血浆N末端脑钠肽前体对急性心肌梗死溶栓治疗的预后影响
发布时间：2018-08-07 18:45
【摘要】：目的 急性心肌梗死(acute myocardial infaction，AMI)是临床最常见的心血管急症。近年来研究显示血浆N氨基酸末端脑钠肽前体（N-Terminal proatrial B-type natriureticpetide，NT-proBNP）在心力衰竭（heart failure，HF）及AMI发作时明显升高，并明显影响患者的预后。如何来评价AMI患者的病情严重程度、预后已成为临床医学当前面临的重要问题之一。目前根据ACC/AHA及中华医学会心血管分会制定的AMI诊疗指南，对ST段抬高的心肌梗死（ST segment elevation myocardial infaction，STEMI）的主要治疗包括急诊经皮冠状动脉腔内成形术（percutaneous coronaryintervention，，PCI）、静脉溶栓，但对一些不具备急诊PCI的医院、有溶栓适应症的病人，给予静脉溶栓治疗，为行之有效的治疗方法。目前国内、外对NT-proBNP在心力衰竭及急性心肌梗死的应用报道较多。对急诊PCI术后患者中的诊断价值及临床意义偶有报道。但对探讨在经过成功溶栓治疗的患者中是否发生早期心血管事件，比较NT-proBNP在二组之间的差异，并研究其与血清肌钙蛋白T（Troponin T，TnT）、肌酸激酶（creatine kinase，CK）、肌酸激酶同工酶（creatine kinase-CK）、左室射血分数（left ventricular ejection，LVEF）、左室舒张末期容积（Left ventricular end diastolicdimension，LVEDD）之间的相关性，尚无报道。本研究旨在观察成功溶栓患者中是否发生早期心血管事件，比较NT-proBNP在二组之间的差异，并研究其与血清肌钙蛋白T、肌酸激酶、肌酸激酶同工酶、左室射血分数，左室舒张末期容积之间的相关性，探讨测定血浆NT-proBNP水平在评价AMI成功溶栓治疗的患者病情严重程度和预后的意义。 材料与方法 研究对象为2009年10月至2012年6月于山东省东阿县人民医院住院治疗的应用瑞替普酶静脉成功溶栓治疗的AMI患者61例，其中男性45例，女性16例，年龄38-78岁，平均年龄62.41±9.408岁。其中广泛前壁心肌梗死、前壁或前间壁心肌梗（前壁组）26例，下壁和或后壁、右室心肌梗死(下壁组)35例。对所有入选的患者记录年龄、身高、体重、总胆固醇、低密度脂蛋白、肌酐、尿素氮、血糖、肌钙蛋白T、心肌酶以及吸烟、高血压、糖尿病史。记录30天内发生心血管死亡、心力衰竭、再发心肌梗死、梗死后心绞痛。所有入选病人治疗前均进行测定NT-proBNP、D二聚体、电解质、血脂系列、血糖、肝、肾功能、感染免疫检测及心电图检查。所有患者在入院时均行心脏超声心动图检查。对所有患者随访30天，观察是否发生早期心血管事件，即30天内发生心血管死亡、心力衰竭、再发心肌梗死、梗死后心绞痛等情况。采用SPSS19.0软件进行统计。计量资料以平均值±标准差(x s)表示。两组之间比较采用t检验。计数资料组间比较采用卡方检验，p＜0.05为有统计学差异。血浆NT-proBNP数据呈非正态分布，经对数转换后呈正态分布。采用pearson相关分析法，对NT-proBNP分别与肌酸激酶、肌酸激酶同工酶、肌钙蛋白T、LVEF及LVDD进行双变量相关分析。本研究的均数、标准差及t检验均为NT-proBNP对数值分析结果。 结果 1.血浆NT-proBNP水平在发生早期心血管事件组明显高于未发生事件组，两组比较差异具有显著性。 2.血浆NT-proBNP水平与左室射血分数呈负相关。 3.血浆NT-proBNP水平与肌钙蛋白T呈正相关，与肌酸激酶、肌酸激酶同工酶呈正相关；NT-proBNP与LVEDD呈正相关。 4.前壁血浆NT-proBNP水平明显高于下壁组，但无统计学差异。 结论 1.血浆NT-proBNP水平在发生早期心血管事件组明显高于未发生事件组。 2.血浆NT-proBNP水平与左室射血分数呈负相关； 3.血浆NT-proBNP与LVEDD呈正相关；与肌钙蛋白T与肌酸激酶、肌酸激酶同工酶呈正相关。
[Abstract]:objective
Acute myocardial infaction (AMI) is the most common clinical cardiovascular emergency. In recent years, studies have shown that plasma N amino acid terminal natriuretic peptide precursor (N-Terminal proatrial B-type natriureticpetide, NT-proBNP) is significantly elevated in heart failure (heart failure) and episodes of heart failure (heart failure), and significantly affects the prognosis of patients. How to evaluate the severity of AMI patients, the prognosis has become one of the most important problems in clinical medicine. At present, the main treatment for ST segment elevation myocardial infarction (ST segment elevation myocardial infaction, STEMI) is an emergency percutaneous coronary, according to the AMI guidance for the cardiovascular branch of the ACC/AHA and the Chinese Medical Association. Percutaneous CoronaryIntervention (PCI), intravenous thrombolysis, but for some hospitals without emergency PCI, patients with thrombolytic adaption and intravenous thrombolytic therapy are effective treatment methods. At present, there are more reports on the application of NT-proBNP in cardiac failure and acute myocardial infarction at home and abroad. Emergency PCI operation is used. The diagnostic value and clinical significance of the patients were reported occasionally. However, the difference between the two groups was compared between the two groups and the serum troponin T (Troponin T, TnT), the creatine kinase (creatine kinase, CK), and the creatine kinase isoenzyme (creatine kina). Se-CK), the correlation between left ventricular ejection fraction (left ventricular ejection, LVEF), left ventricular end diastolic volume (Left ventricular end diastolicdimension, LVEDD) has not yet been reported. The purpose of this study was to observe whether early cardiovascular events occurred in patients with successful thrombolytic disease and compare the difference between the two groups and study the difference between them and the serum. The relevance of troponin T, creatine kinase, creatine kinase isoenzyme, left ventricular ejection fraction, and left ventricular end diastolic volume, to explore the significance of plasma NT-proBNP levels in evaluating the severity and prognosis of patients with AMI successful thrombolytic therapy.
Materials and methods
The subjects were 61 AMI patients who were hospitalized in the people's Hospital of Dong'e County of Shandong province from October 2009 to June 2012 with successful thrombolytic thrombolytic therapy with riyrip vein, including 45 males, 16 females, 38-78 years old and an average age of 62.41 9.408 years. Among them, 26 cases were anterior wall myocardial infarction, anterior wall or anterior wall myocardial infarction (anterior wall group). 35 cases of lower wall and or posterior wall, right ventricular myocardial infarction (lower wall group). All selected patients were recorded age, height, weight, total cholesterol, low density lipoprotein, creatinine, urea nitrogen, blood glucose, troponin T, cardiac enzymes, and smoking, hypertension, and diabetes history. Records of cardiovascular death, heart failure, recurrent myocardial infarction, and post infarction within 30 days after the infarction. Angina pectoris. All patients were tested for NT-proBNP, D two polymer, electrolyte, blood lipid series, blood glucose, liver, kidney function, infection immunity test and electrocardiogram examination. All patients underwent cardiac echocardiography at admission. All patients were followed up for 30 days to observe whether early cardiovascular events occurred, that is, within 30 days. Blood vessel death, heart failure, recurrent myocardial infarction, and post infarction angina pectoris. SPSS19.0 software was used for statistics. The measurement data were expressed with mean standard deviation (x s). T test was used between the two groups. The count data were compared with the chi square test, P < 0.05 was statistically different. The plasma NT-proBNP data showed a non normal distribution, The Pearson correlation analysis was used to analyze the bivariate correlation of NT-proBNP with creatine kinase, creatine kinase isoenzyme, troponin T, LVEF and LVDD, respectively. The average number of this study, the standard deviation and the t test were all NT-proBNP to the numerical analysis.
Result
1. The plasma NT-proBNP level in the early cardiovascular event group was significantly higher than that in the non-event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. Plasma NT-proBNP levels were positively correlated with troponin T, creatine kinase and creatine kinase isozymes, and NT-proBNP levels were positively correlated with LVEDD.
4. the plasma NT-proBNP level in the anterior wall was significantly higher than that in the inferior wall group, but there was no statistical difference.
conclusion
1. the plasma NT-proBNP level in the early cardiovascular events group was significantly higher than that in the non event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. plasma NT-proBNP was positively correlated with LVEDD, and positively correlated with troponin T, creatine kinase and creatine kinase isoenzyme.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
本文编号：2171013
[Abstract]:objective
Acute myocardial infaction (AMI) is the most common clinical cardiovascular emergency. In recent years, studies have shown that plasma N amino acid terminal natriuretic peptide precursor (N-Terminal proatrial B-type natriureticpetide, NT-proBNP) is significantly elevated in heart failure (heart failure) and episodes of heart failure (heart failure), and significantly affects the prognosis of patients. How to evaluate the severity of AMI patients, the prognosis has become one of the most important problems in clinical medicine. At present, the main treatment for ST segment elevation myocardial infarction (ST segment elevation myocardial infaction, STEMI) is an emergency percutaneous coronary, according to the AMI guidance for the cardiovascular branch of the ACC/AHA and the Chinese Medical Association. Percutaneous CoronaryIntervention (PCI), intravenous thrombolysis, but for some hospitals without emergency PCI, patients with thrombolytic adaption and intravenous thrombolytic therapy are effective treatment methods. At present, there are more reports on the application of NT-proBNP in cardiac failure and acute myocardial infarction at home and abroad. Emergency PCI operation is used. The diagnostic value and clinical significance of the patients were reported occasionally. However, the difference between the two groups was compared between the two groups and the serum troponin T (Troponin T, TnT), the creatine kinase (creatine kinase, CK), and the creatine kinase isoenzyme (creatine kina). Se-CK), the correlation between left ventricular ejection fraction (left ventricular ejection, LVEF), left ventricular end diastolic volume (Left ventricular end diastolicdimension, LVEDD) has not yet been reported. The purpose of this study was to observe whether early cardiovascular events occurred in patients with successful thrombolytic disease and compare the difference between the two groups and study the difference between them and the serum. The relevance of troponin T, creatine kinase, creatine kinase isoenzyme, left ventricular ejection fraction, and left ventricular end diastolic volume, to explore the significance of plasma NT-proBNP levels in evaluating the severity and prognosis of patients with AMI successful thrombolytic therapy.
Materials and methods
The subjects were 61 AMI patients who were hospitalized in the people's Hospital of Dong'e County of Shandong province from October 2009 to June 2012 with successful thrombolytic thrombolytic therapy with riyrip vein, including 45 males, 16 females, 38-78 years old and an average age of 62.41 9.408 years. Among them, 26 cases were anterior wall myocardial infarction, anterior wall or anterior wall myocardial infarction (anterior wall group). 35 cases of lower wall and or posterior wall, right ventricular myocardial infarction (lower wall group). All selected patients were recorded age, height, weight, total cholesterol, low density lipoprotein, creatinine, urea nitrogen, blood glucose, troponin T, cardiac enzymes, and smoking, hypertension, and diabetes history. Records of cardiovascular death, heart failure, recurrent myocardial infarction, and post infarction within 30 days after the infarction. Angina pectoris. All patients were tested for NT-proBNP, D two polymer, electrolyte, blood lipid series, blood glucose, liver, kidney function, infection immunity test and electrocardiogram examination. All patients underwent cardiac echocardiography at admission. All patients were followed up for 30 days to observe whether early cardiovascular events occurred, that is, within 30 days. Blood vessel death, heart failure, recurrent myocardial infarction, and post infarction angina pectoris. SPSS19.0 software was used for statistics. The measurement data were expressed with mean standard deviation (x s). T test was used between the two groups. The count data were compared with the chi square test, P < 0.05 was statistically different. The plasma NT-proBNP data showed a non normal distribution, The Pearson correlation analysis was used to analyze the bivariate correlation of NT-proBNP with creatine kinase, creatine kinase isoenzyme, troponin T, LVEF and LVDD, respectively. The average number of this study, the standard deviation and the t test were all NT-proBNP to the numerical analysis.
Result
1. The plasma NT-proBNP level in the early cardiovascular event group was significantly higher than that in the non-event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. Plasma NT-proBNP levels were positively correlated with troponin T, creatine kinase and creatine kinase isozymes, and NT-proBNP levels were positively correlated with LVEDD.
4. the plasma NT-proBNP level in the anterior wall was significantly higher than that in the inferior wall group, but there was no statistical difference.
conclusion
1. the plasma NT-proBNP level in the early cardiovascular events group was significantly higher than that in the non event group.
2. there was a negative correlation between plasma NT-proBNP level and left ventricular ejection fraction.
3. plasma NT-proBNP was positively correlated with LVEDD, and positively correlated with troponin T, creatine kinase and creatine kinase isoenzyme.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
【参考文献】
相关期刊论文 前2条
1 顾国嵘;栾骁;姚晨玲;邓至;童朝阳;;氨基端前脑钠肽对急性心肌梗死患者院内预后的判断价值[J];中华临床医师杂志(电子版);2011年16期
2 赵睿;杨蕊;杜建霖;邓松柏;王喜春;夏爽;佘强;;B型利钠肽联合TIMI危险积分对STEMI患者远期死亡风险预警价值的研究[J];重庆医科大学学报;2010年04期
本文编号：2171013
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2171013.html
最近更新
教材专著
