室间隔缺损患儿介入治疗前后血清MMP-9、TIMP-1水平变化及其与心室重塑的关系

发布时间：2018-05-30 08:08

本文选题：基质金属蛋白酶-9 + 基质金属蛋白酶组织抑制因子-1　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶组织抑制因子-1(TIMP-1)在细胞外基质合成与降解平衡中起重要作用。其二者水平或比例的改变可引起心室重塑。本课题旨在通过观察室间隔缺损患儿介入治疗前后MMP-9、TIMP-1水平的变化,结合心脏超声心动图心脏结构及心功能状态的测定,以了解其二者水平及比值的变化与患儿心室重塑的关系。方法:选取2016年1月-2016年9月在河北医科大学第一医院心内科住院并经超声心动图检查确诊为左向右分流型室间隔缺损(VSD),且符合介入治疗中国专家共识标准适宜行介入治疗并已介入治疗成功的患儿共33例作为治疗组;男18例,女15例;年龄3岁~7岁(4.70±1.40岁)。对照组选取本院同期门诊体检健康儿童共20例,男11例,女9例;年龄3岁~7岁(4.82±1.31岁)。对所有研究对象均采集其临床资料,对实验组的患儿介入治疗前及术后24小时、术后5天、术后1个月、术后3个月、术后6个月及健康对照组儿童采血测定MMP-9、TIMP-1;同时在介入治疗前、术后5天、术后1个月、术后3个月和术后6个月分别行超声心动图检查,其中主要评价心功能的指标包括:右室横径(RVTD)、右房横径(RATD)、左房前后径(LAAD)、左室收缩末前后径(LVESD)、左室舒张末前后径(LVEDD)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、每搏输出量(SV)、左室射血分数(LVEF)。介入治疗前、术后24小时、术后5天、术后1个月、术后3个月和术后6个月观察患儿心率、血压、心脏杂音、是否存在心律失常等情况。统计学处理:采用SPSS21.0软件进行统计分析。结果:1治疗组与对照组分别在性别、年龄、体重等参数上无显著性差异;2 MMP-9、TIMP-1的变化:介入治疗前两者水平均较对照组升高;介入术后24小时出现短暂上升,术后5天开始逐渐下降,至术后6个月较术后3个月数值上虽有下降趋势,但无统计学意义,术后6个月与对照组无差异;3 MMP-9/TIMP-1比值的变化:介入治疗前与治疗后MMP-9/TIMP-1比值无明显变化,与对照组相比无差异;4房室结构及心功能的变化:介入术后5天、术后1个月、术后3个月及术后6个月RVTD、LAAD、LVEDD、LVESD、LVEDV、LVESV、SV均明显小于术前,随访至术后6个月上述指标逐步减小,而RATD、LVEF术后较术前变化不大。5 MMP-9、TIMP-1与心脏结构及功能相关性:治疗前后MMP-9、TIMP-1与RVTD、LAAD、LVEDD、LVESD、LVEDV、LVESV、SV均具有相关性,差异有统计学意义(P0.05),与RATD、LVEF无明显相关性(P0.05)。MMP-9与TIMP-1的相关系数为0.870,差异有统计学意义(P0.01)。结论:血清MMP-9、TIMP-1水平可以有效反映室间隔缺损患儿的心室容量负荷、心腔结构的改变,可作为早期评估室间隔缺损心室重塑的一个评价指标,其有助于评估室间隔缺损患儿封堵术后的远期疗效及预后。
[Abstract]:Aim: Matrix metalloproteinase-9 (MMP-9), a tissue inhibitor of matrix metalloproteinase (TIMP-1), plays an important role in the balance of extracellular matrix synthesis and degradation. Changes in the level or ratio of both may lead to ventricular remodeling. The purpose of this study was to observe the changes of MMP-9 and TIMP-1 levels in children with ventricular septal defect (VSD) before and after interventional therapy, combined with the measurement of cardiac structure and cardiac function by echocardiography, in order to understand the relationship between the changes of the level and ratio of MMP-9 and TIMP-1 and ventricular remodeling in children with ventricular septal defect. Methods: selected from January 2016 to September 2016, hospitalized in the Department of Cardiology, first Hospital of Hebei Medical University, and diagnosed by echocardiography as left to right shunt ventricular septal defect (VSD). 33 cases were treated with interventional therapy and successful interventional therapy. There were 18 males and 15 females, aged from 3 to 7 years (4.70 卤1.40 years). In the control group, 20 healthy children, 11 males and 9 females, aged from 3 years old to 7 years old, were selected from 20 healthy children in the same period of outpatient examination, who were 4.82 卤1.31 years old. The clinical data were collected from all the subjects. 24 hours before and 24 hours after interventional therapy, 5 days after operation, 1 month after operation, 3 months after operation were performed on the children in the experimental group. The levels of MMP-9 and TIMP-1 were measured 6 months after operation and 6 months after operation in healthy children, and echocardiography was performed before, 5 days, 1 month, 3 months and 6 months after interventional therapy, respectively, before interventional therapy, 3 months after operation, 3 months after operation and 6 months after operation. The main indexes for evaluating cardiac function include right ventricular transverse diameter (RVTDV), right atrium transverse diameter (RATD), left atrial anterior and posterior diameter (LAADD), left ventricular end systolic diameter (LVESD), left ventricular end diastolic dimension (LVEDDN), left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), and left ventricular output volume (LVEF). Left ventricular ejection fraction (LVEF). Heart rate, blood pressure, cardiac murmur and arrhythmia were observed before, 24 hours, 5 days, 1 month, 3 months and 6 months after interventional therapy. Statistical processing: SPSS21.0 software was used for statistical analysis. Results there was no significant difference in sex, age, body weight and other parameters between the two groups. The levels of MMP-9 and TIMP-1 before intervention were higher than those in the control group, and there was a brief increase at 24 hours after intervention. After 5 days, the value decreased gradually, but there was no significant difference between 6 months after operation and 3 months after operation. There was no significant change in the ratio of MMP-9/TIMP-1 before and after interventional therapy between the control group and the control group at 6 months postoperatively. There was no significant difference in the changes of atrioventricular structure and cardiac function between the two groups: 5 days after interventional therapy and 1 month after interventional therapy, there were no significant changes in the ratio of MMP-9/TIMP-1 before and after interventional therapy. At 3 months after operation and 6 months after operation, the SV of RVTDD-LVEDD-LVEDD-LVED-LVEDVLVESVV was significantly lower than that of pre-operation, and the above indexes gradually decreased after follow-up to 6 months after operation. However, the changes of RATDD-LVEF after operation were not significant compared with those before and after operation. The relationship between MMP-9TIMP-1 and LVELVELVELVESVSV was significant before and after treatment, and there was no significant correlation between MMP-9TIMP-1 and RVDD-LAVEADVELVELVELVEDVV LVESV before and after treatment. There was no significant correlation with RATDV LVEF. The correlation coefficient between MMP-9 and TIMP-1 was 0.870, and the difference was statistically significant (P 0.01). Conclusion: the level of MMP-9 and TIMP-1 in serum can effectively reflect the ventricular volume load and the changes of ventricular cavity structure in children with ventricular septal defect. It can be used as an early evaluation index for ventricular remodeling of ventricular septal defect. It is helpful to evaluate the long-term effect and prognosis of ventricular septal defect (VSD) in children with ventricular septal defect (VSD).
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

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