本文選題：室間隔缺損 + 心力衰竭　； 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:室間隔缺損(Ventricular Septal Defect,VSD)是小兒最常見的先天性心臟病,終末期易導致充血性心力衰竭(Congestive heart failure,CHF),若不及時診治,病死、病殘率極高。本研究通過對VSD合并心衰患兒血漿腦利鈉肽(Brain Natriuretic Peptide,BNP)及其氨基末端B型利鈉肽前體(N-ter-minal pro-B-type natriuretic peptide,NT-pro BNP)水平與超聲影像資料、臨床評估標準的關(guān)系進行分析,旨在探討血漿BNP及NT-pro BNP在評價VSD患兒心功能中的價值,以探索建立小兒VSD合并CHF的生物學診斷指標。方法:選取2015.03-2016.12我院門診就診及住院治療的室間隔缺損患兒80例作為實驗組,所有患兒均排除中樞神經(jīng)、內(nèi)分泌及免疫系統(tǒng)疾病,且肝腎功能均無異常。同時選取15例于我院門診體檢的健康兒童作為正常對照組。分別測定各組患兒左室舒張末期容量指數(shù)(LVEDVI)、左室收縮末期室壁應力(LVESWS)、左室縮短分數(shù)(LVFS)、左室射血分數(shù)(LVEF),根據(jù)超聲心動圖結(jié)果將實驗組患兒分為心衰組48例及無心衰組32例;應用ELISA方法測定各組患兒血漿BNP及NT-pro BNP濃度。并選取小兒常用心衰診斷標準(如改良Ross標準、NYU PHFI標準)對80例VSD患兒進行評分分級。結(jié)果:1.心衰組患兒的LVEDVI、LVESWS水平高于無心衰組和對照組患兒(P0.05);LVEF、LVFS水平低于無心衰組和對照組患兒(P0.05);心衰組患兒BNP及NT-pro BNP水平明顯高于無心衰組(均P0.05),無心衰組與正常對照組間差別無統(tǒng)計學意義(均P0.05)。2.VSD患兒血漿BNP水平與NT-pro BNP呈正相關(guān)(r=0.933,P0.05)。3.VSD患兒血漿BNP水平與LVESWS(r=0.883,P0.05)、LVEDVI(r=0.868,P0.05)呈正相關(guān),與LVEF(r=-0.751,P0.05)、LVFS(r=-0.527,P0.05)呈負相關(guān);血漿NT-pro BNP水平與LVESWS(r=0.889,P0.05)、LVEDVI(r=0.856,P0.05)呈正相關(guān),與LVEF(r=-0.676,P0.05)、LVFS(r=-0.494,P0.05)呈負相關(guān)。4.血漿BNP診斷室缺合并心衰的ROC曲線下面積為0.876,且BNP≥337pg/ml診斷的敏感度為72.9%,特異度為93.7%,95%可信區(qū)間為0.802-0.951。血漿NTpro BNP診斷室缺合并心衰的ROC曲線下面積為0.924,NT-pro BNP≥493fmol/ml診斷的敏感度為77.1%,特異度為100.0%,95%可信區(qū)間為0.861-0.988。5.改良Ross評分標準診斷室缺合并心衰的ROC曲線下面積為0.862,且當評分≥5分時,診斷的靈敏度為75%,特異度為96.9%,準確率為75%,漏診率為10%,誤診率為15%,95%可信區(qū)間為0.779-0.945。NYU PHFI評分標準診斷室缺合并心衰的ROC曲線下面積達0.870,當評分≥7分時,靈敏度為87.5%,特異度為68.7%,準確率為80%,漏診率為7.5%,誤診率為12.5%,95%可信區(qū)間為0.795-0.946。結(jié)論:1.BNP及NT-pro BNP水平可作為VSD合并心衰患兒心功能評估的簡便、敏感、有效的生物學指標。2.NT-pro BNP診斷室缺合并心衰的價值優(yōu)于BNP。
[Abstract]:Objective: ventricular septal defect (VSD) is the most common congenital heart disease in children. It is easy to cause congestive heart failure (CHF) at the end stage. In this study, the relationship between plasma brain natriuretic peptide (Brain natriuretic peptide BNP) and N-minal pro-B-type natriuretic peptide (NT-pro BNP) and ultrasound imaging data and clinical evaluation criteria in children with heart failure were analyzed. Objective to explore the value of plasma BNP and NT-pro BNP in evaluating heart function in children with VSD, and to establish the biological diagnostic index of VSD with CHF in children. Methods: 80 children with ventricular septal defect (VSD) treated in our hospital from May to June, 2015.03-2016.12 were selected as experimental group. All the children were excluded from central nervous system, endocrine and immune system diseases, and no abnormal liver and kidney function was found. At the same time, 15 healthy children were selected as normal control group. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic wall stress (LVESWS), left ventricular shortening fraction (LVFS) and left ventricular ejection fraction (LVEF) were measured. Plasma BNP and NT-pro BNP were measured by Elisa. The common diagnostic criteria of heart failure in children (such as modified Ross standard and NYU PHFI standard) were selected to grade 80 children with VSD. The result is 1: 1. The level of LVEDVI LVESWS in heart failure group was higher than that in no heart failure group and control group (P0.05), the level of BNP and NT-pro BNP in heart failure group was significantly higher than that in heart failure group (P0.05), and the level of BNP and NT-pro BNP in heart failure group was significantly higher than that in no heart failure group and normal control group (P0.05), and the levels of BNP and NT-pro BNP in heart failure group were significantly higher than those in no heart failure group and control group (P0.05). There was no significant difference between plasma BNP levels and NT-pro BNP levels in VSD children (P 0.05). 3. There was a positive correlation between BNP levels in VSD children and LVESWS (r 0.883P 0.05) and LVEDVI (r = 0.868 P 0.05). There was a negative correlation between plasma NT-pro BNP level and LVESWS (rn 0.889U P 0.05) and LVEDVI (r = 0.856P 0.05), and a negative correlation between NT-pro BNP level and LVEF (r + 0.676P 0.05) and LVFS (r + -0.494P 0.05), and a negative correlation between plasma NT-pro BNP level and LVESWS (r + 0.889U P 0.05), and a negative correlation between NT-pro BNP level and LVEF (r + 0.676P 0.05) and LVFS (r + -0.494P 0.05). The area under the ROC curve was 0.876, the sensitivity of BNP 鈮，

本文編號：2103732