發(fā)布時間：2018-06-13 12:02

  本文選題：慢性心力衰竭 + 急性發(fā)作�。� 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景 隨著慢性心衰患者的逐步增多，其急性發(fā)作已成為心衰患者入院的主要原因，其發(fā)病急、病死率高，因此，探求心衰患者危險分層、指導(dǎo)治療及判斷預(yù)后的更有效的方法致關(guān)重要。 目前已經(jīng)公認(rèn)，在心衰的發(fā)生、發(fā)展過程中，精氨酸加壓素（AVP）系統(tǒng)的激活起著重要作用，尤其是其導(dǎo)致的水鈉潴留。然而，AVP的血漿半衰期很短，，只有10-30分鐘，血漿檢測比較困難，其臨床應(yīng)用及研究明顯受限。近年的研究發(fā)現(xiàn)，和肽素作為與AVP同源的多肽，與AVP等摩爾量釋放，并且其穩(wěn)定、易于檢測，在血漿中與AVP變化相一致，可能有助于心衰的診斷和治療。但是，其在體內(nèi)的具體功能及與心血管系統(tǒng)疾病的關(guān)系尚不清楚。 目的 通過測定慢性心衰急性發(fā)作期患者血漿和肽素水平，分析其與心功能分級、左心室射血分?jǐn)?shù)（LVEF）、氨末端腦鈉肽前體（NT-proBNP）及近期預(yù)后的關(guān)系，探討和肽素能否作為心衰患者診斷、指導(dǎo)治療及判斷預(yù)后的血清標(biāo)志物。 方法 選擇慢性心衰急性發(fā)作期住院治療的患者80例為心衰組，同期無心臟相關(guān)疾病的健康對照組30例。心衰組分別于入院即刻、給予抗心衰治療10天后測定和肽素、NT-proBNP水平，并于入院后24小時內(nèi)行床旁心臟超聲檢查，測量左心室舒張末期內(nèi)徑（LVIDd）和LVEF；并于出院后3個月時隨訪記錄其是否發(fā)生心血管相關(guān)事件（包括因心衰再次急性發(fā)作、惡性心律失常等再住院或死亡等）；對照組采血一次，測定和肽素、NT-proBNP水平。 結(jié)果 心衰組患者入院即刻和肽素、NT-proBNP水平均高于對照組（P0.01）；NYHAⅣ級患者的和肽素、NT-proBNP水平高于NYHAⅢ級的患者(P0.05)；和肽素水平與NT-proBNP呈明顯正相關(guān)（r=0.721,P0.001）；與LVEF呈負(fù)相關(guān)（r=-0.332,P=0.003）；心衰組治療10天后和肽素、NT-proBNP水平較入院時明顯下降（P0.01）；出院后3個月時間內(nèi)，與未發(fā)生心血管事件的患者相比，發(fā)生心血管事件患者的和肽素、NT-proBNP水平在治療前后均較高（P0.01）；用多因素Logistic回歸分析，入院時和肽素、NT-proBNP水平為慢性心衰患者獨立預(yù)后指標(biāo)（P0.01）。 結(jié)論 在慢性心力衰竭急性發(fā)作期患者入院時測定和肽素、NT-proBNP水平有助于心功能的評價及患者病情的嚴(yán)重程度的判斷；在其治療過程中監(jiān)測和肽素、NT-proBNP水平有利于指導(dǎo)治療；測定其水平對預(yù)后判斷具有重要價值。
[Abstract]:Background with the increasing number of patients with chronic heart failure, acute attack has become the main cause of hospitalization of patients with heart failure, and its incidence is acute and mortality is high. Therefore, to explore the risk stratification of patients with heart failure. More effective methods for guiding treatment and judging prognosis are important. The activation of arginine vasopressin (AVP) system plays an important role in the occurrence and development of heart failure, especially the retention of water and sodium. However, the plasma half-life of AVP is very short, only 10-30 minutes, the detection of plasma is difficult, its clinical application and research are obviously limited. In recent years, it has been found that, as a peptide homologous to AVP, it is released in the same molar amount as AVP, and it is stable and easy to detect, which is consistent with the change of AVP in plasma, which may be helpful to the diagnosis and treatment of heart failure. However, its specific function in vivo and its relationship with cardiovascular diseases are unclear. Objective to determine the levels of plasma and peptide in patients with chronic heart failure (CHF) during acute attack and to analyze their relationship with cardiac function classification, left ventricular ejection fraction (LVEF), NT-proBNPs at the end of ammonia-terminal brain natriuretic peptide (NT-proBNPP) and short-term prognosis. To explore whether or not he peptide can be used as a serum marker for diagnosis, treatment and prognosis in patients with heart failure. Methods 80 patients with acute attack of chronic heart failure were selected as heart failure group and 30 healthy persons without heart-related diseases in the same period. NT-proBNP levels were measured 10 days after anti-CHF treatment in CHF group, and bedside echocardiography was performed within 24 hours after admission to measure left ventricular end-diastolic diameter (LVIDd) and LVEF. At 3 months after discharge, the patients were followed up to record whether they had cardiovascular events (including re-acute attack due to heart failure, malignant arrhythmias, etc.) and once in the control group, the levels of NT-proBNP in the control group were measured and the levels of NT-proBNP were measured. Results the levels of NT-proBNP in patients with heart failure were significantly higher than those in patients with NYHA 鈪

本文編號：2013961