血清嗜铬粒蛋白A、尾加压素Ⅱ在小儿慢性心力衰竭中的变化及意义

发布时间：2018-03-09 07:55

  本文选题：慢性心力衰竭　切入点：嗜铬粒蛋白A　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景慢性心力衰竭(chronic heart failure,CHF)是心室收缩或舒张功能障碍所导致的心输出量不足,组织血流灌注减少,不能满足机体需要,造成神经内分泌系统过度激活的一种复杂的临床综合征,是小儿多种心脏疾病的晚期阶段,死亡率高,心室重塑是CHF发展过程中的重要环节。既往CHF的诊断主要依靠临床症状和体征,缺乏早期特异性的诊断指标,近年来,心力衰竭标志物的研究成为热点,其也被越来越多地应用于CHF的早期诊断和病情评估。嗜铬粒蛋白A(chromograninA,CgA)是一种可溶性多肽类物质,具有抑制血管收缩,拮抗肾上腺素、内皮素等的作用,并参与心室重塑过程。尾加压素Ⅱ(human urotensinⅡ,UⅡ)是迄今为止发现的最强大的收缩血管的物质,可增强儿茶酚胺、内皮素、血管紧张素Ⅱ的作用。近年来CgA和UⅡ在心血管系统中的表达也逐渐受到关注。目的本研究旨在通过测定不同心功能分级和病因的CHF患者治疗前后血清的CgA和UⅡ的水平变化,探讨CgA和UⅡ之间的相关性,以及治疗前CgA和UⅡ与心功能分级及心室重塑指标的关系及其意义,探讨其在小儿慢性心力衰竭中的应用价值及其临床意义。方法选取2015年6月至2016年6月于郑州大学第一附属医院小儿内科确诊为CHF的32例患儿为心衰组,其中心内膜弹力纤维增生症9例,扩张型心肌病23例;另选取门诊健康体检儿童20例为正常对照组。采用酶联免疫吸附法(ELISA法)测定心衰组治疗前后血清CgA及UⅡ水平;采用双向侧流免疫法测定氨基末端脑钠肽前体(NT-proBNP)水平;超声心动图测定心室重塑指标。应用SPSS 21.0统计软件进行数据分析,正态分布的计量资料采用均数±标准差(`X±S)表示;非正态分布的计量资料采用中位数(四分位间距)[M(P25,P75)]表示。正态分布且方差齐的计量资料两组间比较采用t检验,多组间两两比较采用LSD-t检验,方差不齐时采用校正的t检验。非正态分布、方差不齐或总体分布不详的计量资料的两组间比较采用Mann-Whitney U检验,多组之间比较采Kruskal-Wallis检验,多组间两两比较采用Bonferroni法。计数资料采用例数表示,两组间比较采用c2检验。关联性分析采用Pearson相关或Spearman相关分析。当P0.05时,认为差异具有统计学意义。结果(1)心衰组患儿治疗前血清CgA浓度、NT-proBNP浓度明显高于对照组(其Z值分别为-6.019、-6.019),且治疗后两者的血清学浓度较治疗前明显下降(其Z值分别为-4.398,-3.585);治疗前血清UⅡ浓度低于对照组(Z=-5.342),治疗后其浓度较治疗前升高(Z=-4.134),其差异均具有统计学意义(P0.001);(2)心衰组治疗前心功能分级Ⅱ级组的血清CgA、NT-proBNP水平与对照组差异不具有统计学意义(P0.05)。心功能分级Ⅲ级、Ⅳ级组的血清CgA、NT-proBNP水平高于对照组(P0.05);并且随着心功能不全程度的加重而逐渐升高(P0.05)。心功能不全Ⅱ级、Ⅲ级、Ⅳ级组患儿的UⅡ浓度均低于对照组(P0.05),并且随着心功能不全程度的加重而逐渐降低,异有统计学意义(P0.05);(3)EFE组和DCM组的血清CgA、UⅡ浓度差异无统计学意义(P0.05);(4)心衰组治疗前患儿血清CgA浓度分别与LVMI、NT-proBNP、心功能分级成正相关(r分别为0.394、0.585及0.720,P0.05),与LVEF、LVFS、UⅡ成负相关(r分别为-0.599、-0.573及-0.628,P0.05)。血清UⅡ分别与LVEF、LVFS成正相关(r分别为0.444、0.472,P0.05),而与NT-proBNP、心功能分级成负相关(r分别为-0.654、-0.866,P0.05),而与LVMI无明显相关性(P0.05)。结论(1)CgA可能参与CHF患儿心室重塑;(2)测定血清CgA和UⅡ可为CHF的诊断、心功能分级以及评估心衰治疗效果提供客观依据。
[Abstract]:Background: chronic heart failure (chronic heart failure, CHF) is ventricular systolic or diastolic dysfunction of cardiac output caused by insufficient tissue perfusion reduced, can not meet the needs of the body, causing a complex clinical excessive activation of the neuroendocrine system syndrome, is a late stage, a variety of pediatric heart disease mortality, ventricular remodeling an important link in the development of CHF. The diagnosis of CHF mainly depends on the clinical symptoms and signs, the lack of early diagnosis index, specific markers of heart failure in recent years, research has become a hot spot, it is early diagnosis and assessment of disease is more and more used in the CHF. Chromogranin A (chromograninA, CgA) is a soluble polypeptide, inhibit vasoconstriction, antagonistic effects of endothelin and adrenaline, and participate in the ventricular remodeling process. Urotensin II (human urotensin II, U II) is by far the most powerful vasoconstrictor substances can enhance catecholamines, endothelin, angiotensin II. In recent years, the expression of CgA and U II in cardiovascular system has attracted more and more attention. The purpose of this study aims to the change of serum CgA and U level II after grading the etiology and treatment of patients with CHF in different heart function, explore the relationship between CgA and U II, and former CgA and U II and the classification of cardiac function and ventricular remodeling index in treatment of the relationship and significance, to explore its application value in the value in children with chronic heart failure and its clinical significance. Methods from June 2015 to June 2016 in the first the Affiliated Hospital of Zhengzhou University Department of Pediatrics 32 children diagnosed as CHF for heart failure group, 9 cases of the center of endocardial fibroelastosis, dilated cardiomyopathy in 23 cases; the other 20 healthy children were selected as normal The control group. Using enzyme-linked immunosorbent assay (ELISA) determination of serum CgA and U levels before and after treatment of heart failure group; two side determination of N-terminal pro brain natriuretic peptide (NT-proBNP) level flow immunoassay; echocardiography ventricular remodeling index. SPSS 21 software was used for data analysis, measurement data the normal distribution by the mean and standard deviation (`X + S); non normal distribution of measurement data using the median (four percentile interval) [M (P25, P75)]. The measurement data is normal distribution and variance of the two groups were compared using t test and multiple comparison between the 22 groups by LSD-t test of homogeneity of variance using t calibration. Non normal distribution, homogeneity of variance or the overall distribution of unknown measurement data of the two groups were compared using Mann-Whitney U test and comparison among multiple groups using Kruskal-Wallis test, multiple comparison between the 22 groups by counting Bonferroni method. Data is expressed by the number of cases, the two groups were compared using C2 test. Correlation analysis using Pearson correlation or Spearman correlation analysis. When P0.05, considered statistically significant. Results (1) heart failure group before treatment, serum CgA concentration, NT-proBNP concentration was significantly higher than the control group (Z = -6.019, -6.019) after the treatment, and the serum concentration of the two was significantly lower than that before treatment (Z = -4.398, -3.585); serum U II concentration lower than the control group (Z=-5.342), after treatment the concentration higher than before treatment (Z=-4.134), the differences were statistically significant (P0.001); (2) serum CgA heart failure group, heart function before treatment of grade II group, and control group NT-proBNP difference was not statistically significant (P0.05). Class III grade of heart function, serum CgA IV group, NT-proBNP was higher than the control group (P0.05); and with the degree of heart failure 鍔犻噸鑰岄，

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