慢性收缩性心力衰竭发生发展中黄嘌呤氧化酶与肌钙蛋白T、BNP的相关性及诊断价值的研究

发布时间：2018-03-16 13:38

本文选题：慢性收缩性心力衰竭　切入点：黄嘌呤氧化酶　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究探讨慢性收缩性心力衰竭患者中血清黄嘌呤氧化酶(Xanthine Oxidase,XO)与B型钠尿肽(B-Type Natriuretic Peptide,BNP)、肌钙蛋白T(Troponin T,c Tn T)之间的关系,并评价XO在慢性收缩性心衰患者中的诊断价值,旨在为慢性收缩性心衰提供一个新的诊断指标。方法:于2015-07~2016-07期间,根据《中国心力衰竭诊断和治疗指南2014》在新疆维吾尔自治区人民医院心内科住院患者中选择符合慢性收缩性心力衰竭(heart failure with reduced ejection fraction,HF-REF)诊断标准的患者94例为病例组。同期选择在我科住院的患有其他心脏疾病的非心衰患者90例为对照组。排除不符合慢性收缩性心力衰竭的诊断标准、肾功能不全、痛风、慢性阻塞性肺疾病、心脏或血管恶性肿瘤或先天畸形、新发的心肌梗死(1个月)、血液系统疾病、妊娠、系统性红斑狼疮等疾病。采用酶联免疫法检测XO的活性。采用双抗体夹心酶联免疫(ELISA)法进行CTn T的检测。BNP水平测定采用(美国Biosite公司)博适Triage床边快速定量心肌梗死心衰诊断仪。并收集两组研究对象的年龄、身高、体重、血压等基线资料。探讨XO与BNP、c Tn T之间的关系,计算黄嘌呤氧化酶诊断试验的灵敏度、特异度及Youden指数,绘制受试者工作曲线(ROC曲线),从而更好地评价该诊断试验的诊断价值。结果:1.各组间基本资料之间的比较,发现两组间年龄、体重、身高、BMI差异均无统计学意义。2.XO与BNP呈正相关,且相关程度较强,与CTn T也呈正相关,但相关程度较弱。3.诊断慢性收缩性心衰中XO的ROC曲线下面积为(AUGROC=0.791),提示该诊断标准有一定准确性,在临床应用中诊断价值中等。4.本试验通过Youden指数(正确诊断指数)得出XO诊断慢性收缩性心衰中最理想临界点为:3633.1pg/ml,其灵敏度0.734、特异度0.733、阳性预测值0.74、阴性预测值0.73。结论:慢性收缩性心力衰竭患者中血清黄嘌呤氧化酶(XO)与B型钠尿肽(BNP)、肌钙蛋白T(c Tn T)呈正相关。血清黄嘌呤氧化酶(XO)对慢性收缩性心力衰竭的诊断价值中等,其诊断的最佳临界点为3633.1pg/ml。
[Abstract]:Objective: To study the serum xanthine oxidase in patients with chronic systolic heart failure (Xanthine Oxidase XO) and B type natriuretic peptide (B-Type Natriuretic, Peptide, BNP), T (Troponin T C, troponin Tn T) the relationship between, and evaluate the diagnostic value of XO in patients with chronic systolic heart failure, in order to provide a new diagnostic index for chronic systolic heart failure. Methods: during the period of 2015-07~2016-07, according to the China guidelines for the diagnosis and treatment of heart failure in the choice of 2014> compliance in patients with chronic congestive heart failure in hospital department of Cardiology, people's Hospital of the Xinjiang Uygur Autonomous Region (heart failure with reduced ejection fraction, HF-REF) in 94 cases of diagnostic criteria for patients at the same period. In our hospital with other heart disease non heart failure patients 90 cases as control group. The diagnostic standards are not consistent with the exclusion of chronic systolic heart failure, kidney The function is not complete, gout, chronic obstructive pulmonary disease, cardiac or vascular tumors or congenital malformations, new onset myocardial infarction (1 months), blood system diseases, pregnancy, systemic lupus erythematosus and other diseases. ELISA was used to examine the activity of XO. By using double antibody sandwich ELISA (ELISA CTn T) method to detect the level of.BNP was determined by the (American Biosite company) for myocardial infarction heart failure diagnosis instrument Bo Triage bedside rapid quantitative. And of the two groups were collected. The age, height, weight, blood pressure and other baseline data. To investigate the XO and BNP, the relationship between C Tn T and the sensitivity calculation of xanthine oxidase diagnostic test the specificity and Youden index, receiveroperating curve (ROC curve), so as to better evaluate the diagnostic value of diagnostic test. Results: the comparison between the 1. groups of the basic data, found that two groups of age, weight, height, the difference was BMI No statistical significance of.2.XO and BNP were positive, and the degree of correlation is strong, positive correlation with the CTn T, but the area of ROC curve and low degree of.3. in the diagnosis of chronic systolic heart failure in under the XO (AUGROC=0.791), suggesting that the diagnostic standard of a certain accuracy, in the clinical application of diagnostic value of this test by Youden index medium.4. (correct diagnosis index) that XO diagnosis of ideal critical point for chronic systolic heart failure: 3633.1pg/ml, its sensitivity was 0.734, specificity 0.733, positive predictive value of 0.74, negative predictive value of 0.73. conclusion: the serum xanthine oxidase in patients with chronic systolic heart failure (XO) and in B type natriuretic peptide (BNP). Troponin T (C Tn T). Positive correlation of serum xanthine oxidase (XO) in the diagnosis of chronic congestive heart failure secondary value, the best critical point for the diagnosis of 3633.1pg/ml.

【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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