慢性收缩性心力衰竭患者血浆可溶性肾素前体受体水平随心功能分级增加而增高

发布时间：2018-03-20 13:26

  本文选题：慢性心力衰竭　切入点：可溶性肾素前体受体　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:在慢性心力衰竭的病理生理机制中,心脏为了应对受到的高负荷或由于心肌梗死或其他原因造成的心肌损伤,会进行心脏重塑。RAS(renin-angiotensin system,肾素-血管紧张素系统)在心脏重塑以及心力衰竭的发病中起着重要的作用。传统的观点认为RAS仅通过AngⅡ(angiotensinⅡ,血管紧张素Ⅱ)、Ald(Aldosterone,醛固酮)发挥作用。2002年Nguyen G等发现肾素(前体)受体[(P)RR]的存在。目前已有临床研究表明(P)RR 水平能反映某些疾病严重程度,如肾脏疾病、妊娠期高血压、妊娠期糖尿病、阻塞性睡眠呼吸暂停综合征等。但有关(P)RR与心力衰竭方面的研究甚少。(P)RR是否可在心力衰竭人体中过度表达及是否与NYHA心功能分级有关尚不明确。目的:本研究主要探讨心力衰竭患者血浆可溶性(P)RR[s(P)RR]是否升高,以及s(P)RR水平是否与NYHA心功能分级具有相关性。方法:入选2015年6月至2015年11月就诊于我院心内科的慢性收缩性心力衰竭患者61例及19例年龄相匹配的健康体检者作为研究对象,按照NYHA(New York Heart Association,纽约心脏病协会)的心功能分级标准对心力衰竭患者进行心功能分级。根据心功能将慢性收缩性心力衰竭患者分为3组:B组:心功能Ⅱ级患者14例;C组:心功能Ⅲ级患者37例;D组:心功能Ⅳ级患者10例。慢性收缩性心力衰竭患者组中,合并肾功能不全[估测的肾小球滤过率(estimated glomerular filltration rate,eGFR)120ml/min/1.73m2]的患者 26 例,将此26例患者按照心功能分级分为2组:α组:心功能Ⅲ级合并eGFR降低患者18例;β组:心功能ⅣV级合并eGFR降低患者8例。获得 BNP(brain natriuretic peptide,脑钠肽)、Scr(serum creatinine,血肌酐)、UA(uricacid,尿酸)、AngⅠ(angiotensionⅠ,血管紧张素Ⅰ)、AngⅡ(angiotensionⅡ,血管紧张素 Ⅱ)、Ald(aldosterone,醛固酮)、s(P)RR 及 PRC 水平。LAD(left atrial diameter,左房内径)、LVEDd(left ventricular end-diastolic diameter,左室舒张末期内径)。统计学分析:采用SPSS 21.0软件对研究数据进行统计分析。计量资料多组比较采用单因素方差分析或Kruskal-walillis秩和检验。计数资料组间比较采用x2检验。α与β组计量资料比较采用独立样本t检验。相关性分析用Spearman直线相关,将心功能分级数值化后采用多元逐步回归分析检验。组间差异采用p值表示,双侧检验p0.05差异有统计学意义。结果:1.与正常对照组相比,心力衰竭组的LAD、LVDs、LVEF、LVMI等指标有显著差异(p0.05)。B组、C组、D组间,以上指标差异无统计学意义。2.D组较其他3组s(P)RR水平显著升高,C组较对照组s(P)RR水平显著升高(p0.05)。C组、D组较A组相比,PRC明显升高,但2组间差异无统计学意义。A组和B组相比s(P)RR差异无统计学意义(p0.05)。3.β组s(P)RR水平较α组显著升高(p0.05)。α组和β组的eGFR差异无统计学意义。4.应用Spearman相关分析法,发现s(P)PR与心功能分级、BNP、LVMI、Scr、UA、AngⅠ成正相关,与eGFR、LVEF等呈负相关(p0.05)。以s(P)PR作为因变量,应用多元逐步线性回归分析结果显示:s(P)PR与心功能分级呈独立正相关(β=0.378,p=0.001)。结论:1.慢性心力衰竭患者NYHA心功能Ⅱ级者较心功能正常者s(P)RR水平升高不明显,但随NYHA心功能分级水平的进一步增高,s(P)RR水平进一步升高。2.慢性心力衰竭患者s(P)RR与NYHA心功能分级、BNP、Scr、UA、AngⅠ呈正相关,与eGFR、LVEF等呈负相关。3.NYHA心功能分级水平是s(P)RR的独立相关因素。
[Abstract]:Background: in the pathophysiology of chronic heart failure, the heart is in order to cope with the high load or due to myocardial infarction or other causes of myocardial injury, cardiac remodeling will.RAS (renin-angiotensin system, renin angiotensin system) plays an important role in cardiac remodeling and heart failure in the pathogenesis of the traditional view. Only by RAS Ang II (angiotensin II, angiotensin II (Aldosterone), Ald, aldosterone) play a role in.2002 Nguyen G found that renin receptor (precursor) [(P) RR]. Many clinical studies have shown that (P) RR level can reflect the severity of certain diseases, such as kidney disease. Gestational hypertension, gestational diabetes mellitus, obstructive sleep apnea syndrome (P). But the study of RR and heart failure is rare. (P) RR is and whether overexpression in human heart failure With NYHA grading of cardiac function is not clear. The objective of this study is to explore the plasma of patients with heart failure (P) and soluble RR[s (P) RR] is increased, and the S (P) RR level is correlated with NYHA grading of cardiac function. Methods: selected from June 2015 to November 2015 in our hospital department of cardiology patients with chronic congestive heart failure 61 patients and 19 age-matched healthy subjects as the research object, according to the NYHA (New York Heart Association, New York Heart Association) on heart failure patients with heart function classification of cardiac function grading standards. According to the cardiac function in patients with chronic congestive heart failure were divided into 3 groups: B group: heart function grade II patients 14 cases; group C: 37 cases of patients with cardiac function of grade III; group D: 10 patients were. In patients with chronic congestive heart failure group, glomerular filtration and renal dysfunction [estimated rate (estimated glomerular Filltration rate, eGFR) of 26 120ml/min/1.73m2] patients, the 26 patients were classified according to the cardiac function were divided into 2 groups: a group: heart function grade and eGFR decreased in 18 cases; beta group: heart function IV V level with eGFR decreased in 8 patients. BNP (brain natriuretic peptide, brain natriuretic peptide Scr (serum), creatinine, serum creatinine (uricacid), UA, uric acid), Ang I (Angiotension I, angiotensin II (angiotension II), Ang, angiotensin II (aldosterone), Ald, aldosterone), s (P) RR and PRC (left atrial diameter.LAD level, left the real LVEDd (left ventricular diameter), end-diastolic diameter, left ventricular end diastolic diameter). Statistical analysis: statistical analysis of research data using SPSS 21 software. Measurement data were compared using one-way ANOVA or Kruskal-walillis test. Enumeration data between groups were compared by x2 test and alpha. 尾缁勮�￠噺璧勬枡姣旇緝閲囩敤鐙�绔嬫牱鏈瑃妫，

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