發(fā)布時(shí)間：2018-05-15 22:18

  本文選題：原發(fā)性高血壓 + 心房顫動(dòng)　； 參考：《蘭州大學(xué)》2015年碩士論文

【摘要】：目的探討原發(fā)性高血壓合并心房顫動(dòng)患者與非心房顫動(dòng)患者生物學(xué)標(biāo)記物的差異以及臨床意義。方法本研究為病例對(duì)照研究,按照病例和對(duì)照進(jìn)行1：1匹配。納入符合原發(fā)性高血壓入排標(biāo)準(zhǔn)的患者120例(均為蘭州大學(xué)第二醫(yī)院心血管內(nèi)科住院患者),按照是否合并心房顫動(dòng)分為兩組：合并心房顫動(dòng)為病例組共63例(至少在入院前48小時(shí)內(nèi)發(fā)生過心房顫動(dòng))；不合并心房顫動(dòng)為對(duì)照組共57例。統(tǒng)計(jì)病例組和對(duì)照組的基線資料(年齡,性別,體重指數(shù),血壓分級(jí),心功能分級(jí),是否合并糖尿病及冠心病)和臨床資料(常規(guī)生化指標(biāo),心電圖,超聲心動(dòng)圖)；比較兩組的生物學(xué)標(biāo)記物(C反應(yīng)蛋白,白介素-6,同型半胱氨酸,腎素-血管緊張素-醛固酮系統(tǒng),可溶性血栓調(diào)節(jié)蛋白,血管性血友病因子,血管細(xì)胞黏附因子-1)的差異。采用SPSS 19.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的統(tǒng)計(jì)學(xué)分析。結(jié)果兩組患者的基線資料：年齡,性別,體重指數(shù),血壓分級(jí),心功能分級(jí),是否合并糖尿病,是否合并冠心病等均無統(tǒng)計(jì)學(xué)差異(P=0.061,P=0.141,P=0.275, P=0.152, P=0.263, P=0.342, P=0.074)。兩組間的常規(guī)生化指標(biāo)：腎功能指標(biāo)(尿素,肌酐,尿酸)無統(tǒng)計(jì)學(xué)差異(P=0.102,P=0.391,P=0.256)；電解質(zhì)(鉀,鎂)無統(tǒng)計(jì)學(xué)差異(P=0.340,P=0.178)；血脂(總膽固醇,甘油三酯,低密度脂蛋白膽固醇,高密度脂蛋白膽固醇),并計(jì)算血漿致動(dòng)脈硬化指數(shù)(甘油三脂和高密度脂蛋白膽固醇比值的對(duì)數(shù)轉(zhuǎn)換值),均無統(tǒng)計(jì)學(xué)差異(P=0.124,P=0.177, P=0.513, P=0.224, P=0.432)。應(yīng)用心電圖Cornell方法計(jì)算是否存在左心室肥厚,兩組間無統(tǒng)計(jì)學(xué)差異(P=0.209)。采用超聲心動(dòng)圖測(cè)量左心室收縮及舒張末期內(nèi)徑,兩組間無統(tǒng)計(jì)學(xué)差異(P=0.339,P=0.886),兩組間左心房前后徑和左心室射血分?jǐn)?shù)有統(tǒng)計(jì)學(xué)差異(P=0.008,P=0.043)。兩組間C反應(yīng)蛋白,白介素-6,同型半胱氨酸無統(tǒng)計(jì)學(xué)差異(P=0.053,P=0.214,P=0.421)；血管緊張素Ⅰ、醛固酮、腎素活性無統(tǒng)計(jì)學(xué)差異(P=0.367,P=0.233,P=0.485),血管緊張素Ⅱ有統(tǒng)計(jì)學(xué)差異(P=0.026)；可溶性血栓調(diào)節(jié)蛋白有統(tǒng)計(jì)學(xué)差異(P=0.002),血管性血友病因子和血管細(xì)胞黏附因子-1兩組間無統(tǒng)計(jì)學(xué)差異(P=0.645,P=0.944)。結(jié)論與單純高血壓患者相比,高血壓合并心房顫動(dòng)患者在基線資料和生化指標(biāo)無明顯差異,但血管緊張素Ⅱ水平以及可溶性血栓調(diào)節(jié)蛋白水平在高血壓合并心房顫動(dòng)患者組明顯升高,且有統(tǒng)計(jì)學(xué)差異。提示在心房顫動(dòng)的發(fā)病過程中血管緊張素Ⅱ和可溶性血栓調(diào)節(jié)蛋白可能起到一定作用。
[Abstract]:Objective to investigate the difference and clinical significance of biological markers in patients with essential hypertension complicated with atrial fibrillation (EH) and non-atrial fibrillation (non-atrial fibrillation). Methods this study is a case-control study, according to the case and control 1:1 matching. A total of 120 patients (all hospitalized in the Department of Cardiovascular Medicine, second Hospital of Lanzhou University) who met the admission criteria for essential hypertension were divided into two groups according to whether they were complicated with atrial fibrillation: 63 patients with atrial fibrillation. Atrial fibrillation occurred less than 48 hours before admission, and no atrial fibrillation was associated with atrial fibrillation in 57 patients in the control group. Baseline data (age, sex, body mass index, blood pressure grading, cardiac function grading, diabetes mellitus and coronary heart disease) and clinical data (routine biochemical indicators, electrocardiogram) were recorded in the case group and control group. Echocardiography, comparison of biological markers such as C-reactive protein, interleukin-6, homocysteine, renin-angiotensin-aldosterone system, soluble thrombomodulin, von Willebrand factor, The difference of vascular cell adhesion factor-1. The data were analyzed by SPSS 19.0 software. Results there were no significant differences in baseline data between the two groups: age, sex, body mass index, blood pressure grade, cardiac function grade, diabetes mellitus, coronary heart disease, etc. There was no significant difference between the two groups (P = 0.061, P = 0.141 or P = 0.275, P = 0.152, P = 0.263, P = 0.342, P = 0.074, P = 0.074). There was no significant difference in renal function (urea, creatinine, uric acid) between the two groups. There was no significant difference between the two groups in renal function (urea, creatinine, uric acid); electrolytes (potassium, magnesium) were not significantly different; serum lipids (total cholesterol, triglyceride, low density lipoprotein cholesterol, low density lipoprotein cholesterol, There was no significant difference in plasma arteriosclerosis index (TG / HDL-C) between high density lipoprotein cholesterol (HDL-C) and high density lipoprotein cholesterol (HDL-C). There was no significant difference in plasma arteriosclerosis index (P = 0.124, P = 0.173, P = 0.513, P = 0.224, P = 0.432, P = 0.432). The left ventricular hypertrophy (LVH) was calculated by electrocardiogram (Cornell) method. There was no statistical difference between the two groups (P < 0. 209). Left ventricular systolic and end-diastolic diameters were measured by echocardiography. There was no significant difference between the two groups (P < 0.01). The left atrial anterior and posterior diameter and left ventricular ejection fraction (LVEF) were significantly different between the two groups. There was no significant difference in C-reactive protein, interleukin-6 and homocysteine between the two groups. There was no significant difference in renin activity between the two groups (P < 0. 367). There was no significant difference in the activity of renin between two groups (P = 0. 363), there was a significant difference in angiotensin 鈪，

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