本文選題：大樣本　切入點：肺結核　出處：《鄭州大學》2013年碩士論文　論文類型：學位論文

【摘要】：背景和目的 結核病是一種全球性的流行病,具有強烈的傳染性,使人類的生命健康受到嚴重威脅。由于結核桿菌的發(fā)現及治療藥物的出現,到20世紀中期,在控制結核病方面才取得了一定成就。不過,由于近些年艾滋病的出現和蔓延,結核桿菌耐藥性的普遍出現,人口數量的增加,人們活動范圍的擴大,結核病仍在廣泛蔓延,并逐漸成為人類死亡的主要原因之一。近期,根據世界衛(wèi)生組織統(tǒng)計的結果顯示,在全世界范圍內,有22個結核病流行嚴重的國家和27個耐多藥結核病流行嚴重的國家,而我國未能幸免。目前,我國結核病的每年發(fā)病人數約為130萬,占全球發(fā)病總人數中的14.3%,在全世界范圍內排名第二。在結核病對人體造成的許多危害中,對心臟的危害逐漸顯著,我們應該對其有充分的認識并給予足夠的重視。 結核桿菌引起機體組織的病理變化主要有變性、增生和壞死,而對心臟損害的國內外報道有,但是較少。我們都知道,因為心臟的電學改變往往早于形態(tài)學的改變,而心電圖做為一種無創(chuàng)傷性電學檢查方法,可以了解肺結核患者心臟損害的情況,及時發(fā)現肺結核合并的早期心臟損害。目前,人們較少關注結核病患者心臟損害,對心電圖的改變關注更少。 本研究主要探討肺結核患者心電圖改變與性別、血常規(guī)、血清蛋白、血小板、紅細胞沉降率(血沉)和C反應蛋白(CRP)檢查結果的關系,分析肺結核患者的心電圖變化。希望通過本研究能有助于早期發(fā)現肺結核患者的心臟損害,并給予及時的診斷和治療。 對象和方法 1研究對象：研究對象來自于河南省傳染病醫(yī)院,共收集2009年2月至2010年12月1114例肺結核住院患者病例,其中男性786例(60.41%),女性328例(39.59%),年齡為0-96歲,平均年齡(374±5)歲。職業(yè)有農民、學生、工人和其他。入選標準：首次確診患有肺結核,痰涂片檢查陽性或痰培養(yǎng)檢查陽性,并且都沒有開始使用抗結核藥物的患者。排除標準：有易引起心臟損害的疾病(如先天性心臟病、急性冠脈綜合癥、高血壓等)及已使用抗結核藥物治療的患者。 2試驗方法：要求肺結核患者平臥,保持安靜狀態(tài)下現場采集心電圖,所用儀器是美國公司生產的MAC-5000型十二導聯同步心電圖機。所收集的心電圖由心電圖教授做出診斷。所參照的診斷標準是美國心臟病學會(AHA)、美國心臟病學會基金會(ACCF)、美國心律學會(HRS)提出的"2009年國際心電圖標準和診斷指南”與《臨床心電圖學及圖譜》。診斷結果包括正常、快速心律失常、緩慢心律失常、左房室肥大、右房室肥大、ST-T改變等。而其他常規(guī)檢查結果都由檢驗科醫(yī)師做出診斷。 3分組方法：我們將收集的資料按性別、血常規(guī)檢查、血清蛋白檢查、血小板檢查、血沉檢查和C反應蛋白檢查等結果進行分組,對各組的心電圖結果進行分析,探討心電圖與各項檢查結果的關系。 4統(tǒng)計學處理：數據處理和統(tǒng)計分析,使用的是SPSS17.0統(tǒng)計分析軟件,計數資料組間比較采用X2檢驗；計量資料用均數±標準差(x±s)表示,兩組比較用t檢驗。檢驗水準為α=0.05。 結果 1肺結核患者總的心電圖異常發(fā)生率高于健康人群； 2肺結核患者心電圖的緩慢性心律失常發(fā)生率比較,男性女性；ST-T改變發(fā)生率比較,女性男性； 3肺結核患者出現紅細胞和白細胞均減少、白蛋白減少球蛋白增加、血小板減少和血沉增快時,快速性心律失常發(fā)生率比較高； 4肺結核患者出現紅細胞和白細胞均減少、白蛋白減少球蛋白增加和血沉增快時,ST-T改變發(fā)生率高；5肺結核患者出現白細胞增多、白蛋白減少球蛋白增加和血小板增多時,右房室肥大發(fā)生率較高； 6肺結核患者心電圖異常組CRP水平高于正常組,快速性心律失常組CRP水平高于非快速性心律失常組。 結論 肺結核患者心電圖總的異常發(fā)生率比較高,并且主要表現為快速性心律失常、右房室肥大和ST-T改變。而對于不同性別肺結核患者心電圖的異常比較,同樣存在差異。這些患者的心電圖改變與血常規(guī)、血清蛋白、血小板、血沉和C反應蛋白檢查結果的異常有不同程度的相關性。
[Abstract]:Background and purpose
Tuberculosis is a global epidemic, with strong infectivity, so that human health is seriously threatened. Because of the discovery of the tubercle bacillus and drug treatment, by the middle of twentieth Century, some achievement was made in the control of tuberculosis. However, due to the recent years and the spread of AIDS, widespread resistance of Mycobacterium tuberculosis the increase in population, expand the range of people's activities, tuberculosis is still widely spread, and gradually become one of the main causes of human death. Recently, according to the results of WHO statistics show that in the whole world, there are 22 serious national tuberculosis epidemic and 27 multi drug resistant tuberculosis epidemic hit countries but in China, has not been spared. At present, the number of annual incidence of tuberculosis in China is about 1 million 300 thousand, accounting for the total number of the global incidence of 14.3%, ranking second in the world scope Among the many hazards caused by tuberculosis to the human body, the harm to the heart is becoming more and more significant. We should have sufficient awareness and pay enough attention to it.
Mycobacterium tuberculosis caused by pathological changes in the tissues are degeneration, hyperplasia and necrosis of heart damage reported at home and abroad, but less. As we all know, because the electrical changes of heart are often earlier than morphological changes and electrocardiogram is a noninvasive electrical inspection method, can understand the cardiac damage in patients with lung tuberculosis, timely detection of early pulmonary tuberculosis complicated with heart damage. At present, people pay less attention to TB patients with heart damage, less attention to the change of ECG.
This study aims to investigate the pulmonary tuberculosis patients ECG changes and sex, blood, serum protein, platelet count, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) to examine the relationship between the results of analysis of electrocardiogram changes of patients with pulmonary tuberculosis. Hope that through this study can contribute to the early detection of cardiac damage in patients with pulmonary tuberculosis, and give timely diagnosis and treatment.
Objects and methods
1 research object from the infectious disease hospital in Henan province from February 2009 to December 2010, a total of 1114 cases of pulmonary tuberculosis cases in hospitalized patients, including 786 cases of male (60.41%), 328 cases were female (39.59%), the age is 0-96 years old, the average age (374 + 5) years old. There are occupation farmers, students, workers and other. Inclusion criteria: first diagnosed with pulmonary tuberculosis, sputum smear positive or positive sputum culture examination, and did not start using anti tuberculosis drugs. Patients with exclusion criteria: easy heart damage caused by diseases (such as congenital heart disease, acute coronary syndrome, hypertension) and has been used for treatment of tuberculosis drug.
2 test methods: supine pulmonary tuberculosis patients, collected ECG quiet state, the instrument used is the type MAC-5000 company production of twelve lead ECG synchronization. The collected ECG ECG by Professor diagnosis. Diagnostic criteria refer to the American Heart Association (AHA), the American College of Cardiology Foundation (ACCF), American Heart Rhythm Society (HRS) proposed the "2009 international standards and guidelines for diagnosis of electrocardiogram and clinical electrocardiography and atlas." the diagnostic results including normal, arrhythmia, bradycardia, left ventricular hypertrophy, right atrial and ventricular hypertrophy, ST-T change and so on. While the other routine examination results from laboratory physicians to make a diagnosis.
3 group method: We collected the data according to gender, blood routine examination, serum protein examination, platelet examination, ESR and C reactive protein examination results. The electrocardiogram results of each group were analyzed, and the relationship between electrocardiogram and various examination results was discussed.
4 statistical processing: data processing and statistical analysis, using SPSS17.0 statistical analysis software, counting data group comparison X2 test, measurement data with mean + standard deviation (x + s), two groups compared with t test. Test level is alpha =0.05..
Result
The incidence of abnormal ECG in 1 patients with pulmonary tuberculosis was higher than that of the healthy people.
The incidence of slow arrhythmia in 2 patients with pulmonary tuberculosis was compared, male female; the incidence of ST-T change was compared, female male;
3, the number of red blood cells and white blood cells decreased, albumin decreased, globulin increased, thrombocytopenia and erythrocyte sedimentation rate increased, the incidence of tachyarrhythmia was relatively high.
4 patients with pulmonary tuberculosis appeared red blood cells and white blood cells were reduced, albumin globulin increases and ESR, ST-T change rate is high; 5 patients with pulmonary tuberculosis leukocytosis, reduction of albumin globulin increases and thrombocytosis, higher incidence of right atrial and ventricular hypertrophy;
In 6 patients with pulmonary tuberculosis, the level of CRP in abnormal electrocardiogram group was higher than that of the normal group, and the level of CRP in the rapid arrhythmia group was higher than that of the non rapid arrhythmia group.
conclusion
The total abnormal electrocardiogram in patients with pulmonary tuberculosis incidence is relatively high, and mainly for rapid arrhythmia, right atrial and ventricular hypertrophy and ST-T changes and comparison for different gender. Abnormal electrocardiogram in patients with pulmonary tuberculosis, there are also differences. Electrocardiogram and blood in these patients, serum protein, platelet count, erythrocyte sedimentation rate and C-reactive protein test results C the anomalies have a different degree of correlation.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R521;R540.41

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