直接膽紅素在先天性心臟病合并肺動脈高壓患者的臨床觀察
發(fā)布時間：2018-07-26 11:07
【摘要】：研究背景和目的肺動脈高壓是由一種或多種已知及未知病因引起的肺動脈壓力異常升高的病理生理狀態(tài)。作為一種嚴(yán)重威脅人類生命的疾病于1973年在日內(nèi)瓦被世界衛(wèi)生組織(WHO)第一次系統(tǒng)描述并命名。其病因中先天性心臟病是常見原因之一,先天性心臟病是心臟及大血管在胎兒時期受到遺傳及環(huán)境等多種因素導(dǎo)致的發(fā)育異常的疾病。先天性心臟病合并肺動脈高壓是指由體-肺分流型的先天性心臟病所引起的肺動脈壓力異常升高的病理狀態(tài),屬于毛細(xì)血管前型的肺高壓。先天性心臟病合并肺動脈高壓早期可行介入封堵和外科手術(shù)矯正治療,但很多患者發(fā)現(xiàn)時已經(jīng)喪失手術(shù)機會。未經(jīng)矯正治療的先天性心臟病合并肺動脈高壓至晚期可發(fā)展為艾森曼格綜合征,平均壽命(32.5±16.0)歲,死亡率極高[1]。晚期可以出現(xiàn)栓塞、出血、紅細(xì)胞增多癥、感染、心律失常、猝死、肝腎功能異常和骨骼疾病等并發(fā)癥�；颊叩闹饕酪蚴切脑葱遭�、心力衰竭和咯血[2],隨著人類對肺動脈高壓的進一步研究,一系列的診斷方法、治療方法被發(fā)現(xiàn),使先天性心臟病合并肺動脈高壓的患者的生存率與生活質(zhì)量都得到了不同水平的提高和改善,但仍未讓人們滿意。我國是先天性心臟病合并肺動脈高壓的高發(fā)國,此病每年給國家造成了巨大的經(jīng)濟負(fù)擔(dān)。因此,針對該疾病診斷及治療的研究具有廣闊的研究前景,并且愈來愈多的研究者們?yōu)橹铝τ趯ふ业叫碌�、有效的、方便的診斷與治療方法而努力。目前針對先天性心臟病合并肺動脈高壓的研究較多,但因其病變過程和機制復(fù)雜,仍有許多機制尚未完全明確。眾多機制中氧化應(yīng)激作為導(dǎo)致先天性心臟病合并肺動脈高壓的重要影響因素之一越來越受到重視[3-5]。通過研究氧化應(yīng)激的反應(yīng)過程發(fā)現(xiàn)其參與物和生成物對先天性心臟病合并肺動脈高壓的診斷與治療具有重要意義。在氧化應(yīng)激反應(yīng)過程中,膽紅素是其中一個重要指標(biāo)。經(jīng)研究發(fā)現(xiàn)膽紅素具有較強的的還原性,做為內(nèi)源性的抗氧化因子,能夠有效地清除氧自由基[6]。直接膽紅素做為膽紅素的一種,同樣具有抵抗氧化作用,因此我們設(shè)計出本試驗,探討直接膽紅素水平與先天性心臟病合并肺動脈高壓疾病程度的關(guān)系。希望進一步揭示先天性心臟病合并肺動脈高壓形成的的機制。實驗方法收集我院2014年1月至2017年1月明確診斷為先天性心臟病合并肺動脈高壓的患者46例,其中包括動脈導(dǎo)管未閉12例,室間隔缺損10例,房間隔缺損24例。所有入選患者行心電圖、超聲心動圖、血常規(guī)、血生化等檢查。根據(jù)患者病情嚴(yán)重程度行WHO分級,將患者分為I/II、III、IV組;根據(jù)肺動脈收縮壓分級將患者分為輕度、中度、重度3組;根據(jù)右心擴張程度(RV/LV)分級將患者分為未擴張、輕度、中度、重度4組。采用SPSS21.0數(shù)據(jù)分析系統(tǒng)對直接膽紅素平與上述分組和肺動脈收縮壓力值、RV/LV值進行非參數(shù)秩-和檢驗、卡方檢驗及相關(guān)性分析處理。分析DBIL在各分組之間的差異和相關(guān)指標(biāo)的相關(guān)性,結(jié)合患者疾病程度對患者病情進行評估。實驗結(jié)果1.在先天性心臟病合并肺動脈高壓的患者各分組中,年齡和性別與WHO分級、右心擴張程度分級、肺動脈高壓收縮壓分級無統(tǒng)計學(xué)差異。2.直接膽紅素與WHO分級、肺動脈收縮壓分級分組之間存在統(tǒng)計學(xué)差異。3.在WHO分級中Ⅰ/Ⅱ級與Ⅳ級比較χ2=17.473,P0.001;Ⅲ級與Ⅳ級比較χ2=10.386,P=0.001。在肺動脈收縮壓分級中輕度與重度比較χ2=8.685,P=0.003。隨著分級的升高直接膽紅素水平有升高趨勢,并且當(dāng)疾病程度較重時相關(guān)性越顯著。4.肺動脈收縮壓與直接膽紅素相關(guān)系數(shù)r=0.390,P=0.007,差異有統(tǒng)計學(xué)意義,呈正相關(guān)。RV與LV比值與直接膽紅素相關(guān)系數(shù)r=0.323,P=0.028,差異有統(tǒng)計學(xué)意義,呈正相關(guān)。實驗結(jié)論直接膽紅素水平與肺動脈收縮壓、心功能、右心擴張程度水平有關(guān),初步研究結(jié)果認(rèn)為直接膽紅素可以用來評估先天性心臟病合并肺動脈高壓患者疾病嚴(yán)重程度,對臨床醫(yī)生選擇相對應(yīng)對臨床治療方案具有一定的臨床指導(dǎo)意義。
[Abstract]:Background and objective pulmonary hypertension is the pathophysiological state of abnormal elevated pulmonary arterial pressure caused by one or more known and unknown causes. As a serious threat to human life, the first system of the WHO (WHO) was described and named in Geneva in 1973. Congenital heart disease is common in the cause of the disease. One of the reasons is that congenital heart disease is a developmental disorder caused by a variety of factors such as heredity and environment in the fetal period. Congenital heart disease combined with pulmonary hypertension refers to the pathological state of abnormal increase of pulmonary arterial pressure caused by the congenital heart disease of the body and lung shunt, which belongs to the pre capillary type. Pulmonary hypertension. Congenital heart disease combined with pulmonary hypertension, early intervention closure and surgical correction, but many patients have been found to have lost the operation opportunity. Uncorrected congenital heart disease combined with pulmonary hypertension can develop into Eisen Mange's syndrome, the average life span is (32.5 + 16) years, and the death rate is very high [1]. late may appear embolism, hemorrhage, erythrocytosis, infection, arrhythmia, sudden death, abnormal liver and kidney function and bone disease. The main cause of death is cardiac sudden death, heart failure and hemoptysis [2]. With the further study of human pulmonary hypertension, a series of diagnostic methods, treatment methods are found, innate The survival rate and quality of life of the patients with sexual heart disease and pulmonary hypertension have been improved and improved, but they are still not satisfied. There are broad prospects for research, and more and more researchers are trying to find new, effective and convenient methods for diagnosis and treatment. At present, there are many studies on congenital heart disease with pulmonary hypertension, but many mechanisms are still not completely clear because of the complicated process and mechanism. Stress is one of the most important factors leading to congenital heart disease combined with pulmonary hypertension. [3-5]. has been paid more and more attention to the reaction process of oxidative stress. It is important for the diagnosis and treatment of congenital heart disease with pulmonary hypertension. In the process of oxidative stress, bilirubin It is one of the important indicators. It has been found that bilirubin has strong reducibility and is an endogenous antioxidant factor. It can effectively remove the oxygen free radical [6]. direct bilirubin as a kind of bilirubin and also resist oxidation. Therefore, we designed this experiment to explore direct bilirubin level and congenital heart. The relationship between disease and the degree of pulmonary hypertension. We hope to further reveal the mechanism of congenital heart disease combined with pulmonary hypertension. 46 cases of congenital heart disease combined with pulmonary hypertension were diagnosed in our hospital from January 2014 to January 2017, including 12 cases of patent ductus arteriosus and 10 cases of ventricular septal defect. 24 cases of atrial septal defect. All selected patients were examined by electrocardiogram, echocardiography, blood routine, and blood biochemistry. According to the severity of the patient's WHO, the patients were divided into I/II, III, and IV groups; the patients were divided into mild, moderate, and heavy groups according to the systolic pressure of pulmonary artery, and the patients were divided into non expansion according to the right heart dilatation degree (RV/LV) classification. 4 groups, mild, moderate, and severe. The SPSS21.0 data analysis system was used to perform non parametric rank sum test, chi square test and correlation analysis on the value of direct bilirubin leveling with the above group and the systolic pressure of pulmonary artery, RV/LV value, chi square test and correlation analysis. The correlation of the differences between the groups and the related indexes of the DBIL was analyzed, and the patient's disease degree was combined with the patient's disease degree. Results 1. in the group of patients with congenital heart disease and pulmonary hypertension, age and sex with WHO classification, right heart dilatation grade, pulmonary hypertension systolic pressure classification,.2. direct bilirubin and WHO classification, pulmonary systolic pressure classification groups between the statistical difference.3. in WHO score Grade I / II was compared with grade IV (2=17.473, P0.001), and grade III was compared with grade IV 2=10.386, and P=0.001. was compared to severe and severe in pulmonary systolic pressure by X 2=8.685. P=0.003. increased the level of direct bilirubin with the increase of classification, and the more significant the correlation was when the degree of disease was heavier, the more significant the correlation of.4. pulmonary systolic pressure and direct bile duct pressure. Erythropoietin correlation coefficient r=0.390, P=0.007, the difference has statistical significance, positive correlation.RV and LV ratio and direct bilirubin correlation coefficient r=0.323, P=0.028, the difference has statistical significance, positive correlation. Experimental conclusion direct bilirubin level is related to pulmonary systolic pressure, cardiac function, right heart dilatation level, preliminary results think direct gallbladder Erythropoietin can be used to assess the severity of the disease in patients with congenital heart disease combined with pulmonary hypertension. It is of certain clinical significance for clinicians to choose relative clinical treatment options.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.1;R544.1
[Abstract]:Background and objective pulmonary hypertension is the pathophysiological state of abnormal elevated pulmonary arterial pressure caused by one or more known and unknown causes. As a serious threat to human life, the first system of the WHO (WHO) was described and named in Geneva in 1973. Congenital heart disease is common in the cause of the disease. One of the reasons is that congenital heart disease is a developmental disorder caused by a variety of factors such as heredity and environment in the fetal period. Congenital heart disease combined with pulmonary hypertension refers to the pathological state of abnormal increase of pulmonary arterial pressure caused by the congenital heart disease of the body and lung shunt, which belongs to the pre capillary type. Pulmonary hypertension. Congenital heart disease combined with pulmonary hypertension, early intervention closure and surgical correction, but many patients have been found to have lost the operation opportunity. Uncorrected congenital heart disease combined with pulmonary hypertension can develop into Eisen Mange's syndrome, the average life span is (32.5 + 16) years, and the death rate is very high [1]. late may appear embolism, hemorrhage, erythrocytosis, infection, arrhythmia, sudden death, abnormal liver and kidney function and bone disease. The main cause of death is cardiac sudden death, heart failure and hemoptysis [2]. With the further study of human pulmonary hypertension, a series of diagnostic methods, treatment methods are found, innate The survival rate and quality of life of the patients with sexual heart disease and pulmonary hypertension have been improved and improved, but they are still not satisfied. There are broad prospects for research, and more and more researchers are trying to find new, effective and convenient methods for diagnosis and treatment. At present, there are many studies on congenital heart disease with pulmonary hypertension, but many mechanisms are still not completely clear because of the complicated process and mechanism. Stress is one of the most important factors leading to congenital heart disease combined with pulmonary hypertension. [3-5]. has been paid more and more attention to the reaction process of oxidative stress. It is important for the diagnosis and treatment of congenital heart disease with pulmonary hypertension. In the process of oxidative stress, bilirubin It is one of the important indicators. It has been found that bilirubin has strong reducibility and is an endogenous antioxidant factor. It can effectively remove the oxygen free radical [6]. direct bilirubin as a kind of bilirubin and also resist oxidation. Therefore, we designed this experiment to explore direct bilirubin level and congenital heart. The relationship between disease and the degree of pulmonary hypertension. We hope to further reveal the mechanism of congenital heart disease combined with pulmonary hypertension. 46 cases of congenital heart disease combined with pulmonary hypertension were diagnosed in our hospital from January 2014 to January 2017, including 12 cases of patent ductus arteriosus and 10 cases of ventricular septal defect. 24 cases of atrial septal defect. All selected patients were examined by electrocardiogram, echocardiography, blood routine, and blood biochemistry. According to the severity of the patient's WHO, the patients were divided into I/II, III, and IV groups; the patients were divided into mild, moderate, and heavy groups according to the systolic pressure of pulmonary artery, and the patients were divided into non expansion according to the right heart dilatation degree (RV/LV) classification. 4 groups, mild, moderate, and severe. The SPSS21.0 data analysis system was used to perform non parametric rank sum test, chi square test and correlation analysis on the value of direct bilirubin leveling with the above group and the systolic pressure of pulmonary artery, RV/LV value, chi square test and correlation analysis. The correlation of the differences between the groups and the related indexes of the DBIL was analyzed, and the patient's disease degree was combined with the patient's disease degree. Results 1. in the group of patients with congenital heart disease and pulmonary hypertension, age and sex with WHO classification, right heart dilatation grade, pulmonary hypertension systolic pressure classification,.2. direct bilirubin and WHO classification, pulmonary systolic pressure classification groups between the statistical difference.3. in WHO score Grade I / II was compared with grade IV (2=17.473, P0.001), and grade III was compared with grade IV 2=10.386, and P=0.001. was compared to severe and severe in pulmonary systolic pressure by X 2=8.685. P=0.003. increased the level of direct bilirubin with the increase of classification, and the more significant the correlation was when the degree of disease was heavier, the more significant the correlation of.4. pulmonary systolic pressure and direct bile duct pressure. Erythropoietin correlation coefficient r=0.390, P=0.007, the difference has statistical significance, positive correlation.RV and LV ratio and direct bilirubin correlation coefficient r=0.323, P=0.028, the difference has statistical significance, positive correlation. Experimental conclusion direct bilirubin level is related to pulmonary systolic pressure, cardiac function, right heart dilatation level, preliminary results think direct gallbladder Erythropoietin can be used to assess the severity of the disease in patients with congenital heart disease combined with pulmonary hypertension. It is of certain clinical significance for clinicians to choose relative clinical treatment options.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.1;R544.1
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