本文選題：生長分化因子-15　切入點：左室重構(gòu)指數(shù)　出處：《大連醫(yī)科大學(xué)》2013年碩士論文

【摘要】：背景和目的：心力衰竭是多種心血管疾病的終末階段，心室重構(gòu)貫穿于心衰發(fā)生、發(fā)展的各個階段。冠心病心肌缺血和（或）急性心肌梗死（Acute MyocardialInfarction,AMI）后，心室肌在缺血、缺氧等損傷性因素的持續(xù)作用下，心臟的大小、形態(tài)和功能逐漸發(fā)生改變，進(jìn)一步發(fā)展為缺血性心肌病，是心力衰竭最常見的原因之一，嚴(yán)重威脅患者的生活質(zhì)量及生命安全。因此，早期預(yù)測AMI患者的心室重構(gòu)并終止或延緩其發(fā)生、發(fā)展具有非常重要的意義。有研究報道AMI發(fā)病早期N末端腦鈉素原(N-terminal probrain natriuretic peptide，NT-proBNP)水平與晚期左室重構(gòu)具有相關(guān)性，但其對左室重構(gòu)的預(yù)測價值存在一定的局限性，因此尋找并發(fā)現(xiàn)更特異、更靈敏的生物標(biāo)志物迫在眉睫。近年來多個多中心臨床研究發(fā)現(xiàn)，生長分化因子-15(growth differentiation factor15，GDF-15)與心血管疾病相關(guān)，其作為心血管疾病的生物標(biāo)記物具有重要的臨床應(yīng)用價值，其水平增高與急性冠狀動脈綜合征(acute coronary syndrome，ACS)的預(yù)后相關(guān)。在動物實驗?zāi)Ｐ椭校珿DF-15在心衰的發(fā)生、發(fā)展過程中強(qiáng)烈表達(dá)，考慮其可能參與了心室重構(gòu)的過程。臨床研究報道，ST段抬高型心肌梗死患者發(fā)病24小時內(nèi)血清GDF-15水平與1年后左室重構(gòu)程度呈正相關(guān)，，但目前此類研究較少。本文旨在探討AMI患者發(fā)病24小時內(nèi)血清GDF-15水平與其近期左室重構(gòu)程度的關(guān)系。 方法：從2012年6月～2012年12月就診于大連醫(yī)科大學(xué)附屬第二醫(yī)院心血管內(nèi)科并明確診斷為急性心肌梗死的患者中選取59例，采集個人資料（包括年齡、性別、身高、體重、吸煙史、高血壓病史、糖尿病病史等），測定血清GDF-15、NT-proBNP水平及其他相關(guān)實驗室檢查。所有患者于發(fā)病1周、1個月、3個月采用實時三維超聲心動圖（real-time three dimensional echocardiography，RT-3DE）測定左室重構(gòu)相關(guān)指標(biāo)，全容積法計算左室重構(gòu)指數(shù)（left ventricular remodeling index，LVRI）。依據(jù)公式LVRI變化率=(LVRI1周或1月－LVRIX月)／LVRI1周或1月，計算患者發(fā)病1周~1個月、1周~3個月和1個月~3個月時的LVRI變化率。采用SPSS17.0軟件進(jìn)行數(shù)據(jù)的統(tǒng)計學(xué)處理，P＜0.05有統(tǒng)計學(xué)差異，P＜0.01有顯著統(tǒng)計學(xué)差異。 結(jié)果： 1. AMI患者發(fā)病1周、1個月及3個月LVRI均有不同，發(fā)病1個月、3個月較1周時明顯降低（1.30±0.17vs1.46±0.14，P0.01；1.15±0.20vs1.46±0.14，P0.01），3個月較1個月時明顯降低（1.15±0.20vs1.30±0.17，P0.01）。 2.以1周~3個月的LVRI變化率中位數(shù)（20%）為標(biāo)準(zhǔn)，將所有患者分為輕度重構(gòu)組（LVRI變化率20%）和重構(gòu)重構(gòu)組（LVRI變化率≥20%），重度重構(gòu)組GDF-15、NT-ProBNP均明顯高于輕度重構(gòu)組（P0.05）。 3.相關(guān)性分析顯示，GDF-15、NT-proBNP水平與LVRI變化率呈正相關(guān)（r=0.726，P=0.000；r=0.500，P=0.000)，且GDF-15與NT-proBNP呈正相關(guān)（r=0.544，P=0.000）；線性回歸分析顯示，GDF-15與LVRI變化率獨立相關(guān)（P0.01），而NT-proBNP與LVRI變化率非獨立相關(guān)（P0.05）。 4. ROC曲線分析比較GDF-15與NT-proBNP對急性心肌梗死患者3個月內(nèi)左室重構(gòu)程度的診斷效能，前者的靈敏度、特異度、Youden指數(shù)、曲線下面積均高于后者（AUC=0.817，P=0.000；AUC=0.680，P=0.017）。 結(jié)論： 1.AMI患者在發(fā)病3個月內(nèi)發(fā)生了不同程度的左室重構(gòu)。 2.高表達(dá)血清GDF-15水平是AMI患者近期發(fā)生左室重構(gòu)的獨立預(yù)測因子。 3.AMI患者血清GDF-15及NT-proBNP水平對左室重構(gòu)程度均有一定的診斷價值，但前者診斷效能高于后者。
[Abstract]:Background and objective: heart failure is the end stage of many cardiovascular diseases, ventricular remodeling throughout all stages of development of heart failure, myocardial ischemia of coronary heart disease. And (or) acute myocardial infarction (Acute, MyocardialInfarction, AMI), ventricular myocytes during ischemia, hypoxia injury sustained effect factors, heart size, morphology and gradually change, further development of ischemic cardiomyopathy, is one of the most common causes of heart failure, a serious threat to the patient's quality of life and life safety. Therefore, the early prediction of ventricular remodeling in patients with AMI and terminate or delay the occurrence and development is very important. Studies have reported the incidence of early AMI N terminal brain natriuretic peptide the original (N-terminal probrain natriuretic peptide, NT-proBNP) is associated with late left ventricular remodeling, but the left ventricular remodeling of the predictive value of certain Bureau Limited, so look for and find more specific, more sensitive biomarkers imminent. In recent years, a multi center clinical study found that growth differentiation factor -15 (growth differentiation factor15, GDF-15) associated with cardiovascular disease, as a biomarker of cardiovascular disease has important clinical application value, the higher level and acute coronary artery syndrome (acute coronary, syndrome, ACS) prognosis. In animal models, GDF-15 in heart failure, strong expression in the development process, considering the involved in the process of ventricular remodeling. Clinical studies have reported that patients with ST segment elevation myocardial infarction within 24 hours of the serum GDF-15 level is associated with 1 years left ventricular remodeling after positively, but at present the research. This paper aims to explore the AMI patients within 24 hours of onset of serum GDF-15 levels and recent left ventricular remodeling. Relationship.
Methods: from June 2012 to December 2012 in the cardiovascular department of the Second Affiliated Hospital of Dalian Medical University and 59 cases were diagnosed as acute myocardial infarction patients were selected, the collection of personal data (including age, gender, height, weight, smoking history, history of hypertension, history of diabetes), serum GDF-15, NT-proBNP levels and other related laboratory tests. All patients in the incidence of 1 weeks, 1 months, 3 months using real-time three-dimensional echocardiography (real-time three dimensional echocardiography, RT-3DE) determination of left ventricular remodeling index, calculation of left ventricular remodeling index (left ventricular remodeling index volume, LVRI). According to the formula LVRI = change rate (LVRI1 weeks or January LVRIX / LVRI1 week or month) in January were calculated after 1 weeks ~1 months. The change of LVRI ~3 for 1 weeks and 1 months ~3 months. The rate of data mining system with SPSS17.0 software The P < 0.05 had statistical difference, and there were significant differences in P < 0.01.
Result錛

本文編號：1710388