低氧血症对血浆氨基末端B型利钠肽前体的影响

发布时间：2018-06-28 20:45

  本文选题：脑利钠肽N端前体肽 + 低氧血症　； 参考：《安徽医科大学》2014年硕士论文

【摘要】：背景和目的：氨基末端B型利钠肽前体（NT-proBNP）在心室容量负荷和（或）室壁压力增加时，可由心室肌细胞（左心室为主）合成和分泌，国内外研究多集中于NT-proBNP与左心功能的关系，并已证实在充血性心力衰竭（CHF）时血浆NT-proBNP浓度明显升高，而在一些呼吸系统疾病如慢性阻塞性肺疾病、肺动脉高压、间质性肺疾病、肺栓塞等血浆NT-proBNP浓度也可见升高。由于这些疾病常并发心功能不全和低氧血症，故NT-proBNP浓度升高的原因尚不十分明确。本研究通过分析低氧血症患者在不同心功能情况下血浆NT-proBNP浓度的变化，探讨血浆NT-proBNP与低氧血症之间的关系及其可能机制。 方法：回顾性分析453例同时行NT-proBNP、动脉血气分析及超声心动图检查的住院患者临床资料，根据氧合指数分为低氧血症组和无低氧血症组，比较两组患者血浆NT-proBNP浓度变化，并分别比较在左心室收缩功能不全、肺动脉高压、左心室收缩功能不全合并肺动脉高压以及心功能正常情况下血浆NT-proBNP浓度的变化。将心功能正常条件下的低氧血症组患者根据氧合指数分为Ⅰ（301~400mmHg）、Ⅱ（201~300mmHg）、Ⅲ（≤200mmHg）三个亚组，分析低氧程度与血浆NT-proBNP浓度的关系。分别对比在低氧血症或无低氧血症情况下，左心室收缩功能不全与肺动脉高压患者、肺动脉高压与心功能正常患者血浆NT-proBNP浓度差异；以及单纯左心室收缩功能不全、单纯肺动脉高压、单纯低氧血症患者三者间血浆浓度变化关系。分别以PaCO240和50mmHg为截断值，分析PaCO2与血浆NT-proBNP的关系，并采用Spearman相关分析，分析左心室功能相关指标、肺动脉收缩压（PASP）、氧合指数、PaCO2与血浆NT-proBNP的相 关性。 结果：①低氧血症组患者血浆NT-proBNP浓度高于无低氧血症组（P＜0.01）。在左心室收缩功能不全、肺动脉高压、心功能正常三种情况下低氧血症组患者NT-proBNP浓度均高于无低氧血症组（P＜0.05）。②在心功能正常条件下的低氧血症组中，Ⅲ组患者的血浆NT-proBNP水平高于Ⅰ和Ⅱ组，Ⅱ、Ⅲ组高于对照组（P＜0.05）。③在低氧血症或无低氧血症情况下，左心室收缩功能不全患者血浆NT-proBNP浓度高于肺动脉高压患者，肺动脉高压患者血浆NT-proBNP浓度高于心功能正常患者；单纯左心室收缩功能不全、单纯肺动脉高压患者血浆NT-proBNP浓度均高于单纯低氧血症患者（P＜0.05）。④Spearman相关分析示NT-proBNP与LVEDD、LVESD、PASP成正相关，与LVEF、FS、氧合指数呈负相关，差异均有统计学意义（P＜0.05），，而与LVPW、PaCO2、心率不相关（P＞0.05）。 结论低氧血症可能是导致血浆NT-proBNP浓度升高的一个独立因素，并且与缺氧程度成正相关。
[Abstract]:Background & AIM: NT-proBNP can be synthesized and secreted by ventricular myocytes (left ventricle) when ventricular volume load and / or wall pressure increase. Most studies have focused on the relationship between NT-proBNP and left ventricular function. The plasma NT-proBNP level was significantly increased in congestive heart failure (CHF), but also in some respiratory diseases such as chronic obstructive pulmonary disease, pulmonary hypertension, interstitial pulmonary disease, pulmonary embolism and other plasma NT-proBNP levels. As these diseases are often associated with cardiac insufficiency and hypoxemia, the reasons for the increase in NT-proBNP concentrations are unclear. This study was to investigate the relationship between plasma NT-proBNP and hypoxemia and its possible mechanism by analyzing the changes of plasma NT-proBNP in patients with hypoxemia under different cardiac function. Methods: the clinical data of 453 inpatients with NT-proBNP, arterial blood gas analysis and echocardiography were retrospectively analyzed. According to the oxygenation index, the patients were divided into hypoxemia group and hypoxemia group. The plasma NT-proBNP concentrations were compared between the two groups. The changes of plasma NT-proBNP concentrations in patients with left ventricular systolic dysfunction pulmonary hypertension left ventricular insufficiency complicated with pulmonary hypertension and normal cardiac function were compared. Patients with hypoxemia with normal cardiac function were divided into three subgroups according to oxygenation index: 鈪

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