本文選題：骨髓增殖性腫瘤 + 真性紅細(xì)胞增多癥��； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析骨髓增殖性腫瘤(Myeloproliferative neoplasms,MPN)患者心臟多功能彩色超聲心動(dòng)儀檢查參數(shù),探討MPN患者心臟結(jié)構(gòu)和功能改變及其特點(diǎn)。方法收集我院2011年9月至2016年9月診治的MPN患者臨床資料及心臟多功能彩色超聲心動(dòng)儀檢查參數(shù),與同期我院收治的非血液病對(duì)照組患者(性別、年齡、主要心血管高危因素與MPN患者匹配)進(jìn)行比較。對(duì)MPN出現(xiàn)的心臟結(jié)構(gòu)和功能改變與MPN臨床特征(血細(xì)胞計(jì)數(shù)、JAK2 V617F基因突變、病程)進(jìn)行相關(guān)分析。結(jié)果1.MPN組患者初診時(shí)白細(xì)胞、中性粒細(xì)胞、嗜堿性粒細(xì)胞、單核細(xì)胞、紅細(xì)胞(Red blood cell,RBC)、紅細(xì)胞壓積(Hematocrit,Hct)、血紅蛋白(Hemoglobin,Hb)、血小板計(jì)數(shù)明顯高于對(duì)照組(P0.05)。兩組之間性別、年齡、主要心血管危險(xiǎn)因素、甘油三酯(Triglyceride,TG)、膽固醇(Cholesterol,CHO)、高密度脂蛋白膽固醇(High density lipoprotein cholesterol,HDL)、低密度脂蛋白膽固醇(Low density lipoprotein cholesterol,LDL)、高敏C反應(yīng)蛋白(High-sensitivity c-reactive protein,hs-CRP)差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。2.MPN組患者左房內(nèi)徑(37.60±6.64mm)明顯高于對(duì)照組(35.01±4.37mm),兩組間差異有統(tǒng)計(jì)學(xué)意義(P=0.016)。MPN組患者左室舒張末期內(nèi)徑、左室收縮末期內(nèi)徑、右室內(nèi)徑、主動(dòng)脈根部內(nèi)徑、左室射血分?jǐn)?shù)、肺動(dòng)脈收縮壓均在正常值范圍;除左室射血分?jǐn)?shù)外,均高于對(duì)照組(P0.05)。3.MPN伴異常心臟結(jié)構(gòu)患者54.17%,明顯高于對(duì)照組患者(32.29%),兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。異常心臟結(jié)構(gòu)以左室肥厚(34.38%)、主動(dòng)脈瓣增厚(即主動(dòng)脈瓣退行性變,27.08%)、左心擴(kuò)大(12.50%)為主,發(fā)生率明顯高于對(duì)照組(分別為17.71%,11.45%,4.17%),均有統(tǒng)計(jì)學(xué)差異(P0.05)。伴2項(xiàng)、3項(xiàng)及以上異常心臟結(jié)構(gòu)發(fā)生率分別為17.71%、5.21%,明顯高于對(duì)照組(6.25%,0%),均有統(tǒng)計(jì)學(xué)差異(P0.05)。4.MPN伴異常心臟功能患者81.25%,明顯高于對(duì)照組患者(64.58%),兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。主要表現(xiàn)為左室舒張功能減退(75%)、肺動(dòng)脈高壓(pulmonary arterial hypertension,PAH)(11.45%)、左室收縮功能減退(12.50%),其中PAH、左室收縮功能減退發(fā)生率明顯高于對(duì)照組(分別為0%,2.08%),差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2項(xiàng)心臟功能異常發(fā)生率為16.67%,明顯高于對(duì)照組(2.08%),均有統(tǒng)計(jì)學(xué)差異(P0.05)。5.單因素相關(guān)分析:初診時(shí)RBC、Hct、Hb與左室舒張末期內(nèi)徑(分別為r=0.281,P=0.001;r=0.374,P=0.000;r=0.343,P=0.000)、左室收縮末期內(nèi)徑(分別為r=0.203,P=0.013;r=0.330,P=0.000;r=0.334,P=0.000)、右室內(nèi)徑(分別為r=0.268,P=0.001;r=0.291,P=0.001;r=0.312,P=0.000)成正相關(guān)。Logistic多因素回歸分析顯示初診時(shí)Hct及Hb升高預(yù)示主動(dòng)脈瓣退行性變風(fēng)險(xiǎn)增加(β=0.436,OR=1.229;β=0.186,OR=0.831)。6.病程5年以上MPN患者左房內(nèi)徑值(39.69±7.55mm)大于病程5年以內(nèi)MPN患者(36.43±5.82mm),差異有統(tǒng)計(jì)學(xué)意義(P0.05);同時(shí)伴PAH患者(20%)明顯多于病程5年以內(nèi)患者(6.56%),兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.MPN患者可出現(xiàn)心臟結(jié)構(gòu)及功能的異常,主要表現(xiàn)為左心房擴(kuò)大、左室肥厚、主動(dòng)脈瓣膜退行性變、左室收縮及舒張功能減退、PAH等。2.左室舒張末期內(nèi)徑、左室收縮末期內(nèi)徑、右室內(nèi)徑與初診時(shí)RBC、Hct、Hb水平有關(guān);初診時(shí)Hct、Hb增高是MPN患者發(fā)生主動(dòng)脈瓣退行性變風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素。3.MPN更易發(fā)生多種心臟結(jié)構(gòu)及功能異常;病程越長,左心房擴(kuò)大、PAH發(fā)生率越高。
[Abstract]:Objective to analyze the parameters of cardiac multi-function color echocardiography in patients with Myeloproliferative neoplasms (MPN) and to explore the changes and characteristics of cardiac structure and function in MPN patients. Methods the clinical data and cardiac multi-function color echocardiography of MPN patients in our hospital from September 2011 to September 2016 were collected. Compared with the non hematologic disease control group (sex, age, major cardiovascular risk factors matched with MPN patients) in our hospital during the same period, the changes in the cardiac structure and function of the MPN were correlated with the clinical features of MPN (blood cell count, JAK2 V617F gene mutation, and the course of disease). Results the leukocyte in the group 1.MPN patients was initially diagnosed. Granulocyte, basophil, monocyte, red blood cell (Red blood cell, RBC), red blood cell pressure (Hematocrit, Hct), hemoglobin (Hemoglobin, Hb), platelet count was significantly higher than that of the control group (P0.05). The sex, age, major cardiovascular risk factors, triglycerides (Triglyceride, TG), cholesterol (Cholesterol, RBC), high density between the two groups High density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (Low density lipoprotein cholesterol, LDL), and high sensitivity C reactive protein (35.01 + 4) were significantly higher than those of the control group (35.01 + 4). .37mm), the differences in the two groups were statistically significant (P=0.016) in group.MPN, left ventricular end diastolic diameter, left ventricular end systolic diameter, right ventricle diameter, aortic root diameter, left ventricular ejection fraction, pulmonary systolic pressure in normal range, except left ventricular ejection fraction, were higher than that of control group (P0.05).3.MPN with abnormal heart structure in 54.17%, Ming Significantly higher than the control group (32.29%), there was significant difference between the two groups (P0.05). Abnormal cardiac structure with left ventricular hypertrophy (34.38%), aortic valve thickening (that is, aortic valve degeneration, 27.08%) and left heart enlargement (12.50%) were significantly higher than those in the control group (17.71%, 11.45%, 4.17%). There were statistically significant differences (P0.05). 2, 3 The incidence of abnormal cardiac structure was 17.71% and 5.21%, which was significantly higher than that of the control group (6.25%, 0%). There were statistically significant differences (P0.05).4.MPN with abnormal cardiac function (81.25%), significantly higher than those in the control group (64.58%). The difference between the two groups was statistically significant (P0.05). The main manifestations were the left ventricular diastolic dysfunction (75%) and pulmonary hypertension ( Pulmonary arterial hypertension, PAH) (11.45%), left ventricular systolic function decreased (12.50%), and the incidence of PAH and left ventricular systolic dysfunction was significantly higher than that of the control group (0%, 2.08%). The difference was statistically significant (P0.05).2 term cardiac dysfunction was 16.67%, significantly higher than that of the control group (2.08%), with statistical difference (P0.05).5. Single factor correlation analysis: RBC, Hct, Hb and left ventricular end diastolic diameter at first visit (r=0.281, P=0.001; r=0.374, P=0.000; r=0.343, P=0.000), and the end systolic inner diameter of left ventricular (r=0.203, P=0.013; r=0.330). IC multivariate regression analysis showed that the increase of Hct and Hb at first diagnosis indicated the increase of the risk of aortic valve degeneration (beta =0.436, OR=1.229; beta =0.186, OR=0.831) and the left atrial diameter (39.69 + 7.55mm) of MPN patients more than 5 years in the course of MPN (36.43 + 5.82mm) within 5 years of the disease course, and the difference was statistically significant (20%). Compared with patients within 5 years (6.56%), there was significant difference between the two groups (P0.05). Conclusion 1.MPN patients could have abnormal cardiac structure and function, including left atrium enlargement, left ventricular hypertrophy, aortic valve degenerative change, left ventricular systolic and diastolic function reduction, PAH and.2. left ventricular end diastolic diameter, and left ventricular end systolic diameter, The internal diameter of the right ventricle is related to the level of RBC, Hct and Hb at the first diagnosis. The higher Hct and Hb at first diagnosis are the independent risk factors for the risk of degenerative aortic valve degeneration in MPN patients..3.MPN is more likely to occur in many kinds of cardiac structural and functional abnormalities; the longer the course, the enlarged left atrium, and the higher the incidence of PAH.

【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.3

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