本文選題：急性心肌梗死 + 左室重構(gòu)　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:急性心肌梗死是心血管內(nèi)科重癥之一,嚴(yán)重威脅人類健康。急性心肌梗死后左室重構(gòu)(left ventricle remodeling,LVR)是心梗后心衰、猝死等不良預(yù)后的病理基礎(chǔ),提升心肌梗死后病人生存質(zhì)量的必要前提是對LVR做出早期診斷及治療。因此不斷探索、發(fā)現(xiàn)與心梗后LVR相關(guān)的因子,具有重要的科研意義。目的:通過測定急性心肌梗死后患者血清CTRP5及NT-proBNP水平,結(jié)合心臟超聲影像學(xué)檢查結(jié)果,研究CTRP5作為評價急性心肌梗死后左室重構(gòu)程度及預(yù)后的生物學(xué)標(biāo)志物,其反映左室重構(gòu)程度、預(yù)測心肌梗死后心力衰竭發(fā)生及發(fā)展的可靠性。方法:選取2016年2月至2016年10月間就診于河北醫(yī)科大學(xué)第二醫(yī)院,首次確診為急性ST段抬高型心肌梗死的患者66例,對照組為同期就診于體檢中心的排除冠心病的健康體檢者22例。詳細(xì)記錄所有研究對象的年齡、性別、飲食等一般情況,并詢問高血壓、糖尿病、高脂血癥等既往史,完善體格檢查。完善所有研究對象的生化全項(xiàng)、心肌酶、肌鈣蛋白、氨基末端腦鈉肽前體(NT-proBNP)、血清CTRP5的測定,隨訪AMI組1個月后超聲心動圖,記錄左心射血分?jǐn)?shù)(LVEF)、左室舒張末期容積(LVEDV)、二尖瓣舒張早期血流速度峰值與二尖瓣環(huán)舒張早期運(yùn)動速度峰值比值(E/E’)。應(yīng)用spss 21.0軟件進(jìn)行統(tǒng)計學(xué)分析,認(rèn)定P0.05時,具有統(tǒng)計學(xué)意義。結(jié)果:AMI組CTRP5水平(210.55±39.82ng/mL)高于對照組CTRP5水平(107.19±11.72ng/mL),差異具有統(tǒng)計學(xué)意義(P0.05)。AMI組CTRP5含量與NT-proBNP水平呈正相關(guān)(r=0.619,P0.01)。AMI組CTRP5水平與LVEF呈負(fù)相關(guān)(r=-0.473,P0.01),與LVEDV呈正相關(guān)(r=0.543,P0.01)、與E/E’呈正相關(guān)(r=0.499,P0.01)。AMI組NT-pro BNP水平與LVEF呈負(fù)相關(guān)(r=-0.753,P0.01),與LVEDV呈正相關(guān)(r=0.705,P0.01)、與E/E’呈正相關(guān)(r=0.752,P0.01)。AMI組血清CTRP5濃度中位數(shù)為206.23ng/mL,以此為依據(jù),將急性心肌梗死組患者分為低CTRP5組與高CTRP5組。低CTRP5組中衡量左室重構(gòu)的各項(xiàng)指標(biāo),其中NT-prBNP、LVEDV、E/E’水平均低于高CTRP5組,LVEF水平高于高CTRP5組,且差異均具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:急性心肌梗死患者血清CTRP5水平明顯高于健康人群,并與NT-proBNP變化趨勢一致,均與心肌梗死后左室重構(gòu)呈正相關(guān)。提示CTRP5作為一個重要指標(biāo),可預(yù)測心肌梗死后左室重構(gòu)程度。
[Abstract]:Background: acute Myocardial Infarction (AMI) is one of the severe cardiovascular diseases, which is a serious threat to human health.Left ventricular remodeling (LVR) after acute myocardial infarction (AMI) is the pathological basis of poor prognosis such as heart failure and sudden death after myocardial infarction. Early diagnosis and treatment of LVR is a necessary prerequisite to improve the quality of life of patients with acute myocardial infarction.Therefore, it is of great significance to explore and discover the factors related to LVR after myocardial infarction.Objective: to study CTRP5 as a biomarker for evaluating the degree of left ventricular remodeling and prognosis after acute myocardial infarction by measuring the serum CTRP5 and NT-proBNP levels and combining with the results of echocardiography.It can reflect the degree of left ventricular remodeling and predict the occurrence and development of heart failure after myocardial infarction.Methods: from February 2016 to October 2016, 66 patients with acute ST-segment elevation myocardial infarction were selected from the second Hospital of Hebei Medical University.The control group consisted of 22 patients who were excluded from coronary heart disease.The age, sex and diet of all the subjects were recorded in detail, and the past history of hypertension, diabetes, hyperlipidemia were inquired, and physical examination was completed.To improve the biochemical parameters of all subjects, including myocardial enzymes, cardiac troponin, NT-proBNPN, NT-proBNPN, and serum CTRP5. After 1 month follow-up, echocardiography was performed in the AMI group.Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEF) and mitral early diastolic velocity ratio (E / E) were recorded.Spss 21 1.0 software was used for statistical analysis, and it was found that P 0. 05 had statistical significance.There was a negative correlation between Ping and LVEF, a positive correlation with LVEDV, a positive correlation with LVEDV, and a positive correlation with E / E'. The median of serum CTRP5 concentration was 206.23ngmL in the group of E / E, 0.752ngmL, 0.752ngmL, 0.752ngmL, and 0.752ngmL, respectively.Patients with acute myocardial infarction were divided into low CTRP5 group and high CTRP5 group.The indexes of left ventricular remodeling in low CTRP5 group were lower than those in high CTRP5 group (P 0.05), and the levels of NT-prBNPP LVEDVV E 'were lower than those in high CTRP5 group.Conclusion: the level of serum CTRP5 in patients with acute myocardial infarction is significantly higher than that in healthy subjects, and it is consistent with the change trend of NT-proBNP, which is positively correlated with left ventricular remodeling after myocardial infarction.As an important index, CTRP5 can predict the degree of left ventricular remodeling after myocardial infarction.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.22

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本文編號：1749352