心脏超声右室收缩功能和肺动脉压测定对慢性肺心病心功能的诊断价值及其与血浆脑钠肽的相关性

发布时间：2018-03-11 11:51

本文选题：慢性肺心病　切入点：超声心动图　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:慢性肺心病是一种老年人常见的多发病。目前对于慢性肺心病的主要是维持治疗,改善患者的生存状态。因此,对于患者的早期诊断就显得尤为重要。在慢性肺心病的诊断中,主要是依靠患者的临床表现、体格检查、心电图等的辅助检查,缺乏特异的实验室依据。血浆脑钠肽(B-type natriurefic peptide,BNP)与心脏负荷之间有很好的相关性,血浆N末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-pro BNP)是BNP激素原分裂后没有活性的N-末端片段,与BNP相比,半衰期更长,更稳定,更能反映BNP通路的激活,血浆NT-pro BNP水平随心衰程度加重而升高。超声心动图作为一种无创、重复性好的检测方法,对于心脏和血管的功能能够起到有效的监测。本研究采用心脏超声检测指南推荐的右心收缩功能相关指标(TAPSE、Tei指数),评价肺心病对右心室收缩功能和肺动脉高压的影响,并通过与NT-pro BNP的比较,探讨上述指标在肺心病发生发展过程中的演变规律及其临床指导意义,为肺心病的诊断提供了一种简便、无创、可靠的方法。方法:对我院收集确定为慢性肺心病患者176例进行分组,其中慢性肺心病代偿期组(57例)和慢性肺心病失代偿期组(119例),并将慢性肺心病失代偿期组分为呼吸困难期组(42例)、右心衰竭期组(55例)和全心衰竭期组(22例)。同时选择正常对照组(门诊健康人群,30例)。分组后24小时内使用电化学发光法检测患者血清中NT-Pro BNP浓度,同时使用彩色多普勒超声诊断仪检测患者三尖瓣环收缩期位移,观察右室Tei指数。根据简化的Bemoulli公式和估测的右房压(RAP)计算出肺动脉收缩压。结果:1 NT-Pro BNP检测肺心病代偿期患者为301.34±43.22pg/ml,慢性肺心病失代偿期呼吸困难组为734.12±52.32 pg/ml,右心衰竭组为2134.45±521.42 pg/ml,全心衰竭组为6345.56±3621.82 pg/ml,正常体检患者为142.42±23.12pg/ml。(1)正常对照组和慢性肺心病疾病组存在差异,差异具有统计学意义(P0.01);(2)慢性肺心病疾病组之间两两比较发现,失代偿期和代偿期之间存在差异,具有统计学意义(P0.01);(3)慢性肺心病失代偿期各组之间,NT-pro BNP含量差异具有统计学意义(P0.01)。2三尖瓣环收缩期位移结果正常对照组为22.72±2.01mm,慢性肺心病代偿期组为20.12±3.23mm,慢性肺心病失代偿期呼吸困难组为17.34±2.73mm,右心衰竭组为12.14±2.47mm,全心衰竭组为8.21±1.32mm。(1)代偿期组与正常对照组之间存在差异,具有统计学意义(P0.01);(2)代偿期和失代偿期相比较,差异具有统计学意义(P0.01);(3)失代偿期,呼吸困难组、右心衰竭组及全心衰竭组之间有差异,差异具有统计学意义(P0.01)3右室Tei指数正常对照组为0.32±0.06,慢性肺心病代偿期组为0.49±0.12,慢性肺心病失代偿期呼吸困难组为0.64±0.11,右心衰竭组为0.72±0.15,全心衰竭组为0.91±0.13。(1)在正常对照组和慢性肺心病之间,Tei值之间具有差异,差异具有统计学意义(P0.01);(2)在慢性肺心病代偿期和失代偿期之间,Tei也具有差异(P0.01);(3)在慢性肺疾病失代偿期的各组之间,Tei值也具有显著差异(P0.01)。4肺动脉收缩压(PASP)正常对照组为23.56±3.10mm Hg,慢性肺心病代偿期为32.45±5.25mm Hg,慢性肺心病失代偿期呼吸困难组为36.45±4.02mm Hg,右心衰竭组为44.12±3.45mm Hg,全心衰竭组为58.34±6.23mm Hg。(1)通过对正常组和慢性肺心病患者肺动脉压比较,两者之间存在差异,差异具有统计学意义(P0.01);(2)在慢性肺心病代偿期和失代偿期之间,肺动脉压之间具有差异(P0.01);(3)在慢性失代偿期组内之间两两比较,肺动脉压之间具有统计学意义(P0.01)。相关性分析中,脑钠肽N末端片段和右室Tei指数、肺动脉收缩压、三尖瓣环收缩期位移具有显著性相关(P0.01)。脑钠肽N末端片段与右室Tei指数Pearson系数为0.583,与肺动脉收缩压Pearson系数为0.675,与三尖瓣环收缩期位移Pearson系数为-0.609。在对肺动脉压和右室Tei指数、三尖瓣环收缩期位移相关性进行分析,肺动脉压与三尖瓣环收缩期位移和右室Tei指数Pearson系数分别为-0.775、0.699,显著性相关(P0.01)。结论:1疾病组中NT-Pro BNP浓度高于健康组,且随着疾病的进展程度,浓度出现上升,提示NT-Pro BNP能够有效反应慢性肺心病疾病变化。2三尖瓣环收缩期位移、右室Tei指数以及肺动脉压可以作为衡量疾病情况的有效指标。三尖瓣环收缩期位移、右室Tei指数以及肺动脉收缩压能够有效的检测患者右心功能变化,对于慢性肺心病早期诊断具有重要意义。3 NT-Pro BNP浓度和三尖瓣环收缩期位移、右室Tei指数以及肺动脉收缩压具有明显相关性,可以作为一种联合检测标准,以提高慢性肺心病诊断手段。
[Abstract]:Objective: chronic pulmonary heart disease is a common disease in the elderly. The chronic pulmonary heart disease is mainly maintenance treatment, improving the living condition of patients. Therefore, it is particularly important for the early diagnosis of patients. In the diagnosis of chronic pulmonary heart disease, mainly depends on the clinical manifestation, patients with physical examination, auxiliary check the electrocardiogram, the lack of specific laboratory evidence. Plasma brain natriuretic peptide (B-type natriurefic, peptide, BNP) has a good correlation with cardiac load between terminal brain natriuretic peptide plasma N (N-terminal pro-brain natriuretic peptide, NT-pro BNP) is a N- terminal fragment of BNP prohormone split after no activity, compared with BNP. The half-life is longer, more stable, more can reflect the activation of BNP pathway, the level of plasma NT-pro BNP level of heart failure increased. Echocardiography is a noninvasive detection method with good reproducibility, for the heart The dirty and vascular function can play an effective monitoring. This study by echocardiography right ventricular systolic function related indexes recommended (TAPSE, Tei index), impact assessment of right ventricular systolic function of pulmonary heart disease and pulmonary hypertension, and compared with NT-pro BNP, to explore the significance of the above indexes were evolution in the process of development and clinical guidance in the diagnosis for pulmonary heart disease, pulmonary heart disease provides a simple, noninvasive and reliable method. Methods: collected in our hospital to determine 176 cases of patients with chronic pulmonary heart disease were divided into two groups, including decompensated chronic pulmonary heart disease group (57 cases) and chronic cor pulmonale. Group (119 cases), and chronic decompensated pulmonary heart disease were divided into dyspnea group (42 cases), right heart failure group (55 cases) and heart failure group (22 cases) and normal control group. (30 cases of Men Zhenjian Kang people). After 24 hours of packet The use of electrochemical NT-Pro BNP concentration in serum of patients with chemiluminescence detection, at the same time the use of color Doppler ultrasonography in three patients with tricuspid annular systolic displacement observation, right ventricular Tei index. According to the Bemoulli equation and the estimation of right atrial pressure (RAP) to calculate the pulmonary artery systolic pressure. Results: 1 patients with NT-Pro BNP detection decompensated pulmonary heart disease was 301.34 + 43.22pg/ml, in patients with chronic cor pulmonale. Dyspnea group was 734.12 + 52.32 pg/ml, right heart failure group was 2134.45 + 521.42 pg/ml, heart failure group was 6345.56 + 3621.82 pg/ml, patients with normal physical examination was 142.42 + 23.12pg/ml. (1) normal control group and chronic pulmonary heart disease group differences, the difference was statistically significant (P0.01); (2) between chronic lung disease group 22 comparison, there are differences between decompensated and decompensated, with statistical significance (P0.01); (3) chronic pulmonary heart disease Between the decompensated group, the difference was statistically significant NT-pro the content of BNP (P0.01).2 three tricuspid annular systolic displacement in the normal control group was 22.72 + 2.01mm, decompensated chronic pulmonary heart disease group was 20.12 + 3.23mm, in patients with chronic cor pulmonale. Dyspnea group was 17.34 + 2.73mm, right heart failure group was 12.14 + 2.47mm, heart failure group was 8.21 + 1.32mm. (1) there are differences between the decompensated group and normal control group, with statistical significance (P0.01); (2) during compensatory and compared, the difference was statistically significant (P0.01); (3) loss compensation period, dyspnea group, there are differences between right heart failure group and heart failure group, the difference was statistically significant (P0.01) 3 right ventricular Tei index in normal control group is 0.32 + 0.06, decompensated chronic pulmonary heart disease group is 0.49 + 0.12, chronic decompensated pulmonary heart disease dyspnea group was 0.64 + 0.11, right heart failure group is 0.72 + 0.15, full The heart failure group was 0.91 + 0.13. (1) between the control group and the chronic pulmonary heart disease with different Tei values, the difference was statistically significant (P0.01); (2) in decompensated chronic pulmonary heart disease and decompensation, Tei also has the difference (P0.01); (3) between the groups in chronic decompensated pulmonary disease, the Tei value also has significant difference (P0.01).4 pulmonary artery systolic pressure (PASP) and normal control group was 23.56 + 3.10mm Hg, decompensated chronic pulmonary heart disease was 32.45 + 5.25mm Hg in patients with chronic cor pulmonale. Dyspnea group was 36.45 + 4.02mm Hg, right heart failure group 44.12 + 3.45mm Hg, heart failure group was 58.34 + 6.23mm Hg. (1) through the pressure of the normal group and chronic pulmonary heart disease in patients with pulmonary artery, differences between the two, the difference was statistically significant (P0.01); (2) in decompensated chronic pulmonary heart disease and decompensation, pulmonary artery with pressure differences between (P0.01) (3); The comparison of 22 chronic decompensated group, pulmonary artery pressure was statistically significant (P0.01). The correlation analysis of brain natriuretic peptide, N terminal fragment and Tei index of right ventricular and pulmonary artery systolic pressure, three tricuspid annular systolic displacement has significant correlation (P0.01). Brain natriuretic peptide and N terminal fragment right ventricular Tei index Pearson index is 0.583, and the pulmonary artery systolic pressure coefficient of Pearson was 0.675, and the systolic displacement of tricuspid valve ring three Pearson coefficient -0.609. on pulmonary artery pressure and right ventricular Tei index, three tricuspid annular systolic displacement correlation analysis, pulmonary artery pressure and three tricuspid annulus and right ventricular systolic displacement the Tei index Pearson coefficient was -0.775,0.699, significant correlation (P0.01). Conclusion: 1 NT-Pro BNP disease group was significantly higher than that in healthy group, and with the progress of disease, the concentration increased, suggesting that NT-Pro BNP can effectively be chronic pulmonary heart disease The change of.2 three tricuspid annular systolic displacement, right ventricular Tei index and pulmonary artery pressure can be used as an effective indicator of disease. Three tricuspid annular systolic displacement, right ventricular Tei index and pulmonary artery systolic pressure can detect changes of right ventricular function in patients with effective, is of great significance for the.3 NT-Pro BNP concentration and three tricuspid valve ring systolic displacement in early diagnosis of chronic pulmonary heart disease, right ventricular Tei index and pulmonary artery systolic pressure was significantly correlated with, can be used as a joint detection standard, in order to improve the diagnosis of chronic pulmonary heart disease.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.5

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