本文選題：慢性心力衰竭　切入點(diǎn)：可溶性腎素前體受體　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:在慢性心力衰竭的病理生理機(jī)制中,心臟為了應(yīng)對受到的高負(fù)荷或由于心肌梗死或其他原因造成的心肌損傷,會進(jìn)行心臟重塑。RAS(renin-angiotensin system,腎素-血管緊張素系統(tǒng))在心臟重塑以及心力衰竭的發(fā)病中起著重要的作用。傳統(tǒng)的觀點(diǎn)認(rèn)為RAS僅通過AngⅡ(angiotensinⅡ,血管緊張素Ⅱ)、Ald(Aldosterone,醛固酮)發(fā)揮作用。2002年Nguyen G等發(fā)現(xiàn)腎素(前體)受體[(P)RR]的存在。目前已有臨床研究表明(P)RR 水平能反映某些疾病嚴(yán)重程度,如腎臟疾病、妊娠期高血壓、妊娠期糖尿病、阻塞性睡眠呼吸暫停綜合征等。但有關(guān)(P)RR與心力衰竭方面的研究甚少。(P)RR是否可在心力衰竭人體中過度表達(dá)及是否與NYHA心功能分級有關(guān)尚不明確。目的:本研究主要探討心力衰竭患者血漿可溶性(P)RR[s(P)RR]是否升高,以及s(P)RR水平是否與NYHA心功能分級具有相關(guān)性。方法:入選2015年6月至2015年11月就診于我院心內(nèi)科的慢性收縮性心力衰竭患者61例及19例年齡相匹配的健康體檢者作為研究對象,按照NYHA(New York Heart Association,紐約心臟病協(xié)會)的心功能分級標(biāo)準(zhǔn)對心力衰竭患者進(jìn)行心功能分級。根據(jù)心功能將慢性收縮性心力衰竭患者分為3組:B組:心功能Ⅱ級患者14例;C組:心功能Ⅲ級患者37例;D組:心功能Ⅳ級患者10例。慢性收縮性心力衰竭患者組中,合并腎功能不全[估測的腎小球?yàn)V過率(estimated glomerular filltration rate,eGFR)120ml/min/1.73m2]的患者 26 例,將此26例患者按照心功能分級分為2組:α組:心功能Ⅲ級合并eGFR降低患者18例;β組:心功能ⅣV級合并eGFR降低患者8例。獲得 BNP(brain natriuretic peptide,腦鈉肽)、Scr(serum creatinine,血肌酐)、UA(uricacid,尿酸)、AngⅠ(angiotensionⅠ,血管緊張素Ⅰ)、AngⅡ(angiotensionⅡ,血管緊張素 Ⅱ)、Ald(aldosterone,醛固酮)、s(P)RR 及 PRC 水平。LAD(left atrial diameter,左房內(nèi)徑)、LVEDd(left ventricular end-diastolic diameter,左室舒張末期內(nèi)徑)。統(tǒng)計學(xué)分析:采用SPSS 21.0軟件對研究數(shù)據(jù)進(jìn)行統(tǒng)計分析。計量資料多組比較采用單因素方差分析或Kruskal-walillis秩和檢驗(yàn)。計數(shù)資料組間比較采用x2檢驗(yàn)。α與β組計量資料比較采用獨(dú)立樣本t檢驗(yàn)。相關(guān)性分析用Spearman直線相關(guān),將心功能分級數(shù)值化后采用多元逐步回歸分析檢驗(yàn)。組間差異采用p值表示,雙側(cè)檢驗(yàn)p0.05差異有統(tǒng)計學(xué)意義。結(jié)果:1.與正常對照組相比,心力衰竭組的LAD、LVDs、LVEF、LVMI等指標(biāo)有顯著差異(p0.05)。B組、C組、D組間,以上指標(biāo)差異無統(tǒng)計學(xué)意義。2.D組較其他3組s(P)RR水平顯著升高,C組較對照組s(P)RR水平顯著升高(p0.05)。C組、D組較A組相比,PRC明顯升高,但2組間差異無統(tǒng)計學(xué)意義。A組和B組相比s(P)RR差異無統(tǒng)計學(xué)意義(p0.05)。3.β組s(P)RR水平較α組顯著升高(p0.05)。α組和β組的eGFR差異無統(tǒng)計學(xué)意義。4.應(yīng)用Spearman相關(guān)分析法,發(fā)現(xiàn)s(P)PR與心功能分級、BNP、LVMI、Scr、UA、AngⅠ成正相關(guān),與eGFR、LVEF等呈負(fù)相關(guān)(p0.05)。以s(P)PR作為因變量,應(yīng)用多元逐步線性回歸分析結(jié)果顯示:s(P)PR與心功能分級呈獨(dú)立正相關(guān)(β=0.378,p=0.001)。結(jié)論:1.慢性心力衰竭患者NYHA心功能Ⅱ級者較心功能正常者s(P)RR水平升高不明顯,但隨NYHA心功能分級水平的進(jìn)一步增高,s(P)RR水平進(jìn)一步升高。2.慢性心力衰竭患者s(P)RR與NYHA心功能分級、BNP、Scr、UA、AngⅠ呈正相關(guān),與eGFR、LVEF等呈負(fù)相關(guān)。3.NYHA心功能分級水平是s(P)RR的獨(dú)立相關(guān)因素。
[Abstract]:Background: in the pathophysiology of chronic heart failure, the heart is in order to cope with the high load or due to myocardial infarction or other causes of myocardial injury, cardiac remodeling will.RAS (renin-angiotensin system, renin angiotensin system) plays an important role in cardiac remodeling and heart failure in the pathogenesis of the traditional view. Only by RAS Ang II (angiotensin II, angiotensin II (Aldosterone), Ald, aldosterone) play a role in.2002 Nguyen G found that renin receptor (precursor) [(P) RR]. Many clinical studies have shown that (P) RR level can reflect the severity of certain diseases, such as kidney disease. Gestational hypertension, gestational diabetes mellitus, obstructive sleep apnea syndrome (P). But the study of RR and heart failure is rare. (P) RR is and whether overexpression in human heart failure With NYHA grading of cardiac function is not clear. The objective of this study is to explore the plasma of patients with heart failure (P) and soluble RR[s (P) RR] is increased, and the S (P) RR level is correlated with NYHA grading of cardiac function. Methods: selected from June 2015 to November 2015 in our hospital department of cardiology patients with chronic congestive heart failure 61 patients and 19 age-matched healthy subjects as the research object, according to the NYHA (New York Heart Association, New York Heart Association) on heart failure patients with heart function classification of cardiac function grading standards. According to the cardiac function in patients with chronic congestive heart failure were divided into 3 groups: B group: heart function grade II patients 14 cases; group C: 37 cases of patients with cardiac function of grade III; group D: 10 patients were. In patients with chronic congestive heart failure group, glomerular filtration and renal dysfunction [estimated rate (estimated glomerular Filltration rate, eGFR) of 26 120ml/min/1.73m2] patients, the 26 patients were classified according to the cardiac function were divided into 2 groups: a group: heart function grade and eGFR decreased in 18 cases; beta group: heart function IV V level with eGFR decreased in 8 patients. BNP (brain natriuretic peptide, brain natriuretic peptide Scr (serum), creatinine, serum creatinine (uricacid), UA, uric acid), Ang I (Angiotension I, angiotensin II (angiotension II), Ang, angiotensin II (aldosterone), Ald, aldosterone), s (P) RR and PRC (left atrial diameter.LAD level, left the real LVEDd (left ventricular diameter), end-diastolic diameter, left ventricular end diastolic diameter). Statistical analysis: statistical analysis of research data using SPSS 21 software. Measurement data were compared using one-way ANOVA or Kruskal-walillis test. Enumeration data between groups were compared by x2 test and alpha. 尾緇勮閲忚祫鏂欐瘮杈冮噰鐢ㄧ嫭绔嬫牱鏈瑃媯，

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