大样本肺结核患者心电图分析

发布时间：2018-03-08 01:28

本文选题：大样本　切入点：肺结核　出处：《郑州大学》2013年硕士论文　论文类型：学位论文

【摘要】：背景和目的结核病是一种全球性的流行病,具有强烈的传染性,使人类的生命健康受到严重威胁。由于结核杆菌的发现及治疗药物的出现,到20世纪中期,在控制结核病方面才取得了一定成就。不过,由于近些年艾滋病的出现和蔓延,结核杆菌耐药性的普遍出现,人口数量的增加,人们活动范围的扩大,结核病仍在广泛蔓延,并逐渐成为人类死亡的主要原因之一。近期,根据世界卫生组织统计的结果显示,在全世界范围内,有22个结核病流行严重的国家和27个耐多药结核病流行严重的国家,而我国未能幸免。目前,我国结核病的每年发病人数约为130万,占全球发病总人数中的14.3%,在全世界范围内排名第二。在结核病对人体造成的许多危害中,对心脏的危害逐渐显著,我们应该对其有充分的认识并给予足够的重视。结核杆菌引起机体组织的病理变化主要有变性、增生和坏死,而对心脏损害的国内外报道有,但是较少。我们都知道,因为心脏的电学改变往往早于形态学的改变,而心电图做为一种无创伤性电学检查方法,可以了解肺结核患者心脏损害的情况,及时发现肺结核合并的早期心脏损害。目前,人们较少关注结核病患者心脏损害,对心电图的改变关注更少。本研究主要探讨肺结核患者心电图改变与性别、血常规、血清蛋白、血小板、红细胞沉降率(血沉)和C反应蛋白(CRP)检查结果的关系,分析肺结核患者的心电图变化。希望通过本研究能有助于早期发现肺结核患者的心脏损害,并给予及时的诊断和治疗。对象和方法 1研究对象：研究对象来自于河南省传染病医院,共收集2009年2月至2010年12月1114例肺结核住院患者病例,其中男性786例(60.41%),女性328例(39.59%),年龄为0-96岁,平均年龄(374±5)岁。职业有农民、学生、工人和其他。入选标准：首次确诊患有肺结核,痰涂片检查阳性或痰培养检查阳性,并且都没有开始使用抗结核药物的患者。排除标准：有易引起心脏损害的疾病(如先天性心脏病、急性冠脉综合症、高血压等)及已使用抗结核药物治疗的患者。 2试验方法：要求肺结核患者平卧,保持安静状态下现场采集心电图,所用仪器是美国公司生产的MAC-5000型十二导联同步心电图机。所收集的心电图由心电图教授做出诊断。所参照的诊断标准是美国心脏病学会(AHA)、美国心脏病学会基金会(ACCF)、美国心律学会(HRS)提出的"2009年国际心电图标准和诊断指南”与《临床心电图学及图谱》。诊断结果包括正常、快速心律失常、缓慢心律失常、左房室肥大、右房室肥大、ST-T改变等。而其他常规检查结果都由检验科医师做出诊断。 3分组方法：我们将收集的资料按性别、血常规检查、血清蛋白检查、血小板检查、血沉检查和C反应蛋白检查等结果进行分组,对各组的心电图结果进行分析,探讨心电图与各项检查结果的关系。 4统计学处理：数据处理和统计分析,使用的是SPSS17.0统计分析软件,计数资料组间比较采用X2检验；计量资料用均数±标准差(x±s)表示,两组比较用t检验。检验水准为α=0.05。结果 1肺结核患者总的心电图异常发生率高于健康人群； 2肺结核患者心电图的缓慢性心律失常发生率比较,男性女性；ST-T改变发生率比较,女性男性； 3肺结核患者出现红细胞和白细胞均减少、白蛋白减少球蛋白增加、血小板减少和血沉增快时,快速性心律失常发生率比较高； 4肺结核患者出现红细胞和白细胞均减少、白蛋白减少球蛋白增加和血沉增快时,ST-T改变发生率高；5肺结核患者出现白细胞增多、白蛋白减少球蛋白增加和血小板增多时,右房室肥大发生率较高； 6肺结核患者心电图异常组CRP水平高于正常组,快速性心律失常组CRP水平高于非快速性心律失常组。结论肺结核患者心电图总的异常发生率比较高,并且主要表现为快速性心律失常、右房室肥大和ST-T改变。而对于不同性别肺结核患者心电图的异常比较,同样存在差异。这些患者的心电图改变与血常规、血清蛋白、血小板、血沉和C反应蛋白检查结果的异常有不同程度的相关性。
[Abstract]:Background and purpose
Tuberculosis is a global epidemic, with strong infectivity, so that human health is seriously threatened. Because of the discovery of the tubercle bacillus and drug treatment, by the middle of twentieth Century, some achievement was made in the control of tuberculosis. However, due to the recent years and the spread of AIDS, widespread resistance of Mycobacterium tuberculosis the increase in population, expand the range of people's activities, tuberculosis is still widely spread, and gradually become one of the main causes of human death. Recently, according to the results of WHO statistics show that in the whole world, there are 22 serious national tuberculosis epidemic and 27 multi drug resistant tuberculosis epidemic hit countries but in China, has not been spared. At present, the number of annual incidence of tuberculosis in China is about 1 million 300 thousand, accounting for the total number of the global incidence of 14.3%, ranking second in the world scope Among the many hazards caused by tuberculosis to the human body, the harm to the heart is becoming more and more significant. We should have sufficient awareness and pay enough attention to it.
Mycobacterium tuberculosis caused by pathological changes in the tissues are degeneration, hyperplasia and necrosis of heart damage reported at home and abroad, but less. As we all know, because the electrical changes of heart are often earlier than morphological changes and electrocardiogram is a noninvasive electrical inspection method, can understand the cardiac damage in patients with lung tuberculosis, timely detection of early pulmonary tuberculosis complicated with heart damage. At present, people pay less attention to TB patients with heart damage, less attention to the change of ECG.
This study aims to investigate the pulmonary tuberculosis patients ECG changes and sex, blood, serum protein, platelet count, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) to examine the relationship between the results of analysis of electrocardiogram changes of patients with pulmonary tuberculosis. Hope that through this study can contribute to the early detection of cardiac damage in patients with pulmonary tuberculosis, and give timely diagnosis and treatment.
Objects and methods
1 research object from the infectious disease hospital in Henan province from February 2009 to December 2010, a total of 1114 cases of pulmonary tuberculosis cases in hospitalized patients, including 786 cases of male (60.41%), 328 cases were female (39.59%), the age is 0-96 years old, the average age (374 + 5) years old. There are occupation farmers, students, workers and other. Inclusion criteria: first diagnosed with pulmonary tuberculosis, sputum smear positive or positive sputum culture examination, and did not start using anti tuberculosis drugs. Patients with exclusion criteria: easy heart damage caused by diseases (such as congenital heart disease, acute coronary syndrome, hypertension) and has been used for treatment of tuberculosis drug.
2 test methods: supine pulmonary tuberculosis patients, collected ECG quiet state, the instrument used is the type MAC-5000 company production of twelve lead ECG synchronization. The collected ECG ECG by Professor diagnosis. Diagnostic criteria refer to the American Heart Association (AHA), the American College of Cardiology Foundation (ACCF), American Heart Rhythm Society (HRS) proposed the "2009 international standards and guidelines for diagnosis of electrocardiogram and clinical electrocardiography and atlas." the diagnostic results including normal, arrhythmia, bradycardia, left ventricular hypertrophy, right atrial and ventricular hypertrophy, ST-T change and so on. While the other routine examination results from laboratory physicians to make a diagnosis.
3 group method: We collected the data according to gender, blood routine examination, serum protein examination, platelet examination, ESR and C reactive protein examination results. The electrocardiogram results of each group were analyzed, and the relationship between electrocardiogram and various examination results was discussed.
4 statistical processing: data processing and statistical analysis, using SPSS17.0 statistical analysis software, counting data group comparison X2 test, measurement data with mean + standard deviation (x + s), two groups compared with t test. Test level is alpha =0.05..
Result
The incidence of abnormal ECG in 1 patients with pulmonary tuberculosis was higher than that of the healthy people.
The incidence of slow arrhythmia in 2 patients with pulmonary tuberculosis was compared, male female; the incidence of ST-T change was compared, female male;
3, the number of red blood cells and white blood cells decreased, albumin decreased, globulin increased, thrombocytopenia and erythrocyte sedimentation rate increased, the incidence of tachyarrhythmia was relatively high.
4 patients with pulmonary tuberculosis appeared red blood cells and white blood cells were reduced, albumin globulin increases and ESR, ST-T change rate is high; 5 patients with pulmonary tuberculosis leukocytosis, reduction of albumin globulin increases and thrombocytosis, higher incidence of right atrial and ventricular hypertrophy;
In 6 patients with pulmonary tuberculosis, the level of CRP in abnormal electrocardiogram group was higher than that of the normal group, and the level of CRP in the rapid arrhythmia group was higher than that of the non rapid arrhythmia group.
conclusion
The total abnormal electrocardiogram in patients with pulmonary tuberculosis incidence is relatively high, and mainly for rapid arrhythmia, right atrial and ventricular hypertrophy and ST-T changes and comparison for different gender. Abnormal electrocardiogram in patients with pulmonary tuberculosis, there are also differences. Electrocardiogram and blood in these patients, serum protein, platelet count, erythrocyte sedimentation rate and C-reactive protein test results C the anomalies have a different degree of correlation.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521;R540.41

【参考文献】