發(fā)布時間：2018-05-04 20:17

  本文選題：骨髓增殖性腫瘤 + 真性紅細胞增多癥��； 參考：《首都醫(yī)科大學》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儀檢查參數(shù),探討MPN患者心臟結構和功能改變及其特點。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儀檢查參數(shù),與同期我院收治的非血液病對照組患者(性別、年齡、主要心血管高危因素與MPN患者匹配)進行比較。對MPN出現(xiàn)的心臟結構和功能改變與MPN臨床特征(血細胞計數(shù)、JAK2 V617F基因突變、病程)進行相關分析。結果1.MPN組患者初診時白細胞、中性粒細胞、嗜堿性粒細胞、單核細胞、紅細胞(Red blood cell,RBC)、紅細胞壓積(Hematocrit,Hct)、血紅蛋白(Hemoglobin,Hb)、血小板計數(shù)明顯高于對照組(P0.05)。兩組之間性別、年齡、主要心血管危險因素、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反應蛋白(High-sensitivity c-reactive protein,hs-CRP)差異均無統(tǒng)計學意義(P0.05)。2.MPN組患者左房內徑(37.60±6.64mm)明顯高于對照組(35.01±4.37mm),兩組間差異有統(tǒng)計學意義(P=0.016)。MPN組患者左室舒張末期內徑、左室收縮末期內徑、右室內徑、主動脈根部內徑、左室射血分數(shù)、肺動脈收縮壓均在正常值范圍;除左室射血分數(shù)外,均高于對照組(P0.05)。3.MPN伴異常心臟結構患者54.17%,明顯高于對照組患者(32.29%),兩組間差異有統(tǒng)計學意義(P0.05)。異常心臟結構以左室肥厚(34.38%)、主動脈瓣增厚(即主動脈瓣退行性變,27.08%)、左心擴大(12.50%)為主,發(fā)生率明顯高于對照組(分別為17.71%,11.45%,4.17%),均有統(tǒng)計學差異(P0.05)。伴2項、3項及以上異常心臟結構發(fā)生率分別為17.71%、5.21%,明顯高于對照組(6.25%,0%),均有統(tǒng)計學差異(P0.05)。4.MPN伴異常心臟功能患者81.25%,明顯高于對照組患者(64.58%),兩組間差異有統(tǒng)計學意義(P0.05)。主要表現(xiàn)為左室舒張功能減退(75%)、肺動脈高壓(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)生率明顯高于對照組(分別為0%,2.08%),差異均有統(tǒng)計學意義(P0.05)。2項心臟功能異常發(fā)生率為16.67%,明顯高于對照組(2.08%),均有統(tǒng)計學差異(P0.05)。5.單因素相關分析:初診時RBC、Hct、Hb與左室舒張末期內徑(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。Logistic多因素回歸分析顯示初診時Hct及Hb升高預示主動脈瓣退行性變風險增加(β=0.436,OR=1.229;β=0.186,OR=0.831)。6.病程5年以上MPN患者左房內徑值(39.69±7.55mm)大于病程5年以內MPN患者(36.43±5.82mm),差異有統(tǒng)計學意義(P0.05);同時伴PAH患者(20%)明顯多于病程5年以內患者(6.56%),兩組間差異有統(tǒng)計學意義(P0.05)。結論1.MPN患者可出現(xiàn)心臟結構及功能的異常,主要表現(xiàn)為左心房擴大、左室肥厚、主動脈瓣膜退行性變、左室收縮及舒張功能減退、PAH等。2.左室舒張末期內徑、左室收縮末期內徑、右室內徑與初診時RBC、Hct、Hb水平有關;初診時Hct、Hb增高是MPN患者發(fā)生主動脈瓣退行性變風險的獨立危險因素。3.MPN更易發(fā)生多種心臟結構及功能異常;病程越長,左心房擴大、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.

【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R733.3

【相似文獻】

相關期刊論文 前10條

1 張玲玉;葉鵬;;兒童早期的生長、肥胖與心臟結構的相關性[J];中華高血壓雜志;2011年10期

2 ;體育鍛煉可改變心臟結構[J];中華中醫(yī)藥學刊;2009年10期

3 姚國英 ,金意華 ,朱志穎 ,方林均 ,徐大地 ,陸穎靜;矮身材兒童心臟結構和功能的變化[J];臨床兒科雜志;2002年07期

4 佟欣;李磊;姜克新;鄭強;臧彬;;肥胖者減肥前后血壓及心臟結構和功能的變化[J];江蘇醫(yī)藥;2008年09期

5 李春敏;石珊;祝希敏;;阻塞性睡眠呼吸暫停低通氣綜合征患者心臟結構及其舒張功能的研究[J];醫(yī)學影像學雜志;2009年10期

6 張映安;郭麗霞;成要平;;妊娠期高血壓疾病患者心臟結構和功能的改變[J];中西醫(yī)結合心腦血管病雜志;2011年07期

7 王藝萍;宋玉環(huán);覃蓮香;肖躍飛;張凌;姚力;;難治性繼發(fā)性甲狀旁腺功能亢進癥患者心臟結構與功能特點及相關因素分析[J];中國血液凈化;2013年10期

8 鄔云紅;王旭萍;;返回平原3年以上的高原移居漢族心臟結構及功能的改變[J];高原醫(yī)學雜志;2013年02期

9 ;鍛煉能改變心臟結構[J];生活與健康;2009年04期

10 梁錦前;沈建雄;邱貴興;王以朋;仉建國;趙宏;劉正;;青少年特發(fā)性脊柱側凸患者心臟結構和功能的研究[J];中國骨與關節(jié)外科;2008年03期

相關會議論文 前7條

1 林玲;陳邁;;老年高血壓病患者肺動脈壓和心臟結構功能改變的關系[A];第九屆全國超聲心動圖學術會議論文集[C];2007年

2 康志敏;王莉;周樹錄;何強;王芳;;慢性腎功衰患者的心臟結構及心功能改變與血壓的關系[A];“中華醫(yī)學會腎臟病學分會2004年年會”暨“第二屆全國中青年腎臟病學術會議”論文匯編[C];2004年

3 周薇薇;侍曉梅;孫旗;佟銘;;22例慢性腎功不全患者腎移植前后的心臟結構和心功能改變的對比觀察[A];第二屆全國心功能學術研討會論文摘要匯編[C];1990年

4 韓麗麗;李明嫻;劉攀;楊松青;;OSAHS對心臟結構和功能的影響[A];全國睡眠呼吸障礙學術會議論文集[C];2007年

5 蔡虎志;陳青揚;陳新宇;;阿霉素對兔心臟結構及血清氨基末端腦鈉尿肽前體的影響[A];全國第十三屆心臟學會、第十六屆心功能專業(yè)委員會和《心臟雜志》編委會聯(lián)合學術大會會議紀要[C];2013年

6 鄧勁松;王潔;張春麗;鄧素雅;曾廣綏;石揮揚;陳慶康;廖濤;;解剖M型超聲心動圖對心力衰竭患者心臟結構與功能的影像學評價分析[A];中華醫(yī)學會第十三次全國超聲醫(yī)學學術會議論文匯編[C];2013年

7 陳勇平;肖一星;;尿毒癥心臟結構與功能的改變及治療對策[A];“中華醫(yī)學會腎臟病學分會2004年年會”暨“第二屆全國中青年腎臟病學術會議”論文匯編[C];2004年

相關重要報紙文章 前1條

1 張潔　通訊員　杜巍巍;心臟結構“錯上加錯”歪打正著[N];湖北日報;2007年

相關博士學位論文 前1條

1 劉建麗;先天性甲狀腺功能減低癥對心臟發(fā)育的影響[D];天津醫(yī)科大學;2017年

相關碩士學位論文 前10條

1 王春鍵;骨髓增殖性腫瘤患者心臟結構與功能改變及其臨床意義[D];首都醫(yī)科大學;2017年

2 田莉;慢性腎臟病患者血清胎盤生長因子水平及其與心臟結構和功能的關系[D];河北醫(yī)科大學;2015年

3 袁芳;老年單純收縮期高血壓患者同型半胱氨酸、尿酸水平與心臟結構的相關性研究[D];河北北方學院;2015年

4 石山慧;促紅細胞生成素對心肌梗死后小鼠心臟結構和功能的影響[D];山西醫(yī)科大學;2016年

5 唐曉霞;高分辨力超聲評價小鼠心臟結構和功能的價值[D];南京醫(yī)科大學;2006年

6 申力軍;老年血透患者生存相關因素及糾正貧血對心臟結構功能的影響[D];中國人民解放軍軍醫(yī)進修學院;2005年

7 顏春龍;高海拔地區(qū)肺心病患者CMRI心臟結構及功能的評價研究[D];青海大學;2015年

8 范克新;維持性血液透析的尿毒癥患者心臟結構及功能改變相關因素分析[D];吉林大學;2014年

9 賈宇恒;3T磁共振對高海拔地區(qū)藏漢民族正常成人心臟結構及功能的研究[D];青海大學;2015年

10 劉金彥;維持性血液透析高血壓患者心臟結構和功能變化及相關因素分析[D];山東大學;2007年

，

本文編號：1844488