二尖瓣置换术患者围术期NT-proBNP测定价值的初步研究
发布时间：2019-04-04 12:20
【摘要】：目的：探讨二尖瓣置换术患者围手术期血清N-末端脑钠素原(NT--proBNP)浓度的变化规律和临床意义以及其对患者早期预后的评估。方法：2014年1月-2014年7月,45例风湿性二尖瓣病变患者接受体外循环下二尖瓣置换术。患者平均年龄(48.13±10.46)岁,分别于术前、术后1天、术后5天、术后7天检测血清N一末端脑钠素原(NT--proBNP)浓度,分析研究围手术期N-末端脑钠素原(NT--proBNP)浓度的变化规律及临床意义,术后根据患者是否发生不良事件分为两组,不良事件组(n=21)与无不良事件组(n=24),比较两组患者术前、术后第一天两个时点血浆N-末端脑钠素原(NT--proBNP)浓度是否存在差异,并用受试者操作特征曲线(receiver operating characteristic, ROC)方法评定术前、术后NT-proBNP对患者预后的评估能力。结果：术后1天、术后5天Log NT-proBNP(N-末端脑钠素原的对数)平均水平高于患者术前LogNT-proBNP水平,差异有统计学意义(P0.05)；术后7天与术前差异无统计学意义(P0.05)；整体LogNT-proBNP平均水平呈先升高后降低的趋势。术后发生不良事件组(n=21)与无不良事件组(n=24)相比,术前、术后一天血清N-末端脑钠素原(NT--proBNP)水平明显升高,差异有统计学意义(P0.05)。用ROC方法评定术前、术后NT-proBNP对其预后的评估能力,术前NT-proBNP预测不良事件的曲线下面积为73.8%,术后一天NT-proBNP预测不良事件的曲线下面积为72%,因此我们可以以813.40pg/mL为截点,若患者术前NT-proBNP水平高于该截点,说明患者发生不良事件的几率增加。结论：风湿性二尖瓣瓣膜病患者围手术期血清NT-proBNP浓度是反应二尖瓣置换术后患者心功能状态及预后的敏感指标。可用术前血清N-末端脑钠素原(NT-proBNP)浓度评估患者预后。
[Abstract]:Aim: to investigate the changes and clinical significance of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration in patients undergoing mitral valve replacement and to evaluate its early prognosis. Methods: from January 2014 to July 2014, 45 patients with rheumatic mitral valve disease underwent mitral valve replacement under cardiopulmonary bypass. The mean age of the patients was (48.13 卤10.46) years. Serum N-terminal pro-brain natriuretic peptide (NT--proBNP) levels were measured before, 1 day, 5 days and 7 days after operation, respectively. The changes and clinical significance of N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration during perioperative period were analyzed and studied. After operation, the patients were divided into two groups according to the occurrence of adverse events, adverse event group (n = 21) and non-adverse event group (n = 24), and the patients were divided into two groups according to whether the patients had adverse events or not. To compare the difference of plasma N-terminal brain natriuretic peptide (NT--proBNP) concentration between the two groups before and on the first day after operation, and to evaluate the plasma N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration by the (receiver operating characteristic, ROC) method of the subjects' operating characteristic curve before and after the operation. The ability of postoperative NT-proBNP to evaluate the prognosis of patients. Results: the mean level of LogNT-proBNP (logarithm of N-terminal pro-brain natriuretic peptide) on day 1 and day 5 after operation was significantly higher than that of preoperative LogNT-proBNP (P0.05). There was no significant difference between 7 days after operation and pre-operation (P0.05), but the average level of LogNT-proBNP increased first and then decreased. The level of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) was significantly higher in the postoperative adverse event group than that in the non-adverse event group before and one day after operation (P0.05). ROC method was used to evaluate the prognosis of preoperative and postoperative NT-proBNP. The area under the curve for predicting adverse events by NT-proBNP before operation was 73.8%, and the area under curve for predicting adverse events by NT-proBNP at one day after operation was 72%. Therefore, we can use 813.40pg/mL as the cut-off point. If the preoperative NT-proBNP level is higher than the cut-off point, the risk of adverse events is increased. Conclusion: the serum NT-proBNP concentration in patients with rheumatic mitral valvular disease is a sensitive indicator of cardiac function and prognosis after mitral valve replacement. Preoperative serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration can be used to evaluate the prognosis of patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
，
本文编号：2453804
[Abstract]:Aim: to investigate the changes and clinical significance of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration in patients undergoing mitral valve replacement and to evaluate its early prognosis. Methods: from January 2014 to July 2014, 45 patients with rheumatic mitral valve disease underwent mitral valve replacement under cardiopulmonary bypass. The mean age of the patients was (48.13 卤10.46) years. Serum N-terminal pro-brain natriuretic peptide (NT--proBNP) levels were measured before, 1 day, 5 days and 7 days after operation, respectively. The changes and clinical significance of N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration during perioperative period were analyzed and studied. After operation, the patients were divided into two groups according to the occurrence of adverse events, adverse event group (n = 21) and non-adverse event group (n = 24), and the patients were divided into two groups according to whether the patients had adverse events or not. To compare the difference of plasma N-terminal brain natriuretic peptide (NT--proBNP) concentration between the two groups before and on the first day after operation, and to evaluate the plasma N-terminal pro-brain natriuretic peptide (NT--proBNP) concentration by the (receiver operating characteristic, ROC) method of the subjects' operating characteristic curve before and after the operation. The ability of postoperative NT-proBNP to evaluate the prognosis of patients. Results: the mean level of LogNT-proBNP (logarithm of N-terminal pro-brain natriuretic peptide) on day 1 and day 5 after operation was significantly higher than that of preoperative LogNT-proBNP (P0.05). There was no significant difference between 7 days after operation and pre-operation (P0.05), but the average level of LogNT-proBNP increased first and then decreased. The level of serum N-terminal pro-brain natriuretic peptide (NT--proBNP) was significantly higher in the postoperative adverse event group than that in the non-adverse event group before and one day after operation (P0.05). ROC method was used to evaluate the prognosis of preoperative and postoperative NT-proBNP. The area under the curve for predicting adverse events by NT-proBNP before operation was 73.8%, and the area under curve for predicting adverse events by NT-proBNP at one day after operation was 72%. Therefore, we can use 813.40pg/mL as the cut-off point. If the preoperative NT-proBNP level is higher than the cut-off point, the risk of adverse events is increased. Conclusion: the serum NT-proBNP concentration in patients with rheumatic mitral valvular disease is a sensitive indicator of cardiac function and prognosis after mitral valve replacement. Preoperative serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration can be used to evaluate the prognosis of patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
，
本文编号：2453804
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