本文選題：慢性心力衰竭 + 肝功能損害�。� 參考：《華北理工大學(xué)》2015年碩士論文

【摘要】：目的分析不同類型(射血分?jǐn)?shù)降低和射血分?jǐn)?shù)保留)心力衰竭(Chronic heart failure,CHF)患者基礎(chǔ)病因、臨床特征,評價N-末端腦鈉肽(NT-pro-BNP)水平、肝腎功能損害等多臟器功能損害的患病情況,探討肝腎功能損害與NT-pro-BNP的相關(guān)性。方法1采取回顧性研究的方法選取2013年6月至2014年10月于華北理工大學(xué)附屬醫(yī)院住院治療的慢性心衰患者作為研究對象,根據(jù)納入排除標(biāo)準(zhǔn),本研究納入284例患者,分別記錄患者首次入院時的臨床特征,包括:一般資料、基礎(chǔ)病因、合并疾病、臨床表現(xiàn)、化驗指標(biāo)及超聲心動圖結(jié)果。2將入選患者根據(jù)LVEF分為2組,分析比較2組患者基礎(chǔ)病因、臨床特征、NT-pro-BNP水平、血脂、血糖、肝、腎功能水平,評價肝功能損害、腎功能不全等多臟器功能損害的患病情況。3本研究數(shù)據(jù)采用Epidate軟件建立數(shù)據(jù)庫,統(tǒng)計軟件SPSS17.0對數(shù)據(jù)進行分析,所有正態(tài)分布的計量數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差表示,兩組間比較采用獨立樣本t檢驗,多組間比較采用單因素方差分析,計數(shù)資料用[例(%)]表示,組間比較用χ2檢驗,偏態(tài)分布的計量資料以M(Q1-Q3)表示,組間比較采用Mann-whitney檢驗。相關(guān)性分析采用Pearson相關(guān)系數(shù)、多元逐步線性回歸分析法。以P0.05(雙側(cè))為差異有統(tǒng)計學(xué)意義。結(jié)果1 284例心衰患者男性152例(53.5%),女性132例(46.5%),平均年齡(66.92±12.25)歲。HF-REF組148例(52.1%),男性92例(62.2%),平均年齡(66.20±11.54)歲;HF-PEF組136例(47.9%),男性60例(44.1%),平均年齡(67.69±12.93)歲。心功能分級:Ⅱ級26例(9.2%),Ⅲ級124例(43.7%),Ⅳ級134例(47.2%)。2基礎(chǔ)病因分析:冠心病206例(72.5%),高血壓性心臟病44例(15.5%);其他:心肌病18例(6.3%),瓣膜病14例(4.9%),先心病2例(0.7%);合并疾病:陳舊性心梗152例(53.9%),高血壓209例(73.6%),糖尿病146例(51.4%)。其中HF-REF組冠心病114例(77.0%),HF-PEF 92例(67.6%),P0.05;HF-REF組高心病16例(10.8%),HF-PEF組28例(20.6%),P0.05;。3 HF-REF組患者NT-proBNP中位數(shù)為9377.23(5784.72~19579.73),HF-PEF組患者NT-pro-BNP中位數(shù)為1714.25(197.48~3562.87),P0.05。4多器官功能損害患者中,肝功能受損者41例(14.4%),腎功能不全者146例(51.4%);其中HF-REF組肝功能損害、腎功能不全的患病情況為19.6%、59.5%,HF-PEF組為18.8%、26.4%,P0.05。HF-REF組Cr、BUN、TBIL、DBIL、ALT、AST水平較HF-PEF組升高,HF-PEF組ALB、GFR水平較HF-REF組高,P0.05。5以NT-pro-BNP為因變量,以肝腎功能指標(biāo)為自變量進行Pearson相關(guān)分析。NT-pro-BNP水平與TBIL、ALT、AST、Cr水平呈正相關(guān),(P0.05);與GFR水平呈負相關(guān),(P0.05)。將各指標(biāo)進行多元逐步線性回歸分析,NT-pro-BNP與TBIL呈正相關(guān)(P0.05),與Cr亦呈正相關(guān)(P0.05),。結(jié)論1不同類型心力衰竭患者的基礎(chǔ)病因為冠心病,其次為高血壓性心臟病。2HFREF組NT-pro-BNP水平高于HF-PEF組,且HFREF組肝功能損害、腎功能不全的患病情況更高。3 TBIL、Cr對判斷心衰的嚴(yán)重程度具有一定的評估價值。
[Abstract]:Objective to analyze the basic etiology and clinical features of patients with different types of heart failure (decreased ejection fraction and retention of ejection fraction), and to evaluate the prevalence of multiple organ dysfunction such as NT-pro-BNPs, liver and kidney dysfunction, and so on.To investigate the correlation between liver and kidney function damage and NT-pro-BNP.Methods 1 A retrospective study was conducted on 284 patients with chronic heart failure who were hospitalized in affiliated Hospital of North China University of Science and Technology from June 2013 to October 2014.The clinical features of the patients at first admission were recorded, including general data, underlying causes, complicated diseases, clinical manifestations, laboratory parameters and echocardiographic results. 2. 2 patients were divided into 2 groups according to LVEF.The basic etiology, clinical features of NT-pro-BNP, blood lipids, blood glucose, liver and renal function were analyzed and compared between the two groups.The data of this study were established by Epidate software. The data were analyzed by statistical software SPSS17.0. All the normal distribution data were expressed as mean 鹵standard deviation.Independent sample t test was used for comparison between two groups, single factor analysis of variance was used for multigroup comparison, 蠂 2 test was used for cross-group comparison, and Mann-whitney test was used for metrological data of skew distribution.Correlation analysis was based on Pearson correlation coefficient and multiple stepwise linear regression analysis.There was significant difference in P 0.05 (bilateral).There were 152 cases with old myocardial infarction, 209 cases with hypertension and 73.6% with diabetes, and 146 cases with diabetes.Using liver and kidney function as the independent variable, the Pearson correlation analysis. NT-pro-BNP level was positively correlated with the level of TBILL alt ASTN Cr and negatively correlated with the level of GFR.NT-pro-BNP was positively correlated with TBIL (P 0.05) and Cr was positively correlated with Cr (P 0.05) by multivariate stepwise linear regression analysis.Conclusion (1) Coronary heart disease is the basic cause of different types of heart failure, followed by NT-pro-BNP level in hypertensive heart disease .2HFREF group is higher than that in HF-PEF group, and liver function is damaged in HFREF group.The prevalence of renal insufficiency is higher. 3. 3 TBILN Cr has certain value in evaluating the severity of heart failure.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.6

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