本文關鍵詞： 治未病 房性早搏 心房顫動 血清標志物　出處：《廣州中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：心房顫動是臨床上最常見的心律失常,部分患者有嚴重的臨床癥狀,而且發(fā)生缺血性卒中、心肌梗死、心力衰竭等并發(fā)癥風險較高,因此盡早防治房顫有重要意義。房顫主要的病理表現(xiàn)是心房重構,而房性早搏可能是心房重構的早期表現(xiàn)。本研究通過系統(tǒng)評價,以評估現(xiàn)有臨床研究中房性早搏預測心房顫動的效應；并通過回顧性研究,以探討房性早搏和心房顫動血清標志物的相關性；以中醫(yī)“治未病”理念綜合探討房顫早期的“未病”狀態(tài),提供房性早搏是心房重構早期表現(xiàn)的依據(jù),為進一步預防房顫“已病”狀態(tài)的發(fā)生帶來啟發(fā)。方法：通過全面的文獻復習,詳細了解心房顫動與房性早搏、心房顫動與血清標志物的關系以及中醫(yī)“治未病”的概念；再通過對房性早搏預測心房顫動的臨床觀察性隊列研究進行系統(tǒng)評價和meta分析,系統(tǒng)地提取各項研究的基本特征,使用Newcastle-Ottawa Scale評價研究質量,應用stata軟件對相關研究報道的危險比(HR)進行統(tǒng)計合成,同時應用敏感性分析、meta回歸和亞組分析尋找異質性來源；通過病例回顧,對完善病史、輔助檢查的患者進行統(tǒng)計分析,用房早數(shù)量分布的中位數(shù)定義頻發(fā)與非頻發(fā)房早患者,注重比較兩組患者之間心房內徑、CRP、尿酸等指標的差異,基于“治未病”理念對房性早搏與房顫前狀態(tài)的關系進行討論。結果：1.目前的研究認為心房顫動需要早期干預,其中房性早搏是新興的危險因素之一,同時,心房顫動的發(fā)生與血清標志物如CRP和尿酸等密切相關,基于中醫(yī)“治未病”理念對房性早搏、心房顫動、血清標志物進行探討,具有重要意義；.2.對房性早搏預測房顫的研究進行系統(tǒng)評價和meta分析,最終納入11個研究進行系統(tǒng)評價和質量評估,其中選擇6項研究進行meta分析,共涉及9519例對象和782例房顫患者。總體上頻發(fā)房早與房顫發(fā)生風險增高相關(HR=3.13[95%CI 1.92-5.11], P=0.007)。納入meta分析研究的異質性較大(T2=68.8%)。研究人群類型差異、不同的隨訪時程和頻發(fā)房早定義不同是造成異質性的因素；3.病例回顧研究發(fā)現(xiàn),在納入的122例研究病例中,房性早搏數(shù)量中位數(shù)為24/24h,以此相對界定“頻發(fā)”與“非頻發(fā)”房早,對比兩組(“頻發(fā)”房早組vs“非頻發(fā)”房早組)患者血清CRP水平(7.1±14.8 vs 2.7±5.2 mg/L,P=0.013)、血清尿酸水平(410.0±115.8 vs 363.5±96.3μmol/L, P=0.018).左房內徑(35.0±5.7 vs 32.0±4.8mm,P=0.002)、右房上下徑(47.8±6.7vs 45.3±5.2mm,P=0.011)、右房左右徑(36.8±5.1 vs 34.2±3.9mm,P=0.002),提示頻發(fā)房早患者可能存在心房重構的病理解剖改變；而兩組在年齡、性別、基礎病史和服藥史方面則無統(tǒng)計學差異。此外,“頻發(fā)”房早組證候要素包含氣虛、陰虛和血瘀的比例較“非頻發(fā)”房早組多(P0.05),具有統(tǒng)計學差異。結論：房性早搏與心房顫動具有明確相關性,其也與房顫血清標志物相關。基于中醫(yī)“治未病”理念,房顫為己病,而房早則是相對的未病狀態(tài),伴有房顫血清標志物升高的房早可能是心房重構的早期表現(xiàn)。及早關注房早,與血清標志物相結合,早期進行預防,以中醫(yī)“治未病”和中醫(yī)理論作指導,開發(fā)更多改善心房重構的藥物,對防止或延緩房顫的發(fā)生有重要意義。
[Abstract]:Objective: atrial fibrillation is the most common clinical arrhythmia, some patients had serious clinical symptoms, and the incidence of stroke, myocardial infarction, heart failure and other complications in high risk, so early prevention and treatment of atrial fibrillation has important significance. The main pathological manifestation is atrial fibrillation and atrial premature atrial remodeling, may be an early manifestation of atrial remodeling this study. Through the system evaluation, to evaluate the predictive effect of atrial fibrillation on the existing clinical arrhythmias; and through retrospective study, to investigate the premature atrial and atrial serum markers associated with fibrillation; Chinese "disease" concept for the study of atrial fibrillation early "disease". For atrial premature atrial remodeling is the early performance of the basis, provide inspiration for further prevention of atrial fibrillation has disease state. Methods: through a comprehensive literature review, a detailed understanding of the atrium Fibrillation and atrial premature beat, and the relationship between the concept of "preventive treatment of disease" signs and serum atrial fibrillation; then through the systematic review and meta analysis on prediction of atrial premature atrial fibrillation clinical observational cohort, systematically study the basic feature extraction, using the quality evaluation on Newcastle-Ottawa Scale, Using Stata software the relevant research reports of the hazard ratio (HR) for statistical synthesis, at the same time the application of sensitivity analysis, meta regression and subgroup analysis for sources of heterogeneity; through case review, to improve the statistical analysis of history, auxiliary examination of patients, the median real number distribution is defined by early frequent and non frequent atrial premature patients, pay attention to the comparison between the two groups of patients with atrial diameter, CRP, uric acid difference index, based on the concept of "prevention of disease" of premature atrial and atrial fibrillation state before the relationship with results discussed. 1.: the present study considers the need for early intervention including atrial fibrillation, atrial premature beat is one of the emerging risk factors at the same time, the occurrence of atrial fibrillation by CRP and uric acid were closely related with serum markers, TCM "disease" concept of atrial premature atrial fibrillation, based on serum markers, are discussed, with the significance of.2. on atrial premature beat; prediction of atrial fibrillation of system evaluation and meta analysis, a total of 11 studies of system evaluation and quality evaluation, the selection of the 6 study meta analysis, involving a total of 9519 cases and 782 cases of patients with atrial fibrillation. The frequent atrial premature and increased risk of atrial fibrillation related (HR=3.13[95%CI 1.92-5.11], P=0.007). In meta analysis of heterogeneity (T2=68.8%). The study population type differences, different follow-up duration and frequent atrial premature definition are caused by the different factors of heterogeneous; 3.鐥呬緥鍥為【鐮旂┒鍙戠幇,鍦ㄧ撼鍏ョ殑122渚嬬爺絀剁梾渚嬩腑,鎴挎，

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