本文選題：圍生期心肌病 + 血漿催乳素　； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 探討血漿超敏C反應(yīng)蛋白(hs-CRP)、催乳素(PRL)、腦鈉肽(BNP))聯(lián)合檢測與圍生期心肌病（PPCM）的相關(guān)性，進(jìn)一步探索圍生期心肌病的發(fā)病機(jī)制。 方法 從我院心內(nèi)科收集符合目前圍生期心肌病診斷標(biāo)準(zhǔn)的患者19例（試驗(yàn)組），進(jìn)行常規(guī)體格檢查、12導(dǎo)聯(lián)心電圖、胸部正側(cè)位片、血細(xì)胞分析、尿液分析、便常規(guī)加隱血實(shí)驗(yàn)、肝腎功能、血糖、血脂、電解質(zhì)、心肌損傷標(biāo)記物、D-二聚體、凝血實(shí)驗(yàn)、血清總甲狀腺素（TT4）、血清總?cè)饧谞钕僭彼幔═T3）、血清游離甲狀腺素（FT4）、血清游離三碘甲狀腺原氨酸（FT3）、促甲狀腺激素（TSH）、紅細(xì)胞沉降率（ESR）常規(guī)項(xiàng)目的檢查，同時采取上述患者外周靜脈血使用我院檢驗(yàn)科及急診科全自動電化學(xué)發(fā)光分析儀和全自動特定蛋白分析儀測定hs-CRP、PRL、BNP；采用我院超聲科PHLIPS5500型，探頭頻率為3.5MHz的彩色多普勒超聲診斷儀測量患者左心房內(nèi)徑（LAD）、左室舒張末期內(nèi)徑（LVEDD）、每搏量（SV）、每分心輸出量（CO）、射血分?jǐn)?shù)（EF）；從我院婦產(chǎn)科門診及病房選擇12導(dǎo)聯(lián)心電圖，超聲心動圖，胸部X線片、血細(xì)胞分析、尿液分析、便常規(guī)、血生化、甲狀腺系列、凝血實(shí)驗(yàn)等檢查均正常的圍生期婦女30例（對照組），采用同樣的儀器及方法測量hs-CRP、PRL、BNP。試驗(yàn)組再根據(jù)所側(cè)左室射血分?jǐn)?shù)分為兩組，左室射血分?jǐn)?shù)（LVEF），比較各組hs-CRP、PRL、BNP水平，評價三個指標(biāo)與圍生期心肌病的相關(guān)性。 結(jié)果 （1）試驗(yàn)組患者血清BNP水平明顯高于對照組（P0．05），試驗(yàn)組根據(jù)射血分?jǐn)?shù)是否大于35%再分為兩組，比較兩組間BNP水平，差異有統(tǒng)計(jì)學(xué)意義，試驗(yàn)組各組與對照組比較差異均有統(tǒng)計(jì)學(xué)意義。 （2）試驗(yàn)組患者血清PRL水平明顯高于正常組對照組(P0．001)，試驗(yàn)組各組分別與對照組比較差異明顯，有統(tǒng)計(jì)學(xué)意義（P0．05）；試驗(yàn)組組間差異不明顯，無統(tǒng)計(jì)學(xué)意義。 （3）試驗(yàn)組患者血清hs-CRP水平明顯高于正常對照組(P0．001)，試驗(yàn)組各組分別與對照組比較差異明顯，有統(tǒng)計(jì)學(xué)意義（P0．05）；試驗(yàn)組組間差異不明顯，無統(tǒng)計(jì)學(xué)意義。 結(jié)論 （1）BNP在正常圍生期孕婦中可輕度增高，但多不超過未孕時的兩倍，可能與妊娠后全身血容量的增加至心臟負(fù)荷增加有關(guān)，而在圍生期心肌病患者中BNP水平會明顯升高達(dá)正常時的數(shù)十倍；試驗(yàn)組中隨著射血分?jǐn)?shù)的降低，BNP水平會明顯增高，與心功能有明顯的相關(guān)性。 （2）血漿催乳素、超敏C反應(yīng)蛋白受多種因素的影響，本研究在年齡、妊娠次數(shù)、喂養(yǎng)方式等方面無統(tǒng)計(jì)學(xué)差異的情況下分析，，表明上述兩個因素與圍生期心肌病發(fā)病有一定的相關(guān)性，但與心臟左室的射血分?jǐn)?shù)無明顯的相關(guān)性。
[Abstract]:Objective to investigate the relationship between plasma hypersensitive C-reactive protein (hs-CRP), prolactin (PRL), brain natriuretic peptide (BNPN) and perinatal cardiomyopathy (PPCM), and to explore the pathogenesis of perinatal cardiomyopathy. Methods A total of 19 patients with perinatal cardiomyopathy were collected from cardiology department of our hospital. The patients in the test group underwent routine physical examination with 12 leads electrocardiogram, positive and lateral chest radiography, blood cell analysis and urine analysis. Fecal routine plus occult blood test, liver and kidney function, blood glucose, blood lipid, electrolyte, myocardial injury marker, D-dimer, coagulation test, The routine items of serum Thyroxine TT _ 4, serum total triiodothyronine, serum free thyroxine FT _ 4, serum free triiodothyronine FT _ 3, thyroid stimulating hormone TSHN, erythrocyte sedimentation rate and ESRs were examined. At the same time, the peripheral venous blood of the patients mentioned above was determined by automatic electrochemiluminescence analyzer and automatic specific protein analyzer in our laboratory and emergency department, and the PHLIPS5500 was used in the ultrasonic department of our hospital. A 3.5MHz color Doppler ultrasound instrument was used to measure the left atrial diameter (LADV), left ventricular end-diastolic diameter (LVEDDN), SVV volume (SVN), ejection fraction (EFF) and ejection fraction (EFF), and to select 12-lead electrocardiogram (ECG) from outpatient department and ward of gynecology and obstetrics department in our hospital. Echocardiography, chest X-ray, blood cell analysis, urine analysis, stool routine, blood biochemistry, thyroid series and coagulation test were all normal in 30 perinatal women (control group). The experimental group was divided into two groups according to left ventricular ejection fraction, left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEFN). The BNP levels of hs-CRP were compared in each group, and the correlation between the three indexes and perinatal cardiomyopathy was evaluated. Results 1) the serum BNP level in the trial group was significantly higher than that in the control group (P 0.05). The patients in the trial group were divided into two groups according to whether the ejection fraction was greater than 35%, and the difference between the two groups was statistically significant. The serum PRL level in the test group was significantly higher than that in the normal control group (P 0.001), and the difference between the test group and the control group was significant (P 0.05). The serum hs-CRP level in the test group was significantly higher than that in the normal control group (P 0.001), and there was significant difference between the test group and the control group (P 0.05). There was no significant difference between the two groups. Conclusion BNP may be slightly increased in normal perinatal pregnant women, but it is not more than twice that of non-pregnant women, which may be related to the increase of systemic blood volume after pregnancy to the increase of cardiac load. The BNP level in perinatal cardiomyopathy patients was significantly higher than that in normal cardiomyopathy patients, and that in the experimental group increased significantly with the decrease of ejection fraction, which was significantly correlated with cardiac function. Hypersensitive C-reactive protein was influenced by many factors. In this study, there were no statistical differences in age, pregnancy frequency and feeding pattern. The results showed that the two factors were related to the incidence of perinatal cardiomyopathy. However, there was no significant correlation between ejection fraction and left ventricular ejection fraction.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.252

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