本文選題：腦鈉肽　切入點(diǎn)：心力衰竭　出處：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:檢測不同病因所致的心功能IV級心力衰竭患者血清腦鈉肽(brain natriuretic peptide,BNP)水平,評估BNP在不同病因所致心力衰竭診斷及預(yù)后評估中的意義。方法:1.研究對象:收集2014年06月至2016年01月期間,根據(jù)患者癥狀、體征、心臟彩超等檢查確診的不同病因所致慢性心力衰竭患者共計297例,按照美國紐約心臟病協(xié)會的分級方法均為心功能IV級,其中男150例、女147例,年齡(66.8±12.4)歲,根據(jù)心力衰竭病因共分為6個組,其中冠狀動脈粥樣硬化性心臟病組51例,高血壓性心臟病組50例,風(fēng)濕性心臟瓣膜病組41例,非風(fēng)濕性心臟瓣膜病組56例,擴(kuò)張型心肌病組52例,肺源性心臟病組47例。各組患者年齡、性別、吸煙史、血脂異常史、血壓等方面比較差異無統(tǒng)計學(xué)意義(P0.05),具有可比性。排除標(biāo)準(zhǔn):(1)急性心力衰竭;(2)腎小球濾過率60mL/min,且存在嚴(yán)重腎功能障礙(血肌酐250μmol/L);(3)合并2種及以上基礎(chǔ)病因心力衰竭;(4)三尖瓣、肺動脈瓣病變的心臟瓣膜病;(5)梗阻性肥厚型心肌病;(6)甲狀腺功能異常;(7)嚴(yán)重感染;(8)心肺復(fù)蘇術(shù)后;(9)合并血液系統(tǒng)疾病;(10)惡性腫瘤。2.診斷標(biāo)準(zhǔn):依據(jù)2012年歐洲心臟病學(xué)會(ESC)心力衰竭診斷治療指南。3.血清BNP水平檢測:297例患者入院時未經(jīng)治療前,抽取肘正中靜脈血3ml,經(jīng)EDTA抗凝處理,采用熒光免疫法測定血清BNP水平。4.統(tǒng)計分析方法:所得數(shù)據(jù)采用SPSS19.0統(tǒng)計軟件進(jìn)行處理,正態(tài)分布或近似正態(tài)分布的數(shù)據(jù)以(?)±s表示。各組均數(shù)間的BNP數(shù)據(jù)比較采用完全隨機(jī)設(shè)計資料方差分析,若各組間均數(shù)整體差異具有統(tǒng)計學(xué)意義,進(jìn)一步采用LSD法進(jìn)行均數(shù)間的兩兩比較。計數(shù)資料采用χ2檢驗。p0.05為差別具有統(tǒng)計學(xué)意義。結(jié)果:冠狀動脈粥樣硬化性心臟病組、高血壓性心臟病組、風(fēng)濕性心臟瓣膜病組、非風(fēng)濕性心臟瓣膜病組、擴(kuò)張型心肌病組、肺源性心臟病組患者的血清BNP水平分別為(1513.9±1125.5)pg/mL、(1087.9±812.0)pg/mL、(636.0±821.0)pg/mL、(1171.8±935.6)pg/mL、(1462.4±988.6)pg/mL、(641.4±610.9)pg/mL。不同病因所致心功能IV級心力衰竭患者血清BNP水平存在顯著差別(P0.001),其中,冠狀動脈粥樣硬化性心臟病組、擴(kuò)張型心肌病組、高血壓性心臟病組、非風(fēng)濕性心臟瓣膜病組患者血清BNP水平均高于風(fēng)濕性心臟瓣膜病組、肺源性心臟病組患者(P0.05);風(fēng)濕性心臟瓣膜病組患者和肺源性心臟病組患者血清BNP水平比較差異無統(tǒng)計學(xué)意義(P0.05);冠狀動脈粥樣硬化性心臟病組、擴(kuò)張型心肌病組患者血清BNP水平均高于高血壓性心臟病組、非風(fēng)濕性心臟瓣膜病組患者(P0.05);高血壓性心臟病組患者和非風(fēng)濕性心臟瓣膜病組患者血清BNP水平比較差異無統(tǒng)計學(xué)意義(P0.05);冠狀動脈粥樣硬化性心臟病組和擴(kuò)張型心肌病組患者血清BNP水平比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:不同病因心力衰竭患者血清BNP水平不同,其中擴(kuò)張型心肌病組和冠狀動脈粥樣硬化性心臟病組患者血清BNP水平最高,高血壓性心臟病組和非風(fēng)濕性心臟瓣膜病組患者血清BNP水平次之,風(fēng)濕性心臟瓣膜病組和肺源性心臟病組患者血清BNP水平最低。因此,以BNP作為診斷心力衰竭、評估病情、判斷預(yù)后的指標(biāo)時要考慮到不同病因。
[Abstract]:Objective: to detect the different etiologies of heart function in patients with grade IV of serum brain natriuretic peptide (brain natriuretic peptide heart failure, BNP) level of significance to evaluate BNP in the diagnosis and prognosis of heart failure caused by different etiology in. Methods: 1. subjects: during the period from 2014 06 to 2016 01 months, according to the patient's symptoms, signs, heart color Doppler ultrasound examination confirmed the different causes of chronic heart failure in patients with a total of 297 cases, according to the grading method of the New York Heart Association were NYHA class IV, male 150 cases, female 147 cases, age (66.8 + 12.4) years old, according to the etiology of heart failure were divided into 6 groups, including coronary atherosclerotic heart disease group of 51 cases, hypertensive heart disease group of 50 cases of rheumatic heart disease group 41 cases, non rheumatic heart disease group of 56 cases, 52 cases of dilated cardiomyopathy group, pulmonary heart disease group of 47 cases. The age of patients, Gender, smoking history, history of dyslipidemia, blood pressure and other aspects of the difference was not statistically significant (P0.05), comparable. Exclusion criteria: (1) acute heart failure; (2) the glomerular filtration rate of 60mL/min, and there are serious renal function (serum creatinine 250 mol/L); (3) with 2 and above the basic cause of heart failure; (4) three tricuspid valvular heart disease, pulmonary artery valve disease; (5) obstructive hypertrophic cardiomyopathy; (6) abnormal thyroid function; (7) severe infection; (8) after cardiopulmonary resuscitation; (9) in patients with hematological malignant disease (10);.2. diagnosis standard: Based on the 2012 European Society of Cardiology (ESC) heart failure diagnosis and treatment of serum BNP.3. guidelines: 297 patients with untreated before extraction, median cubital vein blood 3ml, EDTA after anticoagulant treatment, serum BNP levels were measured by.4. statistical analysis method with fluorescence immunoassay: the data by SPSS19.0 statistics soft Treatment of normal distribution or approximate normal distribution of the data in (?) + s. BNP data were used to compare between the number of completely randomized design ANOVA, if the differences are statistically significant differences, further using LSD method were compared between the number of 22. Count data using 2 test for.P0.05 was statistically significant difference. Results: the coronary heart disease group, hypertensive heart disease, rheumatic heart disease group, non rheumatic valvular heart disease, dilated cardiomyopathy group, the serum BNP level of pulmonary heart disease patients respectively (1513.9 + 1125.5) pg/mL, (1087.9 + 812) pg/mL, (636 + 821) pg/mL, (1171.8 + 935.6) pg/mL, (1462.4 + 988.6) pg/mL, (641.4 + 610.9) pg/mL. caused by different etiology of grade IV heart function in patients with congestive heart failure and serum level of BNP and there was a significant difference (P0.001), which, Coronary heart disease, dilated cardiomyopathy, hypertensive heart disease group, non rheumatic heart disease group were higher than the level of serum BNP in patients with rheumatic heart disease, pulmonary heart disease group (P0.05); rheumatic heart disease group were compared with pulmonary heart disease the serum BNP level of group no significant difference (P0.05); coronary heart disease group, dilated cardiomyopathy group were higher than that of serum BNP levels in patients with hypertensive heart disease group, non rheumatic heart disease group (P0.05); no significant hypertensive heart disease patients and non rheumatic valvular heart disease the serum BNP level of group differences (P0.05); no significant coronary heart disease group and dilated cardiomyopathy patients serum BNP level difference (P0.05). Conclusion: different etiology 蹇冨姏琛扮鎮(zhèn)ｈ，

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