评估慢性缺氧引起早期肾脏功能损害的生物标志物及早期心肾损害的相关性

发布时间：2018-02-25 18:01

本文关键词： 慢性缺氧慢性阻塞性肺疾病肾损害生物标记物心肾综合征　出处：《宁夏医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的分析和评估慢性阻塞性肺疾病（Chronicobstructivepulmonarydisease,COPD）患者慢性缺氧早期肾脏功能损伤的生物标志物及早期心肾损害的相关性。方法分组：COPD组（病例组）60例，对照组（健康体检者）53例；COPD组患者进一步依据血气分析中氧分压程度分为轻、中、重度缺氧三个亚组；依据心脏彩色多普勒超声中有无肺动脉高压分为肺动脉高压组和无肺动脉高压组。测定相关指标：血清β_2微球蛋白（β_2-MG）、血清胱抑素C(CysC)、血清肌酐（Scr）、尿素氮（BUN）、超敏C反应蛋白（CRP）、视黄醇结合蛋白（RBP）及估算肾小球滤过率（eGFR）、左室射血分数（LVEF）、肺动脉收缩压（PASP）、左室舒张末期内径（LVEDD）。结果与对照组比较，COPD组血清β_2-MG、CysC明显增高，eGFR明显降低，差异均有统计学意义（P0.05）。而血清Scr、BUN、RBP与对照组比较差异无统计学差异；进一步亚组分析：与对照组相比较，血清CysC、β_2-MG在轻、中、重度缺氧组均明显升高，eGFR仅在中、重度缺氧组明显降低，差异存在统计学意义（P0.05）。血清CysC、β_2-MG在COPD组增高比例分别占41.67%和45%，二者血清浓度增高与氧分压、eGFR均存在良好负性相关关系。β_2-MG与CRP呈正相关（P＜0.05），受炎症等因素影响。血清CysC和β_2-MG在不同缺氧程度亚组间增高的比例随缺氧程度加重而升高，，在重度缺氧组增高的比例明显高于轻和中度缺氧组，存在统计学差异（P0.05）；在有和无肺动脉高压组中血清CysC、β_2-MG较对照组明显增高，比例分别是36.67%和43.33%，肺动脉高压组增高的比例明显高于无肺动脉高压组，有统计学差异（P0.05）；进一步分析COPD组早期心肾损伤关系：与对照组相比，COPD组LVEDD、CRP明显升高，LVEF明显降低，差异均有统计学意义（P0.05）。左室舒张功能减低、心肌缺血、二尖瓣、三尖瓣、肺动脉瓣、主动脉瓣反流，分别占61.60%、30.00%、51.66%、66.66%、68.33%、45.00%，均明显高于对照组，有统计学差异（P0.05）；Pearson相关性分析：eGFR与LVEF呈正相关，β_2-MG、CysC、Scr、LVEDD与LVEF呈负相关（P＜0.001），eGFR与LVEDD呈负相关（P＜0.05）。结论COPD慢性缺氧可以引起早期肾脏功能损伤，血清CysC、β_2-MG、eGFR是评估COPD患者早期肾损害的灵敏指标。β_2-MG易受炎症等因素影响，不能单独评估COPD患者肾功能早期损伤，血清CysC更具优越性；随缺氧程度加重和缺氧时间延长肾功能损伤加重；COPD慢性缺氧可引起早期心肾功能同时受损，表现为早期心肾综合征；LVEF、LVEDD值为COPD慢性缺氧患者心功能受损监测指标。
[Abstract]:Objective to analyze and evaluate the correlation between early renal function damage and early cardiorenal damage in patients with chronic obstructive pulmonary disease (COPDD). Methods 60 patients with chronic obstructive pulmonary disease (COPD) were divided into two groups: 60 patients with chronic obstructive pulmonary disease (COPD), 60 patients with chronic obstructive pulmonary disease (COPD) and 60 patients with chronic obstructive pulmonary disease (COPD). In the control group, 53 patients with COPD were further divided into three subgroups: mild, moderate and severe hypoxia according to the degree of oxygen partial pressure in blood gas analysis. Pulmonary hypertension was divided into pulmonary hypertension group and non pulmonary hypertension group according to color Doppler echocardiography. Serum 尾 2 microglobulin (尾 2 MGG), cystatin C cystatin CysCU, serum creatinine creatinine Scrn, urea nitrogen bun, hypersensitive C reverse reaction were measured. Serum 尾 2-MGCysC in COPD group was significantly higher than that in control group (P < 0.05), and the estimation of glomerular filtration rate (GFR), left ventricular ejection fraction (LVEF), pulmonary systolic pressure (PAP) and left ventricular end-diastolic diameter (LVEDDD) were significantly higher in COPD group than in control group, and the serum 尾 2-MGCysC level in COPD group was significantly higher than that in control group. Compared with the control group, the serum CysC, 尾 2-MG were significantly increased in the mild, moderate and severe hypoxia groups, and the serum CysCand 尾 2-MG increased significantly in the moderate, moderate and severe hypoxia groups, but there was no significant difference in the serum Scr-BUNRBP between the control group and the control group, and the further subgroup analysis showed that the serum CysCand 尾 2-MG increased significantly in the mild, moderate and severe hypoxia groups. Severe hypoxia group significantly decreased, Serum CysCand 尾 2-MG increased in COPD group (41.67% and 45, respectively). There was a good negative correlation between the increase of serum concentration and oxygen partial pressure (P0. 05). There was a positive correlation between 尾-2-MG and CRP (P < 0. 05), which was affected by inflammation and other factors. The increased proportion of subgroups with different degrees of hypoxia and 尾 2-MG increased with the severity of hypoxia. The proportion of serum CysC and 尾 2-MG in severe hypoxia group was significantly higher than that in mild and moderate hypoxia group (P 0.05), and serum CysC and 尾 2-MG in patients with and without pulmonary hypertension were significantly higher than those in control group. The proportion of pulmonary hypertension group was significantly higher than that of no pulmonary hypertension group (P 0.05). Further analysis of the relationship between heart and kidney injury in COPD group: compared with control group, LVEDD CRP significantly increased and LVEF significantly decreased. There were significant differences in left ventricular diastolic function, myocardial ischemia, mitral valve, tricuspid valve, pulmonary valve, aortic valve regurgitation, respectively. There was a positive correlation between LVEF and LVEF, and a negative correlation between LVEF and LVEF (P < 0.001). Conclusion chronic hypoxia of COPD can cause early renal function damage. Serum CysC, 尾 -2 MGG GFR is a sensitive index for evaluating early renal damage in patients with COPD. Serum CysC is superior in evaluating early renal function damage in patients with COPD because it is easy to be affected by inflammation and other factors. Chronic hypoxia may lead to early cardiorenal function damage along with the severity of hypoxia and the prolongation of hypoxic time. LVEF and LVEDD value of early cardiorenal syndrome is the monitoring index of heart function impairment in COPD patients with chronic hypoxia.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9

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