發(fā)布時間：2018-07-05 03:11

  本文選題：心力衰竭 + N末端B型利鈉肽原�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討不同腎功能損傷程度下氨基末端B型利鈉肽原用于診斷心力衰竭的價值;根據(jù)腎功能狀態(tài)分層界定NT-proBNP用于診斷心力衰竭的截斷值;利用Meta分析評價根據(jù)腎功能的損傷情況分層界定NT-proBNP用于診斷心力衰竭的截斷值的準(zhǔn)確性。方法:選取年齡在50~75歲之間的心血管疾病患者420例,根據(jù)左室射血分?jǐn)?shù)(LVEF)將納入研究的患者分為心功能正常組(LVEF≥40%,n=232)和心力衰竭組(LVEF40%,n=188),再按估測的腎小球濾過率(e GFR)將兩組均進一步分為腎功能正常亞組[e GFR≥90 ml/(min·1.73 m~2)]、腎功能輕度損傷亞組[90e GFR≥60 ml/(min·1.73 m~2)]、腎功能中度損傷亞組[60e GFR≥30ml/(min·1.73 m~2)]及腎功能重度損傷亞組[e GFR30 ml/(min·1.73 m~2)4個亞組。觀察不同亞組中血清NT-proBNP水平的變化及應(yīng)用其診斷心力衰竭的最佳截斷值。從Pub Med、Web of Science、Science Direct、Cochrane Library、中國知網(wǎng)、萬方、維普、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫中檢索關(guān)于腎功能正常與腎功能不全患者在合并心力衰竭時血清NT-proBNP水平變化的隨機對照試驗,檢索時間均從建庫至2016年4月,納入符合入選標(biāo)準(zhǔn)的文獻進行Meta分析。結(jié)果:心力衰竭組患者血清NT-proBNP水平明顯高于心功能正常組(P0.05);血清NT-proBNP水平與e GFR呈顯著負(fù)相關(guān)性(相關(guān)系數(shù)分別為:總樣本r=㧟0.664;心力衰竭組r=㧟0.721;心功能正常組r=㧟0.686,P0.05);在心功能正常組中,與腎功能正常亞組比較,腎功能輕度損傷亞組患者的NTproBNP無明顯升高(P0.05),腎功能中度損傷亞組與腎功能重度損傷亞組患者的血清NT-proBNP水平均明顯升高(P0.05);在心力衰竭組中,僅腎功能重度損傷亞組患者血清NT-proBNP水平較其他亞組顯著升高(P0.05);腎功能正�；蜉p度損傷時NT-proBNP診斷心力衰竭的最佳截斷值為1070pg/mL(敏感性為91.8%,特異性為72.6%),腎功能中度損傷時診斷的最佳截斷值為7121pg/mL(敏感性為80.2%,特異性為89.7%),腎功能重度損傷時診斷的最佳截斷值為33344pg/mL(敏感性為83.3%,特異性為80.0%)。其最佳曲線下面積(AUC)分別為0.899、0.714、0.825。腎功能不全的心力衰竭患者血清NT-proBNP水平較腎功能正常的心力衰竭患者明顯升高,差異具有統(tǒng)計學(xué)意義(SMD=㧟0.90,95%CI[㧟1.04,㧟0.75],P0.01);無腎功能損傷與輕度腎功能損傷比較、輕度腎功能損傷與中度腎功能損傷比較、中度腎功能損傷與重度腎功能損傷比較,后者血清NT-proBNP水平均較前者高,且差異均有統(tǒng)計學(xué)意義(SMD=㧟0.52,95%CI[㧟0.86,㧟0.19],P0.01;SMD=㧟0.84,95%CI[㧟1.15,㧟0.52],P0.01;SMD=㧟0.95,95%CI[㧟1.43,㧟0.47],P0.01)結(jié)論:腎功能中、重度損傷會影響循環(huán)中NT-proBNP水平,心力衰竭患者在合并腎功能損傷時,血清NT-proBNP水平將明顯升高,且與腎功能損傷的程度呈正相關(guān);在腎功能損傷情況下,應(yīng)用NT-proBNP診斷心力衰竭的截斷值應(yīng)該相應(yīng)提高;NT-proBNP診斷心力衰竭的準(zhǔn)確性在于它的高陰性預(yù)測值,所界定的截斷值能有效地排除心力衰竭,提高診斷率,減少漏診,而由于受多種因素的影響,其特異性較差。意義:本研究結(jié)果及結(jié)論提示:腎功能狀態(tài)會影響循環(huán)中NT-proBNP的水平,當(dāng)合并腎功能中、重度損傷時,心力衰竭患者血清NT-proBNP水平顯著升高。因此,在應(yīng)用N proBNP診斷心力衰竭時要充分考慮到腎功能狀態(tài)的影響。根據(jù)腎功能損傷程度分層界定NT-proBNP用于診斷心力衰竭的截斷值,可以更準(zhǔn)確地診斷合并有腎功能損傷的心力衰竭,對臨床心力衰竭的診斷有著重要的意義。
[Abstract]:Objective to explore the value of amino terminal B natriuretic peptide for diagnosis of heart failure with different renal function injuries, and to define the truncated value of NT-proBNP in diagnosis of heart failure according to the stratification of renal function, and to evaluate the diagnostic accuracy of the truncated value of NT-proBNP for the diagnosis of heart failure based on Meta analysis. Methods: 420 patients aged 50~75 years were selected and divided into normal cardiac function group (LVEF > 40%, n=232) and heart failure group (LVEF40%, n=188) according to the left ventricular ejection fraction (LVEF), and then the two groups were further divided into [e GFR in the normal subgroup of renal function according to the estimated glomerular filtration rate (E GFR). 90 ml/ (min. 1.73 m~2)], mild renal injury subgroup [90e GFR > 60 ml/ (min. 1.73 m~2)], 4 subgroups of renal function moderate injury [60e GFR > 30ml/ (min. 1.73)) and renal function severe injury subgroup 4 subgroups. Optimal truncation value. From Pub Med, Web of Science, Science Direct, Cochrane Library, Chinese knowledge network, Wanfang, VP, Chinese biomedical literature database, a randomized controlled trial on the changes in serum NT-proBNP levels in patients with normal renal function and renal failure in patients with congestive heart failure was retrieved from the establishment to April 2016. The serum NT-proBNP level of patients with heart failure was significantly higher than that of normal cardiac function group (P0.05), and the serum NT-proBNP level was negatively correlated with e GFR (the correlation coefficient was the total sample r=? 0.664; cardiac failure group r=? 0.721; cardiac function normal group r=? 0.686, P0.05); in cardiac function. In the normal group, compared with the normal subgroup of renal function, the NTproBNP was not significantly increased in the subgroup of mild renal impairment subgroup (P0.05). The serum NT-proBNP water in the subgroup of renal function moderate injury and the severe renal damage subgroup increased significantly (P0.05); in the heart failure group, the serum NT-proBNP water in the subgroup of the renal function severe injury subgroup was only NT-proBNP water. The best truncated value of NT-proBNP in the diagnosis of heart failure was 1070pg/mL (sensitivity 91.8%, specificity 72.6%), and the best truncation value of the diagnosis of renal function moderate injury was 7121pg/mL (sensitivity 80.2%, specificity 89.7%), and the diagnosis of renal function severe injury. The optimal truncation value was 33344pg/mL (sensitivity 83.3%, specificity 80%). The level of NT-proBNP in patients with heart failure with 0.899,0.714,0.825. renal insufficiency (AUC) was significantly higher than that of normal renal failure patients (SMD=? 0.90,95%CI[? 1.04, 0.75], P0.01); Comparison of renal function injury and mild renal function injury, compared with mild renal function injury and moderate renal function injury, moderate renal function injury and severe renal function injury, the latter serum NT-proBNP level was higher than the former, and the difference was statistically significant (SMD=? 0.52,95%CI[? 0.19], P0.01; SMD=? 0.84,95%CI[? 1.15, 0.52], P0.01; SMD=? 0.95,95%CI[? 1.43,? 0.47], P0.01) conclusion: severe injury in renal function affects the level of NT-proBNP in the circulation. The level of serum NT-proBNP in patients with heart failure is significantly higher in the case of renal function injury, and it is positively related to the degree of renal function injury; the truncated value of NT-proBNP in the diagnosis of heart failure should be applied in the case of renal function injury. The accuracy of NT-proBNP in the diagnosis of heart failure lies in its high negative predictive value. The defined value of truncation can effectively eliminate heart failure, improve the diagnostic rate and reduce missed diagnosis, and its specificity is poor due to various factors. Significance: the results of this study and conclusion suggest that renal function will affect the NT-proBN in the circulation. The level of P, when combined with renal function and severe injury, significantly increases the level of serum NT-proBNP in patients with heart failure. Therefore, the effect of renal function should be taken into full consideration in the application of N proBNP in the diagnosis of heart failure. A delamination of NT-proBNP for diagnosis of heart failure based on the degree of renal impairment can be more accurately diagnosed. Heart failure combined with renal impairment is of great significance in the diagnosis of clinical heart failure.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6

【參考文獻】

相關(guān)期刊論文 前10條

1 路娜;;N-末端前體腦鈉肽在腎疾病中的應(yīng)用[J];實用醫(yī)技雜志;2016年10期

2 周巖芬;張敏;周萬保;;NT-proBNP、肥胖及心力衰竭風(fēng)險之間的相關(guān)性研究[J];陜西醫(yī)學(xué)雜志;2016年09期

3 李凱;鄭偉;;冠心病患者NT-proBNP水平與心力衰竭的程度相關(guān)[J];湖北科技學(xué)院學(xué)報(醫(yī)學(xué)版);2016年04期

4 李輝煜;;血清NT-ProBNP水平與心衰患者的相關(guān)性及對心衰的診斷、心功能評估的價值研究[J];現(xiàn)代診斷與治療;2016年13期

5 劉利群;耿煜;段卉娣;;NT-proBNP與心力衰竭相關(guān)性研究[J];中西醫(yī)結(jié)合心腦血管病雜志;2016年07期

6 李彥娜;;血清NT-proBNP水平與NYHA心功能分級的相關(guān)性分析[J];中國實用醫(yī)藥;2016年04期

7 付杰;苗梅菊;初桂艷;李簡薇;李艷;董志武;;腎功能不全對心力衰竭患者NT-proBNP影響的初步研究[J];熱帶醫(yī)學(xué)雜志;2015年02期

8 高芳琳;林青;;探討腎功能不全對應(yīng)用NT-proBNP診斷心力衰竭的影響[J];國際檢驗醫(yī)學(xué)雜志;2014年04期

9 侯光友;李冰;徐華麗;李少珊;;BNP/NT-proBNP在心力衰竭診斷治療中的應(yīng)用進展[J];實用醫(yī)藥雜志;2013年12期

10 潘泓;潘靜薇;陸志剛;魏盟;;BNP與pro-BNP對心力衰竭合并腎功能不全患者的診斷價值[J];同濟大學(xué)學(xué)報(醫(yī)學(xué)版);2013年06期

相關(guān)碩士學(xué)位論文 前1條

1 李迪;慢性心力衰竭患者血、尿NT-proBNP的臨床研究[D];寧波大學(xué);2011年

，

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