脑型利钠肽评估儿童扩张型心肌病急性失代偿性心力衰竭及心室重构的临床价值探讨

发布时间：2018-05-10 15:35

本文选题：儿童 + 扩张型心肌病　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:研究血清脑型利钠肽(Brain-type natriuretic peptide,BNP)用于评估儿童扩张型心肌病急性失代偿性心力衰竭(Acute decompensated heart failure,ADHF)、心室重构的临床价值;同时探究儿童扩张型心肌病预后影响因素。方法:(1)收集2004年1月~2016年8月共12年间在重庆医科大学附属儿童医院诊治的40例合并ADHF的扩张型心肌病患儿的一般资料、心功能分级(改良ROSS评分)、血清检验结果(BNP、CK-MB、肌钙蛋白)、超声心动图(LVEF、LVEDd、LVEDs、IVSD)、心电图、胸片等资料。回顾性分析BNP在治疗前后的变化,及与改良ROSS评分、LVEF、LVEDd、IVSD等相应指标的相关性。(2)随访40例扩张型心肌病患儿激素使用情况及生存情况。对预后影响因素进行单因素分析,并对有统计学差异的单因素进一步进行Logistic回归分析。结果:(1)BNP、改良ROSS评分、LVEF、LVEDd等在ADHF治疗前后差异有统计学意义,ADHF治疗前BNP与改良ROSS评分值呈正相关(R=0.936,P0.01),与LVEF负相关(R=-0.838,P0.01),与LVEDd轻微相关(R=-0.318,P=0.0460.05),与IVSD呈负相关(R=-0.551,P0.01),ADHF治疗后BNP与改良ROSS评分值仍然呈正相关(R=0.959,P0.01),但BNP与LVEF及LVEDd、IVSD等心室重构指标无明显相关。可见ADHF治疗前BNP与心室重构有一定相关性,但当心衰症状明显控制及BNP水平明显下降甚至正常时心脏重构并无明显改善。(2)根据随访结果分为失访组、死亡组、存活组。单因素分析结果显示,儿童DCM死亡组在入院时年龄(月)、改良ROSS评分、BNP、心胸比例、CK-MB、肌钙蛋白高于儿童DCM存活组,LVEF低于存活组,且在是否合并心律失常、是否使用激素治疗上均有统计学差异。多因素Logistic回归分析,结果显示改良ROSS评分、BNP、心胸比例、是否合并心律失常是DCM患者的预后影响因素。结论:(1)儿童扩张型心肌病血清BNP水平与ADHF严重程度密切相关,血清BNP水平结合改良ROSS评分和LVEF评价ADHF的发生发展有重要临床价值,而BNP水平评估儿童扩张型心肌病心室重构的临床价值有待进一步探究。(2)评估儿童DCM预后需结合BNP、改良ROSS评分、心胸比例、是否合并心律失常综合分析。发病年龄、CK-MB、肌钙蛋白、LVEF、是否使用激素治疗对预后影响不大,仅可作判断预后的参考指标之一。
[Abstract]:Objective: to study the clinical value of serum brain-type natriuretic peptide (BNPs) in assessing acute decompensated heart failure and ventricular remodeling in children with dilated cardiomyopathy, and to explore the prognostic factors of children with dilated cardiomyopathy. Methods from January 2004 to August 2016, 40 children with dilated cardiomyopathy associated with ADHF were collected and treated in Chongqing Medical University affiliated Children's Hospital from January 2004 to August 2016. Cardiac function grade (modified ROSS score, serum test result: CK-MBB, troponin I, LVEF, LVEDdD, LVEDsVSD, electrocardiogram, chest radiography, etc.) The changes of BNP before and after treatment and the correlation with the improved ROSS score and the corresponding indexes such as LVEF and LVEDdD were analyzed retrospectively. 40 children with dilated cardiomyopathy were followed up for hormone use and survival. Univariate analysis of prognostic factors and further Logistic regression analysis of univariate factors with statistical differences were performed. Results there were significant differences between BNP and modified ROSS scores before and after ADHF treatment. There was a positive correlation between BNP and modified ROSS scores. There was a negative correlation between BNP and LVEF, a negative correlation with LVEF, a slight correlation with LVEDd, and a negative correlation with IVSD, a negative correlation between BNP and improved ROSS after ADHF treatment. The scores were still positively correlated with RV 0.959 and P0.01g, but there was no significant correlation between BNP and LVEF, LVEDdV IVSD and other indexes of ventricular remodeling. It can be seen that there is a certain correlation between BNP and ventricular remodeling before ADHF treatment, but when the symptoms of heart failure are obviously controlled and the level of BNP is obviously decreased or even normal, cardiac remodeling is not significantly improved .2According to the follow-up results, it is divided into three groups: lost visit group, dead group and survival group. Univariate analysis showed that the age at admission, modified ROSS score, cardiothoracic ratio and cardiac troponin were significantly higher in the DCM death group than in the survival group, and in the presence or absence of arrhythmia. There were statistical differences in whether hormone therapy was used. Multivariate Logistic regression analysis showed that modified ROSS score, cardiothoracic ratio and arrhythmia were the prognostic factors in DCM patients. Conclusion (1) Serum BNP level in children with dilated cardiomyopathy is closely related to the severity of ADHF. Serum BNP level combined with modified ROSS score and LVEF evaluation of the occurrence and development of ADHF has important clinical value. The clinical value of BNP level in evaluating ventricular remodeling in children with dilated cardiomyopathy needs to be further explored. (2) to evaluate the prognosis of DCM in children, we should combine BNPs, modified ROSS score, cardiothoracic ratio and comprehensive analysis of cardiac arrhythmia. The age of onset was CK-MBand troponin LVEF. Whether or not hormone therapy had little effect on prognosis was only one of the reference indexes to judge prognosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

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