血浆超敏C反应蛋白；催乳素；脑钠肽联合检测与围生期心肌病的相关性

发布时间：2018-06-19 00:32

本文选题：围生期心肌病 + 血浆催乳素　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的探讨血浆超敏C反应蛋白(hs-CRP)、催乳素(PRL)、脑钠肽(BNP))联合检测与围生期心肌病（PPCM）的相关性，进一步探索围生期心肌病的发病机制。方法从我院心内科收集符合目前围生期心肌病诊断标准的患者19例（试验组），进行常规体格检查、12导联心电图、胸部正侧位片、血细胞分析、尿液分析、便常规加隐血实验、肝肾功能、血糖、血脂、电解质、心肌损伤标记物、D-二聚体、凝血实验、血清总甲状腺素（TT4）、血清总三碘甲状腺原氨酸（TT3）、血清游离甲状腺素（FT4）、血清游离三碘甲状腺原氨酸（FT3）、促甲状腺激素（TSH）、红细胞沉降率（ESR）常规项目的检查，同时采取上述患者外周静脉血使用我院检验科及急诊科全自动电化学发光分析仪和全自动特定蛋白分析仪测定hs-CRP、PRL、BNP；采用我院超声科PHLIPS5500型，探头频率为3.5MHz的彩色多普勒超声诊断仪测量患者左心房内径（LAD）、左室舒张末期内径（LVEDD）、每搏量（SV）、每分心输出量（CO）、射血分数（EF）；从我院妇产科门诊及病房选择12导联心电图，超声心动图，胸部X线片、血细胞分析、尿液分析、便常规、血生化、甲状腺系列、凝血实验等检查均正常的围生期妇女30例（对照组），采用同样的仪器及方法测量hs-CRP、PRL、BNP。试验组再根据所侧左室射血分数分为两组，左室射血分数（LVEF），比较各组hs-CRP、PRL、BNP水平，评价三个指标与围生期心肌病的相关性。结果（1）试验组患者血清BNP水平明显高于对照组（P0．05），试验组根据射血分数是否大于35%再分为两组，比较两组间BNP水平，差异有统计学意义，试验组各组与对照组比较差异均有统计学意义。（2）试验组患者血清PRL水平明显高于正常组对照组(P0．001)，试验组各组分别与对照组比较差异明显，有统计学意义（P0．05）；试验组组间差异不明显，无统计学意义。（3）试验组患者血清hs-CRP水平明显高于正常对照组(P0．001)，试验组各组分别与对照组比较差异明显，有统计学意义（P0．05）；试验组组间差异不明显，无统计学意义。结论（1）BNP在正常围生期孕妇中可轻度增高，但多不超过未孕时的两倍，可能与妊娠后全身血容量的增加至心脏负荷增加有关，而在围生期心肌病患者中BNP水平会明显升高达正常时的数十倍；试验组中随着射血分数的降低，BNP水平会明显增高，与心功能有明显的相关性。（2）血浆催乳素、超敏C反应蛋白受多种因素的影响，本研究在年龄、妊娠次数、喂养方式等方面无统计学差异的情况下分析，，表明上述两个因素与围生期心肌病发病有一定的相关性，但与心脏左室的射血分数无明显的相关性。
[Abstract]:Objective to investigate the relationship between plasma hypersensitive C-reactive protein (hs-CRP), prolactin (PRL), brain natriuretic peptide (BNPN) and perinatal cardiomyopathy (PPCM), and to explore the pathogenesis of perinatal cardiomyopathy. Methods A total of 19 patients with perinatal cardiomyopathy were collected from cardiology department of our hospital. The patients in the test group underwent routine physical examination with 12 leads electrocardiogram, positive and lateral chest radiography, blood cell analysis and urine analysis. Fecal routine plus occult blood test, liver and kidney function, blood glucose, blood lipid, electrolyte, myocardial injury marker, D-dimer, coagulation test, The routine items of serum Thyroxine TT _ 4, serum total triiodothyronine, serum free thyroxine FT _ 4, serum free triiodothyronine FT _ 3, thyroid stimulating hormone TSHN, erythrocyte sedimentation rate and ESRs were examined. At the same time, the peripheral venous blood of the patients mentioned above was determined by automatic electrochemiluminescence analyzer and automatic specific protein analyzer in our laboratory and emergency department, and the PHLIPS5500 was used in the ultrasonic department of our hospital. A 3.5MHz color Doppler ultrasound instrument was used to measure the left atrial diameter (LADV), left ventricular end-diastolic diameter (LVEDDN), SVV volume (SVN), ejection fraction (EFF) and ejection fraction (EFF), and to select 12-lead electrocardiogram (ECG) from outpatient department and ward of gynecology and obstetrics department in our hospital. Echocardiography, chest X-ray, blood cell analysis, urine analysis, stool routine, blood biochemistry, thyroid series and coagulation test were all normal in 30 perinatal women (control group). The experimental group was divided into two groups according to left ventricular ejection fraction, left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEFN). The BNP levels of hs-CRP were compared in each group, and the correlation between the three indexes and perinatal cardiomyopathy was evaluated. Results 1) the serum BNP level in the trial group was significantly higher than that in the control group (P 0.05). The patients in the trial group were divided into two groups according to whether the ejection fraction was greater than 35%, and the difference between the two groups was statistically significant. The serum PRL level in the test group was significantly higher than that in the normal control group (P 0.001), and the difference between the test group and the control group was significant (P 0.05). The serum hs-CRP level in the test group was significantly higher than that in the normal control group (P 0.001), and there was significant difference between the test group and the control group (P 0.05). There was no significant difference between the two groups. Conclusion BNP may be slightly increased in normal perinatal pregnant women, but it is not more than twice that of non-pregnant women, which may be related to the increase of systemic blood volume after pregnancy to the increase of cardiac load. The BNP level in perinatal cardiomyopathy patients was significantly higher than that in normal cardiomyopathy patients, and that in the experimental group increased significantly with the decrease of ejection fraction, which was significantly correlated with cardiac function. Hypersensitive C-reactive protein was influenced by many factors. In this study, there were no statistical differences in age, pregnancy frequency and feeding pattern. The results showed that the two factors were related to the incidence of perinatal cardiomyopathy. However, there was no significant correlation between ejection fraction and left ventricular ejection fraction.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.252

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