代謝綜合征患者左房重構(gòu)及相關(guān)因素的觀察
發(fā)布時(shí)間：2018-08-29 16:04
【摘要】：目的:了解代謝綜合征(MS)患者是否存在左房重構(gòu)及影響左房重構(gòu)的因素;探討代謝綜合征患者N末端腦鈉肽前體(NT-pro BNP)水平變化及代謝綜合征患者左房重構(gòu)與N末端腦鈉肽前體水平間的關(guān)系,了解左房重構(gòu)可能的機(jī)制;討論代謝綜合征患者左房重構(gòu)與房性心律失常的關(guān)系。方法:選擇健康對(duì)照組30人、代謝綜合征非高血壓組30人、代謝綜合征并高血壓組30人、混合代謝綜合征組64人,其中健康對(duì)照組、代謝綜合征非高血壓組、代謝綜合征并高血壓組,采用臨床標(biāo)準(zhǔn)生化法測(cè)定、甘油三脂(TG)、總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、空腹血糖(FBG)、尿酸(UA),采用超聲心動(dòng)圖檢測(cè)左心房容積指數(shù)(LAVI)、左心房最大容積(LAVmax)等指標(biāo),采用Elisa技術(shù)測(cè)定心房利鈉肽及空腹胰島素水平(FINS);混合代謝綜合征組采用臨床標(biāo)準(zhǔn)生化法測(cè)定甘油三脂(TG)、高密度脂蛋白膽固醇(HDL-C)、空腹血糖(FBG),超聲心動(dòng)圖檢測(cè)左心房?jī)?nèi)徑指數(shù)(LADI),測(cè)量常規(guī)12導(dǎo)聯(lián)心電圖及監(jiān)測(cè)24h動(dòng)態(tài)心電圖,同時(shí)12導(dǎo)聯(lián)心電圖測(cè)量結(jié)果及24h動(dòng)態(tài)心電圖檢測(cè)結(jié)果根據(jù)Kleiger分級(jí)分為簡(jiǎn)單房性心律失常組和復(fù)雜性房性心律失常組,比較兩組左房?jī)?nèi)徑指數(shù)(LADI)、最大P波時(shí)限(PMAX)、macruze指數(shù)、P波離散度(PWD)及Morris指數(shù)異常頻率的差別。采用SPSS18.0統(tǒng)計(jì)軟件處理。計(jì)量資料采用(x-±s)表示,均數(shù)的比較采用AN0VA和t檢驗(yàn),兩個(gè)變量間的依存關(guān)系采用Pearson相關(guān)分析,多個(gè)變量影響因素的分析采用多元線性回歸分析,計(jì)數(shù)資料使用χ2檢驗(yàn),以P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)與健康對(duì)照組相比,代謝綜合征非高血壓組LAVI、LAVmax、LAVmix、LARV、LASV、LAVP增加;LACV、LAEF、LVVmax無(wú)差別。與健康對(duì)照組和代謝綜合征非高血壓組相比,代謝綜合征并高血壓疾病組LAVI、LAVmax、LAVmin、LARV、LACV、LASV、LAVP、LVVmax均增加,LAEF均無(wú)差別。(2)Pearson相關(guān)分析表明代謝綜合征非高血壓組和代謝綜合征并高血壓組LAVI與年齡、BMI、腰圍、TG、SBP、DBP、SIL、FBG、HOME-IR均呈正相關(guān),與HDL-C呈負(fù)相關(guān),與TC、LDL-C、UA無(wú)相關(guān)關(guān)系。多元線性回歸分析表明代謝綜合征非高血壓組和代謝綜合征并高血壓組腰圍、TG、HOMR-IRI均為影響LAVI的因素,其中TG對(duì)LAVI影響最大。(3)與健康對(duì)照組相比代謝綜合征非高血壓組血清NT-pro BNP增加;與健康對(duì)照組和代謝綜合征非高血壓組相比,代謝綜合征并高血壓組NT-pro BNP進(jìn)一步增加。(4)Pearson相關(guān)分析表明代謝綜合征非高血壓組和代謝綜合征并高血壓組血清NT-pro BNP與年齡、BMI、SBP、FIN、HOME-IR、UA呈正相關(guān),與腰圍、TG、TC、LDL-C、DBP、FBG無(wú)相關(guān)關(guān)系。多元線性回歸分析表明代謝綜合征非高血壓組和代謝綜合征并高血壓組FIN、年齡、SBP、BMI均為影響血清NT-pro BNP的因素,其中FIN對(duì)血清NT-pro BNP的影響最大。(5)Pearson相關(guān)分析表明代謝綜合征非高血壓組和代謝綜合征并高血壓組NT-pro BNP與LAVI、LAVmax、LAVmin、LASV、LAVP均呈正相關(guān),與LARV、LACV、LAEF無(wú)相關(guān)關(guān)系。多元線性回歸分析表明單純代謝綜合征組代謝綜合征非高血壓組和代謝綜合征并高血壓組LAVI、LAVP為影響血清NT-pro BNP的重要因素,其中LAVI對(duì)血清NT-pro BNP的影響最大。(6)在混合代謝綜合征組中,與簡(jiǎn)單心律失常相比,復(fù)雜房性心律失常組LADI、PMAX、macruze指數(shù)、PWD數(shù)值明顯增大,Morris指數(shù)異常頻率明顯增加。結(jié)論:(1)代謝綜合征患者存在左房重構(gòu),腰圍、TG、HOME-IR皆為影響代謝代謝綜合征患者左房重構(gòu)的主要因素。(2)代謝綜合征患者血清NT-pro BNP增加,FIN、年齡、SBP、BMI為影響代謝綜合征患者血清NT-pro BNP分泌的主要因素。同時(shí)代謝綜合征患者NT-pro BNP的分泌與左房重構(gòu)密切相關(guān)。(3)代謝綜合征患者左房重構(gòu)后加重其房性心律失常的發(fā)生。
[Abstract]:Objective: To investigate whether there is left atrial remodeling in patients with metabolic syndrome (MS) and the factors affecting it, to explore the changes of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome and the relationship between left atrial remodeling and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome, and to understand the possible mechanism of left atrial remodeling. Methods: 30 healthy controls, 30 non-hypertension patients with metabolic syndrome, 30 patients with metabolic syndrome complicated with hypertension, 64 patients with mixed metabolic syndrome, including healthy control group, non-hypertension patients with metabolic syndrome and hypertension patients with metabolic syndrome were selected. Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), uric acid (UA), left atrial volume index (LAVI), left atrial maximum volume (LAVmax) were measured by echocardiography, and atrial natriuretic peptide (ANP) and fasting insulin (FI) were measured by Elisa technique. In the mixed metabolic syndrome group, triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), left atrial diameter index (LADI), routine 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured, while 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured. Results According to Kleiger classification, the patients were divided into simple atrial arrhythmia group and complex atrial arrhythmia group. The differences of abnormal frequencies of left atrial diameter index (LADI), maximum P wave duration (PMAX), macruze index, P wave dispersion (PWD) and Morris index between the two groups were compared. Compared with AN0VA and T test, Pearson correlation analysis was used to analyze the dependence between the two variables, multiple linear regression analysis was used to analyze the influencing factors of the two variables, and_2 test was used to analyze the counting data. The difference was statistically significant with P 0.05. Results: (1) Compared with the healthy control group, LAVI, LAVmax, LAVmix, LAR in the non-hypertension group of metabolic syndrome were significantly different. Compared with the healthy control group and the non-hypertension group of metabolic syndrome, LAVI, LAVmax, LAVmin, LARV, LACV, LASV, LAVP, LVVmax increased in the metabolic syndrome patients with hypertension, but LAEF did not differ between the non-hypertension group of metabolic syndrome and the non-hypertension group of metabolic syndrome. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, TG, SBP, DBP, SIL, FBG, HOME-IR were positively correlated with HDL-C, but not with TC, LDL-C, UA. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, and TG had the greatest influence on LAVI. (3) LAVI was negatively correlated with health. The serum NT-pro BNP levels in the control group were higher than those in the non-hypertensive group with metabolic syndrome, and the NT-pro BNP levels in the hypertensive group with metabolic syndrome were higher than those in the healthy control group and the non-hypertensive group with metabolic syndrome. (4) Pearson correlation analysis showed that the serum NT-pro BNP levels in the non-hypertensive group with metabolic syndrome and the hypertensive group with metabolic syndrome were higher than BMI, SBP, FIN, HOME-IR, UA were positively correlated with waist circumference, TG, TC, LDL-C, DBP, FBG. Multivariate linear regression analysis showed that FIN, age, SBP, BMI were all factors affecting serum NT-pro BNP in non-hypertensive group and hypertensive group with metabolic syndrome, and FIN had the greatest influence on serum NT-pro BNP. The results showed that NT-pro BNP was positively correlated with LAVI, LAVmax, LAVmin, LASV and LAVP, but not with LARV, LACV and LAEF. Multivariate linear regression analysis showed that LAVI and LAVP in metabolic syndrome group and metabolic syndrome with hypertension group were correlated with serum NT. LAVI had the greatest effect on serum NT-pro BNP. (6) Compared with simple arrhythmia, LADI, PMAX, macruze index, PWD and Morris index were significantly increased in patients with complex atrial arrhythmia, and the abnormal frequency of Morris index was significantly increased. G, HOME-IR were the main factors affecting the left atrial remodeling in patients with metabolic syndrome. (2) The increase of serum NT-pro BNP, FIN, age, SBP and BMI were the main factors affecting the secretion of NT-pro BNP in patients with metabolic syndrome. The left atrial remodeling of the patient aggravated the occurrence of atrial arrhythmia.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R589
本文編號(hào)：2211705
[Abstract]:Objective: To investigate whether there is left atrial remodeling in patients with metabolic syndrome (MS) and the factors affecting it, to explore the changes of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome and the relationship between left atrial remodeling and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome, and to understand the possible mechanism of left atrial remodeling. Methods: 30 healthy controls, 30 non-hypertension patients with metabolic syndrome, 30 patients with metabolic syndrome complicated with hypertension, 64 patients with mixed metabolic syndrome, including healthy control group, non-hypertension patients with metabolic syndrome and hypertension patients with metabolic syndrome were selected. Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), uric acid (UA), left atrial volume index (LAVI), left atrial maximum volume (LAVmax) were measured by echocardiography, and atrial natriuretic peptide (ANP) and fasting insulin (FI) were measured by Elisa technique. In the mixed metabolic syndrome group, triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), left atrial diameter index (LADI), routine 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured, while 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured. Results According to Kleiger classification, the patients were divided into simple atrial arrhythmia group and complex atrial arrhythmia group. The differences of abnormal frequencies of left atrial diameter index (LADI), maximum P wave duration (PMAX), macruze index, P wave dispersion (PWD) and Morris index between the two groups were compared. Compared with AN0VA and T test, Pearson correlation analysis was used to analyze the dependence between the two variables, multiple linear regression analysis was used to analyze the influencing factors of the two variables, and_2 test was used to analyze the counting data. The difference was statistically significant with P 0.05. Results: (1) Compared with the healthy control group, LAVI, LAVmax, LAVmix, LAR in the non-hypertension group of metabolic syndrome were significantly different. Compared with the healthy control group and the non-hypertension group of metabolic syndrome, LAVI, LAVmax, LAVmin, LARV, LACV, LASV, LAVP, LVVmax increased in the metabolic syndrome patients with hypertension, but LAEF did not differ between the non-hypertension group of metabolic syndrome and the non-hypertension group of metabolic syndrome. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, TG, SBP, DBP, SIL, FBG, HOME-IR were positively correlated with HDL-C, but not with TC, LDL-C, UA. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, and TG had the greatest influence on LAVI. (3) LAVI was negatively correlated with health. The serum NT-pro BNP levels in the control group were higher than those in the non-hypertensive group with metabolic syndrome, and the NT-pro BNP levels in the hypertensive group with metabolic syndrome were higher than those in the healthy control group and the non-hypertensive group with metabolic syndrome. (4) Pearson correlation analysis showed that the serum NT-pro BNP levels in the non-hypertensive group with metabolic syndrome and the hypertensive group with metabolic syndrome were higher than BMI, SBP, FIN, HOME-IR, UA were positively correlated with waist circumference, TG, TC, LDL-C, DBP, FBG. Multivariate linear regression analysis showed that FIN, age, SBP, BMI were all factors affecting serum NT-pro BNP in non-hypertensive group and hypertensive group with metabolic syndrome, and FIN had the greatest influence on serum NT-pro BNP. The results showed that NT-pro BNP was positively correlated with LAVI, LAVmax, LAVmin, LASV and LAVP, but not with LARV, LACV and LAEF. Multivariate linear regression analysis showed that LAVI and LAVP in metabolic syndrome group and metabolic syndrome with hypertension group were correlated with serum NT. LAVI had the greatest effect on serum NT-pro BNP. (6) Compared with simple arrhythmia, LADI, PMAX, macruze index, PWD and Morris index were significantly increased in patients with complex atrial arrhythmia, and the abnormal frequency of Morris index was significantly increased. G, HOME-IR were the main factors affecting the left atrial remodeling in patients with metabolic syndrome. (2) The increase of serum NT-pro BNP, FIN, age, SBP and BMI were the main factors affecting the secretion of NT-pro BNP in patients with metabolic syndrome. The left atrial remodeling of the patient aggravated the occurrence of atrial arrhythmia.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R589
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