本文選題：兒童 + 擴(kuò)張型心肌病　； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究血清腦型利鈉肽(Brain-type natriuretic peptide,BNP)用于評(píng)估兒童擴(kuò)張型心肌病急性失代償性心力衰竭(Acute decompensated heart failure,ADHF)、心室重構(gòu)的臨床價(jià)值;同時(shí)探究?jī)和瘮U(kuò)張型心肌病預(yù)后影響因素。方法:(1)收集2004年1月~2016年8月共12年間在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院診治的40例合并ADHF的擴(kuò)張型心肌病患兒的一般資料、心功能分級(jí)(改良ROSS評(píng)分)、血清檢驗(yàn)結(jié)果(BNP、CK-MB、肌鈣蛋白)、超聲心動(dòng)圖(LVEF、LVEDd、LVEDs、IVSD)、心電圖、胸片等資料�；仡櫺苑治鯞NP在治療前后的變化,及與改良ROSS評(píng)分、LVEF、LVEDd、IVSD等相應(yīng)指標(biāo)的相關(guān)性。(2)隨訪40例擴(kuò)張型心肌病患兒激素使用情況及生存情況。對(duì)預(yù)后影響因素進(jìn)行單因素分析,并對(duì)有統(tǒng)計(jì)學(xué)差異的單因素進(jìn)一步進(jìn)行Logistic回歸分析。結(jié)果:(1)BNP、改良ROSS評(píng)分、LVEF、LVEDd等在ADHF治療前后差異有統(tǒng)計(jì)學(xué)意義,ADHF治療前BNP與改良ROSS評(píng)分值呈正相關(guān)(R=0.936,P0.01),與LVEF負(fù)相關(guān)(R=-0.838,P0.01),與LVEDd輕微相關(guān)(R=-0.318,P=0.0460.05),與IVSD呈負(fù)相關(guān)(R=-0.551,P0.01),ADHF治療后BNP與改良ROSS評(píng)分值仍然呈正相關(guān)(R=0.959,P0.01),但BNP與LVEF及LVEDd、IVSD等心室重構(gòu)指標(biāo)無(wú)明顯相關(guān)�？梢夾DHF治療前BNP與心室重構(gòu)有一定相關(guān)性,但當(dāng)心衰癥狀明顯控制及BNP水平明顯下降甚至正常時(shí)心臟重構(gòu)并無(wú)明顯改善。(2)根據(jù)隨訪結(jié)果分為失訪組、死亡組、存活組。單因素分析結(jié)果顯示,兒童DCM死亡組在入院時(shí)年齡(月)、改良ROSS評(píng)分、BNP、心胸比例、CK-MB、肌鈣蛋白高于兒童DCM存活組,LVEF低于存活組,且在是否合并心律失常、是否使用激素治療上均有統(tǒng)計(jì)學(xué)差異。多因素Logistic回歸分析,結(jié)果顯示改良ROSS評(píng)分、BNP、心胸比例、是否合并心律失常是DCM患者的預(yù)后影響因素。結(jié)論:(1)兒童擴(kuò)張型心肌病血清BNP水平與ADHF嚴(yán)重程度密切相關(guān),血清BNP水平結(jié)合改良ROSS評(píng)分和LVEF評(píng)價(jià)ADHF的發(fā)生發(fā)展有重要臨床價(jià)值,而BNP水平評(píng)估兒童擴(kuò)張型心肌病心室重構(gòu)的臨床價(jià)值有待進(jìn)一步探究。(2)評(píng)估兒童DCM預(yù)后需結(jié)合BNP、改良ROSS評(píng)分、心胸比例、是否合并心律失常綜合分析。發(fā)病年齡、CK-MB、肌鈣蛋白、LVEF、是否使用激素治療對(duì)預(yù)后影響不大,僅可作判斷預(yù)后的參考指標(biāo)之一。
[Abstract]:Objective: to study the clinical value of serum brain-type natriuretic peptide (BNPs) in assessing acute decompensated heart failure and ventricular remodeling in children with dilated cardiomyopathy, and to explore the prognostic factors of children with dilated cardiomyopathy. Methods from January 2004 to August 2016, 40 children with dilated cardiomyopathy associated with ADHF were collected and treated in Chongqing Medical University affiliated Children's Hospital from January 2004 to August 2016. Cardiac function grade (modified ROSS score, serum test result: CK-MBB, troponin I, LVEF, LVEDdD, LVEDsVSD, electrocardiogram, chest radiography, etc.) The changes of BNP before and after treatment and the correlation with the improved ROSS score and the corresponding indexes such as LVEF and LVEDdD were analyzed retrospectively. 40 children with dilated cardiomyopathy were followed up for hormone use and survival. Univariate analysis of prognostic factors and further Logistic regression analysis of univariate factors with statistical differences were performed. Results there were significant differences between BNP and modified ROSS scores before and after ADHF treatment. There was a positive correlation between BNP and modified ROSS scores. There was a negative correlation between BNP and LVEF, a negative correlation with LVEF, a slight correlation with LVEDd, and a negative correlation with IVSD, a negative correlation between BNP and improved ROSS after ADHF treatment. The scores were still positively correlated with RV 0.959 and P0.01g, but there was no significant correlation between BNP and LVEF, LVEDdV IVSD and other indexes of ventricular remodeling. It can be seen that there is a certain correlation between BNP and ventricular remodeling before ADHF treatment, but when the symptoms of heart failure are obviously controlled and the level of BNP is obviously decreased or even normal, cardiac remodeling is not significantly improved .2According to the follow-up results, it is divided into three groups: lost visit group, dead group and survival group. Univariate analysis showed that the age at admission, modified ROSS score, cardiothoracic ratio and cardiac troponin were significantly higher in the DCM death group than in the survival group, and in the presence or absence of arrhythmia. There were statistical differences in whether hormone therapy was used. Multivariate Logistic regression analysis showed that modified ROSS score, cardiothoracic ratio and arrhythmia were the prognostic factors in DCM patients. Conclusion (1) Serum BNP level in children with dilated cardiomyopathy is closely related to the severity of ADHF. Serum BNP level combined with modified ROSS score and LVEF evaluation of the occurrence and development of ADHF has important clinical value. The clinical value of BNP level in evaluating ventricular remodeling in children with dilated cardiomyopathy needs to be further explored. (2) to evaluate the prognosis of DCM in children, we should combine BNPs, modified ROSS score, cardiothoracic ratio and comprehensive analysis of cardiac arrhythmia. The age of onset was CK-MBand troponin LVEF. Whether or not hormone therapy had little effect on prognosis was only one of the reference indexes to judge prognosis.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.4

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