对特发性扩张型心肌病患者心血管事件的预测指标的探索

发布时间：2018-01-13 15:21

本文关键词：对特发性扩张型心肌病患者心血管事件的预测指标的探索　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探索能预测特发性扩张型心肌病患者心血管事件风险的指标,同时探索心肌重构指标、心功能及射血分数之间的相关关系,了解本院对特发性扩张型心肌病患者的诊疗情况。方法:1、收集入选的59例特发性扩张型心肌病患者(39名男性,20名女性,平均年龄59.66±14.77岁)的临床资料,如心功能NYHA分级、左室射血分数、左室舒张末期直径、治疗情况等,计算T值(T=左室舒张末期直径/体表面积),并对其存在的心血管事件进行Q评分。通过分析心功能分级、左室射血分数、左室舒张末期直径和T值这四个指标之间的相关关系,推导出它们可能存在的联系。通过分析Q评分与上述各指标的相关关系,推导出能预测心血管事件风险的指标。2、分别根据心功能、左室射血分数、左室舒张末期直径、T值的差别将入选患者进行人为分组,比较各个预测指标下不同组别间各类心血管事件的风险是否存在差异。结果:1、入选患者的T值与LVEDD呈正相关关系(p0.05);这两个指标以及心功能分别与LVEF呈负相关关系(p0.05),T值与LVEF的相关系数高于LVEDD或心功能与LVEF的相关系数。2、Q评分及室性心律失常Q评分分别与T值、心功能(NYHA分级)呈正相关关系(p0.05),与LVEF呈负相关关系(p0.05),与LVEDD不呈相关关系(p0.05)。各个指标与Q评分的相关系数从大到小排列分别为LVEF、心功能(NYHA分级)、T值;各个指标与室性心律失常Q评分的系数从大到小排列分别为心功能(NYHA分级)、LVEF、T值。在一定范围内Q评分及室性心律失常Q评分较高者LVEDD通常较大(p0.05)。3、比较各个指标(心功能(NYHA分级)、LVEF、T值、LVEDD)不同分组间各类心血管事件的发生频率,可以看到不同心功能组别间发生浆膜腔积液的概率、不同LVEF组别间发生瓣膜病变及左束支传导阻滞的概率、不同T值组别间发生血压90/60mmHg及瓣膜病变的概率、不同LVEDD组别间发生室上性心律失常的概率均存在差异(p0.05)。结论:1.LVEF越低,T值或LVEDD越大、心功能越差;T值或LVEDD和心功能之间无必然联系。2.T值可以作为左心室重构指标,在一定程度上能代替甚至优于LVEDD。3.T值、心功能(NYHA分级)、LVEF与IDCM患者心血管事件的风险相关,即左心室重构越严重、心功能NYHA分级越高、左室收缩功能越差,心血管事件风险越高。LVEDD在一足范围内也能预测心血管事件的风险。4.不同指标能预测不同类别心血管事件的风险。
[Abstract]:Objective: to explore the predictors of cardiovascular event risk in idiopathic dilated cardiomyopathy (IDMC), and to explore the correlation among myocardial remodeling index, cardiac function and ejection fraction in patients with idiopathic dilated cardiomyopathy. Methods to investigate the diagnosis and treatment of idiopathic dilated cardiomyopathy in our hospital. Methods 59 patients with idiopathic dilated cardiomyopathy were selected. The mean age was 59.66 卤14.77 years old), such as NYHA classification of cardiac function, left ventricular ejection fraction, left ventricular end-diastolic diameter, treatment, etc. T = left ventricular end-diastolic diameter / body surface area was calculated, and its cardiovascular events were evaluated by Q score. The left ventricular ejection fraction (LVEF) was analyzed by analyzing the cardiac function grade and the left ventricular ejection fraction (LVEF). The correlation between left ventricular end-diastolic diameter and T value and their possible relationship were deduced. The correlation between Q score and the above indexes was analyzed. According to cardiac function, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED) T value, the patients will be selected for artificial grouping according to their cardiac function, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED). The risk of various cardiovascular events among different groups was compared under different predictors. Results the T value of the selected patients had a positive correlation with LVEDD (p 0.05). There was a negative correlation between these two indexes and LVEF, respectively. The correlation coefficient between the two indexes and LVEF was higher than that of LVEDD or the correlation coefficient between cardiac function and LVEF. 2. Q score and Q score of ventricular arrhythmia were positively correlated with T and cardiac function (P 0.05), and negatively correlated with LVEF (p 0.05). There was no correlation between LVEF and LVEDD. The correlation coefficient between each index and Q score was LVEF. The parameters and Q scores of ventricular arrhythmias ranged from large to small in the order of cardiac function NYHA grade and LVEF. T value. In a certain range of Q score and Q score of ventricular arrhythmia, LVEDD was usually larger than that of P0.05. 3, and each index (cardiac function NYHA grade) was compared. The frequency of various kinds of cardiovascular events among different groups of T value LVEDDs can see the probability of serous cavity effusion among different cardiac function groups. The probability of valve lesion and left bundle branch block among different LVEF groups, blood pressure 90 / 60 mmHg and valvular disease probability among different T value groups. There were significant differences in the probability of supraventricular arrhythmias among different LVEDD groups. Conclusion: 1. The lower the T value or the greater the LVEDD, the worse the cardiac function. T or LVEDD is not associated with cardiac function. 2. T can be used as an index of left ventricular remodeling, which can replace or even outperform LVEDD.3.T to some extent. NYHA classification was associated with the risk of cardiovascular events in patients with IDCM, that is, the more severe left ventricular remodeling, the higher the NYHA grade of cardiac function and the worse left ventricular systolic function. The higher the risk of cardiovascular events. LVEDD can also predict the risk of cardiovascular events within one foot. 4. Different indicators can predict the risk of different types of cardiovascular events.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.2

【参考文献】