group. The plasma and pleural effusion levels of NT-proBNP in patients with congestive heart failure pleural effusion and non-heart failure pleural effusion were measured by colloidal gold immunochromatography. Results: the average contents of NT-proBNP in plasma and pleural effusion were 13725pg / ml and 12309pg / ml, respectively, which were significantly higher than those in plasma and pleural effusion of patients with heart failure. The difference was statistically significant (P 0.001). There was a significant linear positive correlation between the NT-proBNP content in plasma and NT-proBNP content in pleural effusion. The NT-proBNP content in plasma and pleural effusion was 0.961.The positive correlation coefficient was 0.961.The positive correlation coefficient was 0.961.There was a significant linear correlation between the NT-proBNP content in plasma and pleural effusion, and the correlation coefficient of NT-proBNP in pleural effusion was 0.961.There was a significant linear positive correlation between the content of NT-proBNP in plasma and pleural effusion. The areas under the ROC curve were 0.97. When the plasma NT-proBNP content was greater than 4000ng / L as the diagnostic threshold, Its sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and accuracy in the diagnosis of heart failure are 89, respectively. The sensitivity, specificity, specificity and specificity of NT-proBNP in pleural fluid when it is greater than 4000ng / L in diagnosing heart failure. Positive likelihood ratio, The negative likelihood ratio and accuracy were 91C / 74-97g and 922T, respectively. The NT-proBNP content in pleural effusion and plasma was significantly higher in patients with heart failure than that in non-heart failure patients. The content of NT-proBNP in pleural effusion was positively correlated with the NT-proBNP content in plasma, and it was significantly correlated with the content of NT-proBNP in plasma of patients with congestive heart failure, and there was a significant positive correlation between NT-proBNP content in pleural effusion and the content of NT-proBNP in plasma. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5BZ] [WT5BZ] [WT5BZ] [WT5BZ] [WT5 "HZ]. The sensitivity of NT-proBNP in pleural effusion due to heart failure was high. The specificity is strong and the accuracy is high.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6;R561.3

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本文編號：1599500