本文選題：先天性心臟病相關(guān)肺動(dòng)脈高壓(PAH-CHD) + 血清Hcy��； 參考：《南昌大學(xué)》2016年碩士論文

【摘要】：目的:研究先天性心臟病相關(guān)肺動(dòng)脈高壓(PAH-CHD)患者介入封堵前后血清同型半胱氨酸(Hcy)濃度變化及其與血流動(dòng)力學(xué)參數(shù)相關(guān)性,綜合評(píng)價(jià)血清Hcy對(duì)于PAH-CHD診斷的臨床意義。方法:收集南昌大學(xué)第二附屬醫(yī)院心血管內(nèi)科住院部2015年1月到2015年12月在心內(nèi)科心導(dǎo)管室成功行CHD介入封堵術(shù)的左向右分流的CHD患者104例,按照術(shù)中平均肺動(dòng)脈壓力將其分成四組:先天性心臟病未合并肺動(dòng)脈高壓組(CHD-NPAH組)27例;先天性心臟病合并輕度肺動(dòng)脈高壓組(CHD-LPAH組)32例;先天性心臟病合并中度肺動(dòng)脈高壓組(CHD-MPAH組)26例;先天性心臟病合并重度肺動(dòng)脈高壓組(CHD-SPAH組)19例;收集同期體檢中心30名健康患者作為正常對(duì)照組,收集納入對(duì)象的臨床資料,超聲心動(dòng)圖測(cè)量心室腔大小;使用右心導(dǎo)管檢查術(shù)獲得血流動(dòng)力學(xué)參數(shù);采用速率法測(cè)定血清HCY濃度。結(jié)果:(1)術(shù)前PAH-CHD患者(CHD-LPAH組、CHD-MPAH組及CHD-SPAH組)血清Hcy濃度顯著高于正常對(duì)照組及CHD-NPAH組患者,P均0.05,有顯著統(tǒng)計(jì)學(xué)意義;組間多重比較,CHD-LPAH組、CHD-MPAH組、CHD-SPAH組各組之間比較均有統(tǒng)計(jì)學(xué)差異(P0.05);CHD-NPAH組患者血清Hcy水平高于正常對(duì)照組,但是差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(2)CHD患者血清Hcy濃度高于正常對(duì)照組,P0.01;但是ASD、PDA、VSD各組之間Hcy濃度雖然有差異,卻沒有統(tǒng)計(jì)學(xué)意義(P0.05);(3)術(shù)前PAH-CHD患者血清Hcy濃度與PASP、MPAP、PVR呈正相關(guān)(r分別為0.283,P0.05;0.374,0.347,P0.01);(4)血清Hcy濃度為16.84umol/L時(shí),對(duì)CHD-SPAH有一定的識(shí)別作用,敏感度為79.3%,特異性為58.9%,ROC曲線下面積為0.778,P0.01;(5)介入封堵術(shù)后PAH-CHD患者血清Hcy濃度及肺動(dòng)脈壓力均下降,術(shù)后Hcy濃度與PASP仍存在一定正相關(guān)(r為0.315,P0.01)。結(jié)論:1.PAH-CHD患者血清Hcy濃度明顯升高。2.PAH-CHD患者血清Hcy水平整體上與PASP、MPAP、PVR存在一定正相關(guān)的關(guān)系,并且Hcy在診斷CHD-SPAH上有較強(qiáng)的敏感性,故檢測(cè)血清Hcy濃度可作為一種評(píng)估PAH-CHD患者嚴(yán)重程度的輔助手段。3.介入封堵術(shù)后患者的PASP及血清Hcy濃度明顯下降,兩者仍存在線性關(guān)系,故介入封堵術(shù)是治療PAH-CHD的有效手段,檢測(cè)血清Hcy濃度有望成為PAH-CHD患者重要的隨訪指標(biāo)。
[Abstract]:Objective: to study the changes of serum homocysteine cysteine (Hcy) concentration and its correlation with hemodynamic parameters in patients with congenital heart disease associated pulmonary hypertension (PAH-CHD) before and after interventional occlusion, and to evaluate the clinical significance of serum Hcy in the diagnosis of PAH-CHD. Methods: a total of 104 patients with left to right shunt CHD who were successfully performed CHD interventional closure from January 2015 to December 2015 in Department of Cardiovascular Medicine, second affiliated Hospital of Nanchang University, were collected. According to the mean pulmonary artery pressure during operation, the patients were divided into four groups: 27 cases in CHD-NPAH group without congenital heart disease complicated with pulmonary hypertension, 32 cases in CHD-LPAH group with congenital heart disease complicated with mild pulmonary hypertension. There were 26 cases of CHD-MPAH in congenital heart disease with moderate pulmonary hypertension and 19 cases of CHD-SPAH in congenital heart disease with severe pulmonary hypertension. Ventricular cavity size was measured by echocardiography, hemodynamic parameters were obtained by right cardiac catheterization, and serum HCY concentration was measured by rate method. Results (1) the serum Hcy levels of PAH-CHD patients with CHD-LPAH and CHD-SPAH were significantly higher than those of normal control group and CHD-NPAH group (P < 0.05). There was significant difference between CHD-MPAH group and CHD-SPAH group. The serum Hcy level of CHD-MPAH group was higher than that of normal control group. However, there was no significant difference in serum Hcy concentration between the two groups. However, there was a significant difference in the concentration of Hcy between the two groups. However, there was no statistical significance between serum Hcy concentration and PASP MPAPPVR in patients with PAH-CHD before operation. The positive correlation between serum Hcy concentration and PASP MPAPPVR was 0.283 P0.05 ~ 0.374 ~ 0.347 ~ 0.347 ~ 0.37 ~ (1) ~ (-1) 16.84umol/L. The serum Hcy concentration could recognize CHD-SPAH in a certain degree, but it had a significant effect on the recognition of CHD-SPAH when the serum Hcy concentration was 16.84umol/L (P _ (0.05) P _ (0.05) P ~ (0.01). The sensitivity was 79.3, the specificity was 58.9 and the area under the ROC curve was 0.778g / P0.01g / 5) after interventional occlusion, the serum Hcy concentration and pulmonary artery pressure decreased in patients with PAH-CHD. There was still a positive correlation between Hcy concentration and PASP after interventional occlusion. Conclusion the serum Hcy level in patients with PAH-CHD was significantly higher than that in patients with PAH-CHD. 2. There was a positive correlation between the serum Hcy level of patients with PAH-CHD and the Hcy of PASP-MPAPP, and Hcy had a strong sensitivity in the diagnosis of CHD-SPAH. Therefore, the detection of serum Hcy concentration can be used as an auxiliary method to evaluate the severity of PAH-CHD patients. The concentration of PASP and serum Hcy decreased significantly after interventional closure, and there was still a linear relationship between them. Therefore, interventional occlusion is an effective method for the treatment of PAH-CHD. The detection of serum Hcy concentration is expected to be an important follow-up index for PAH-CHD patients.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.1;R544.1

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