和肽素在慢性心力衰竭急性发作时的变化与预后的关系

发布时间：2018-06-13 12:02

  本文选题：慢性心力衰竭 + 急性发作　； 参考：《山西医科大学》2014年硕士论文

【摘要】：研究背景 随着慢性心衰患者的逐步增多，其急性发作已成为心衰患者入院的主要原因，其发病急、病死率高，因此，探求心衰患者危险分层、指导治疗及判断预后的更有效的方法致关重要。 目前已经公认，在心衰的发生、发展过程中，精氨酸加压素（AVP）系统的激活起着重要作用，尤其是其导致的水钠潴留。然而，AVP的血浆半衰期很短，，只有10-30分钟，血浆检测比较困难，其临床应用及研究明显受限。近年的研究发现，和肽素作为与AVP同源的多肽，与AVP等摩尔量释放，并且其稳定、易于检测，在血浆中与AVP变化相一致，可能有助于心衰的诊断和治疗。但是，其在体内的具体功能及与心血管系统疾病的关系尚不清楚。 目的 通过测定慢性心衰急性发作期患者血浆和肽素水平，分析其与心功能分级、左心室射血分数（LVEF）、氨末端脑钠肽前体（NT-proBNP）及近期预后的关系，探讨和肽素能否作为心衰患者诊断、指导治疗及判断预后的血清标志物。 方法 选择慢性心衰急性发作期住院治疗的患者80例为心衰组，同期无心脏相关疾病的健康对照组30例。心衰组分别于入院即刻、给予抗心衰治疗10天后测定和肽素、NT-proBNP水平，并于入院后24小时内行床旁心脏超声检查，测量左心室舒张末期内径（LVIDd）和LVEF；并于出院后3个月时随访记录其是否发生心血管相关事件（包括因心衰再次急性发作、恶性心律失常等再住院或死亡等）；对照组采血一次，测定和肽素、NT-proBNP水平。 结果 心衰组患者入院即刻和肽素、NT-proBNP水平均高于对照组（P0.01）；NYHAⅣ级患者的和肽素、NT-proBNP水平高于NYHAⅢ级的患者(P0.05)；和肽素水平与NT-proBNP呈明显正相关（r=0.721,P0.001）；与LVEF呈负相关（r=-0.332,P=0.003）；心衰组治疗10天后和肽素、NT-proBNP水平较入院时明显下降（P0.01）；出院后3个月时间内，与未发生心血管事件的患者相比，发生心血管事件患者的和肽素、NT-proBNP水平在治疗前后均较高（P0.01）；用多因素Logistic回归分析，入院时和肽素、NT-proBNP水平为慢性心衰患者独立预后指标（P0.01）。 结论 在慢性心力衰竭急性发作期患者入院时测定和肽素、NT-proBNP水平有助于心功能的评价及患者病情的严重程度的判断；在其治疗过程中监测和肽素、NT-proBNP水平有利于指导治疗；测定其水平对预后判断具有重要价值。
[Abstract]:Background with the increasing number of patients with chronic heart failure, acute attack has become the main cause of hospitalization of patients with heart failure, and its incidence is acute and mortality is high. Therefore, to explore the risk stratification of patients with heart failure. More effective methods for guiding treatment and judging prognosis are important. The activation of arginine vasopressin (AVP) system plays an important role in the occurrence and development of heart failure, especially the retention of water and sodium. However, the plasma half-life of AVP is very short, only 10-30 minutes, the detection of plasma is difficult, its clinical application and research are obviously limited. In recent years, it has been found that, as a peptide homologous to AVP, it is released in the same molar amount as AVP, and it is stable and easy to detect, which is consistent with the change of AVP in plasma, which may be helpful to the diagnosis and treatment of heart failure. However, its specific function in vivo and its relationship with cardiovascular diseases are unclear. Objective to determine the levels of plasma and peptide in patients with chronic heart failure (CHF) during acute attack and to analyze their relationship with cardiac function classification, left ventricular ejection fraction (LVEF), NT-proBNPs at the end of ammonia-terminal brain natriuretic peptide (NT-proBNPP) and short-term prognosis. To explore whether or not he peptide can be used as a serum marker for diagnosis, treatment and prognosis in patients with heart failure. Methods 80 patients with acute attack of chronic heart failure were selected as heart failure group and 30 healthy persons without heart-related diseases in the same period. NT-proBNP levels were measured 10 days after anti-CHF treatment in CHF group, and bedside echocardiography was performed within 24 hours after admission to measure left ventricular end-diastolic diameter (LVIDd) and LVEF. At 3 months after discharge, the patients were followed up to record whether they had cardiovascular events (including re-acute attack due to heart failure, malignant arrhythmias, etc.) and once in the control group, the levels of NT-proBNP in the control group were measured and the levels of NT-proBNP were measured. Results the levels of NT-proBNP in patients with heart failure were significantly higher than those in patients with NYHA 鈪

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