代谢综合征患者左房重构及相关因素的观察
发布时间：2018-08-29 16:04
【摘要】：目的:了解代谢综合征(MS)患者是否存在左房重构及影响左房重构的因素;探讨代谢综合征患者N末端脑钠肽前体(NT-pro BNP)水平变化及代谢综合征患者左房重构与N末端脑钠肽前体水平间的关系,了解左房重构可能的机制;讨论代谢综合征患者左房重构与房性心律失常的关系。方法:选择健康对照组30人、代谢综合征非高血压组30人、代谢综合征并高血压组30人、混合代谢综合征组64人,其中健康对照组、代谢综合征非高血压组、代谢综合征并高血压组,采用临床标准生化法测定、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、尿酸(UA),采用超声心动图检测左心房容积指数(LAVI)、左心房最大容积(LAVmax)等指标,采用Elisa技术测定心房利钠肽及空腹胰岛素水平(FINS);混合代谢综合征组采用临床标准生化法测定甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG),超声心动图检测左心房内径指数(LADI),测量常规12导联心电图及监测24h动态心电图,同时12导联心电图测量结果及24h动态心电图检测结果根据Kleiger分级分为简单房性心律失常组和复杂性房性心律失常组,比较两组左房内径指数(LADI)、最大P波时限(PMAX)、macruze指数、P波离散度(PWD)及Morris指数异常频率的差别。采用SPSS18.0统计软件处理。计量资料采用(x-±s)表示,均数的比较采用AN0VA和t检验,两个变量间的依存关系采用Pearson相关分析,多个变量影响因素的分析采用多元线性回归分析,计数资料使用χ2检验,以P0.05表示差异有统计学意义。结果:(1)与健康对照组相比,代谢综合征非高血压组LAVI、LAVmax、LAVmix、LARV、LASV、LAVP增加;LACV、LAEF、LVVmax无差别。与健康对照组和代谢综合征非高血压组相比,代谢综合征并高血压疾病组LAVI、LAVmax、LAVmin、LARV、LACV、LASV、LAVP、LVVmax均增加,LAEF均无差别。(2)Pearson相关分析表明代谢综合征非高血压组和代谢综合征并高血压组LAVI与年龄、BMI、腰围、TG、SBP、DBP、SIL、FBG、HOME-IR均呈正相关,与HDL-C呈负相关,与TC、LDL-C、UA无相关关系。多元线性回归分析表明代谢综合征非高血压组和代谢综合征并高血压组腰围、TG、HOMR-IRI均为影响LAVI的因素,其中TG对LAVI影响最大。(3)与健康对照组相比代谢综合征非高血压组血清NT-pro BNP增加;与健康对照组和代谢综合征非高血压组相比,代谢综合征并高血压组NT-pro BNP进一步增加。(4)Pearson相关分析表明代谢综合征非高血压组和代谢综合征并高血压组血清NT-pro BNP与年龄、BMI、SBP、FIN、HOME-IR、UA呈正相关,与腰围、TG、TC、LDL-C、DBP、FBG无相关关系。多元线性回归分析表明代谢综合征非高血压组和代谢综合征并高血压组FIN、年龄、SBP、BMI均为影响血清NT-pro BNP的因素,其中FIN对血清NT-pro BNP的影响最大。(5)Pearson相关分析表明代谢综合征非高血压组和代谢综合征并高血压组NT-pro BNP与LAVI、LAVmax、LAVmin、LASV、LAVP均呈正相关,与LARV、LACV、LAEF无相关关系。多元线性回归分析表明单纯代谢综合征组代谢综合征非高血压组和代谢综合征并高血压组LAVI、LAVP为影响血清NT-pro BNP的重要因素,其中LAVI对血清NT-pro BNP的影响最大。(6)在混合代谢综合征组中,与简单心律失常相比,复杂房性心律失常组LADI、PMAX、macruze指数、PWD数值明显增大,Morris指数异常频率明显增加。结论:(1)代谢综合征患者存在左房重构,腰围、TG、HOME-IR皆为影响代谢代谢综合征患者左房重构的主要因素。(2)代谢综合征患者血清NT-pro BNP增加,FIN、年龄、SBP、BMI为影响代谢综合征患者血清NT-pro BNP分泌的主要因素。同时代谢综合征患者NT-pro BNP的分泌与左房重构密切相关。(3)代谢综合征患者左房重构后加重其房性心律失常的发生。
[Abstract]:Objective: To investigate whether there is left atrial remodeling in patients with metabolic syndrome (MS) and the factors affecting it, to explore the changes of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome and the relationship between left atrial remodeling and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome, and to understand the possible mechanism of left atrial remodeling. Methods: 30 healthy controls, 30 non-hypertension patients with metabolic syndrome, 30 patients with metabolic syndrome complicated with hypertension, 64 patients with mixed metabolic syndrome, including healthy control group, non-hypertension patients with metabolic syndrome and hypertension patients with metabolic syndrome were selected. Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), uric acid (UA), left atrial volume index (LAVI), left atrial maximum volume (LAVmax) were measured by echocardiography, and atrial natriuretic peptide (ANP) and fasting insulin (FI) were measured by Elisa technique. In the mixed metabolic syndrome group, triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), left atrial diameter index (LADI), routine 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured, while 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured. Results According to Kleiger classification, the patients were divided into simple atrial arrhythmia group and complex atrial arrhythmia group. The differences of abnormal frequencies of left atrial diameter index (LADI), maximum P wave duration (PMAX), macruze index, P wave dispersion (PWD) and Morris index between the two groups were compared. Compared with AN0VA and T test, Pearson correlation analysis was used to analyze the dependence between the two variables, multiple linear regression analysis was used to analyze the influencing factors of the two variables, and_2 test was used to analyze the counting data. The difference was statistically significant with P 0.05. Results: (1) Compared with the healthy control group, LAVI, LAVmax, LAVmix, LAR in the non-hypertension group of metabolic syndrome were significantly different. Compared with the healthy control group and the non-hypertension group of metabolic syndrome, LAVI, LAVmax, LAVmin, LARV, LACV, LASV, LAVP, LVVmax increased in the metabolic syndrome patients with hypertension, but LAEF did not differ between the non-hypertension group of metabolic syndrome and the non-hypertension group of metabolic syndrome. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, TG, SBP, DBP, SIL, FBG, HOME-IR were positively correlated with HDL-C, but not with TC, LDL-C, UA. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, and TG had the greatest influence on LAVI. (3) LAVI was negatively correlated with health. The serum NT-pro BNP levels in the control group were higher than those in the non-hypertensive group with metabolic syndrome, and the NT-pro BNP levels in the hypertensive group with metabolic syndrome were higher than those in the healthy control group and the non-hypertensive group with metabolic syndrome. (4) Pearson correlation analysis showed that the serum NT-pro BNP levels in the non-hypertensive group with metabolic syndrome and the hypertensive group with metabolic syndrome were higher than BMI, SBP, FIN, HOME-IR, UA were positively correlated with waist circumference, TG, TC, LDL-C, DBP, FBG. Multivariate linear regression analysis showed that FIN, age, SBP, BMI were all factors affecting serum NT-pro BNP in non-hypertensive group and hypertensive group with metabolic syndrome, and FIN had the greatest influence on serum NT-pro BNP. The results showed that NT-pro BNP was positively correlated with LAVI, LAVmax, LAVmin, LASV and LAVP, but not with LARV, LACV and LAEF. Multivariate linear regression analysis showed that LAVI and LAVP in metabolic syndrome group and metabolic syndrome with hypertension group were correlated with serum NT. LAVI had the greatest effect on serum NT-pro BNP. (6) Compared with simple arrhythmia, LADI, PMAX, macruze index, PWD and Morris index were significantly increased in patients with complex atrial arrhythmia, and the abnormal frequency of Morris index was significantly increased. G, HOME-IR were the main factors affecting the left atrial remodeling in patients with metabolic syndrome. (2) The increase of serum NT-pro BNP, FIN, age, SBP and BMI were the main factors affecting the secretion of NT-pro BNP in patients with metabolic syndrome. The left atrial remodeling of the patient aggravated the occurrence of atrial arrhythmia.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589
本文编号：2211705
[Abstract]:Objective: To investigate whether there is left atrial remodeling in patients with metabolic syndrome (MS) and the factors affecting it, to explore the changes of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome and the relationship between left atrial remodeling and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in patients with metabolic syndrome, and to understand the possible mechanism of left atrial remodeling. Methods: 30 healthy controls, 30 non-hypertension patients with metabolic syndrome, 30 patients with metabolic syndrome complicated with hypertension, 64 patients with mixed metabolic syndrome, including healthy control group, non-hypertension patients with metabolic syndrome and hypertension patients with metabolic syndrome were selected. Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), uric acid (UA), left atrial volume index (LAVI), left atrial maximum volume (LAVmax) were measured by echocardiography, and atrial natriuretic peptide (ANP) and fasting insulin (FI) were measured by Elisa technique. In the mixed metabolic syndrome group, triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), left atrial diameter index (LADI), routine 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured, while 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram were measured. Results According to Kleiger classification, the patients were divided into simple atrial arrhythmia group and complex atrial arrhythmia group. The differences of abnormal frequencies of left atrial diameter index (LADI), maximum P wave duration (PMAX), macruze index, P wave dispersion (PWD) and Morris index between the two groups were compared. Compared with AN0VA and T test, Pearson correlation analysis was used to analyze the dependence between the two variables, multiple linear regression analysis was used to analyze the influencing factors of the two variables, and_2 test was used to analyze the counting data. The difference was statistically significant with P 0.05. Results: (1) Compared with the healthy control group, LAVI, LAVmax, LAVmix, LAR in the non-hypertension group of metabolic syndrome were significantly different. Compared with the healthy control group and the non-hypertension group of metabolic syndrome, LAVI, LAVmax, LAVmin, LARV, LACV, LASV, LAVP, LVVmax increased in the metabolic syndrome patients with hypertension, but LAEF did not differ between the non-hypertension group of metabolic syndrome and the non-hypertension group of metabolic syndrome. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, TG, SBP, DBP, SIL, FBG, HOME-IR were positively correlated with HDL-C, but not with TC, LDL-C, UA. Multivariate linear regression analysis showed that waist circumference, TG, HOMR-IRI were all the factors influencing LAVI, and TG had the greatest influence on LAVI. (3) LAVI was negatively correlated with health. The serum NT-pro BNP levels in the control group were higher than those in the non-hypertensive group with metabolic syndrome, and the NT-pro BNP levels in the hypertensive group with metabolic syndrome were higher than those in the healthy control group and the non-hypertensive group with metabolic syndrome. (4) Pearson correlation analysis showed that the serum NT-pro BNP levels in the non-hypertensive group with metabolic syndrome and the hypertensive group with metabolic syndrome were higher than BMI, SBP, FIN, HOME-IR, UA were positively correlated with waist circumference, TG, TC, LDL-C, DBP, FBG. Multivariate linear regression analysis showed that FIN, age, SBP, BMI were all factors affecting serum NT-pro BNP in non-hypertensive group and hypertensive group with metabolic syndrome, and FIN had the greatest influence on serum NT-pro BNP. The results showed that NT-pro BNP was positively correlated with LAVI, LAVmax, LAVmin, LASV and LAVP, but not with LARV, LACV and LAEF. Multivariate linear regression analysis showed that LAVI and LAVP in metabolic syndrome group and metabolic syndrome with hypertension group were correlated with serum NT. LAVI had the greatest effect on serum NT-pro BNP. (6) Compared with simple arrhythmia, LADI, PMAX, macruze index, PWD and Morris index were significantly increased in patients with complex atrial arrhythmia, and the abnormal frequency of Morris index was significantly increased. G, HOME-IR were the main factors affecting the left atrial remodeling in patients with metabolic syndrome. (2) The increase of serum NT-pro BNP, FIN, age, SBP and BMI were the main factors affecting the secretion of NT-pro BNP in patients with metabolic syndrome. The left atrial remodeling of the patient aggravated the occurrence of atrial arrhythmia.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589
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