超敏C反应蛋白及胱抑素C与急性心肌梗死后心室重构的相关性研究

发布时间：2018-04-06 20:24

  本文选题：急性心肌梗死　切入点：超敏C反应蛋白　出处：《广西医科大学》2017年硕士论文

【摘要】：目的急性心肌梗死(AMI)是临床上的急危重症,是冠心病常见且危重的类型,有着高住院率、高死亡率的特点,严重危害着人类的健康。急性心肌梗死后心室重构是导致病情进行性发展,引起心力衰竭、恶性心律失常甚至心源性猝死等的重要因素。目前很多研究已经表明炎症反应在AMI的发病过程中起着重要作用,但在AMI后心室重构的具体作用和机制仍不甚明确。本研究通过检测AMI患者入院时血清超敏C反应蛋白(Hs-CRP)和胱抑素C(CysC)的水平,结合入院后1周及随访末(12个月)的超声心动图指标。探讨血清Hs-CRP和CysC的水平与首发AMI后心室重构程度的相关性,为临床AMI的治疗、病情评估和预后的预测提供科学依据。方法纳入2013年10月-2015年10月期间,在广西医科大学第八附属医院心血管内科住院治疗的发病24h以内的首次确诊急性ST段抬高型心肌梗死患者80例,包括前壁32例,广泛前壁13例,下壁24例,正后壁11例;入选者均符合2012年美国心脏病协会(AHA)、美国心脏病学会(ACC)、欧洲心脏病学会(ESC)及世界心脏联盟(WHF)共同制定并发表的AMI的诊断标准。排除陈旧心梗、周围血管或血栓性疾病、脑卒中、风心病、甲状腺疾病、结核、恶性肿瘤、急慢性感染等患者;对入选患者入院后24小时内抽静脉血测定血清Hs-CRP、CysC及其他生化指标,于入院后1周行心脏超声测定左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)等指标,另选同期门诊健康体检者80例为对照组,分析两组间各参数的差异。所入选AMI患者于随访末(12个月)复查超声心动图,并详细记录以上指标,设定发病后1周LVEDV为LVEDV0,随访末(12个月)时lvedv为lvedv1,lvedv增长率△lvedv%=(lvedv1-lvedv0)/lvedv0×100%。并根据△lvedv%的大小将ami组患者划分为心室重构组(△lvedv≥20%,n=19)和非重构组(△lvedv20%,n=61),比较两组之间各参数的差异。用统计学软件spss16.0对数据进行分析,计量资料用均数±标准差表示,计量资料组间差异的比较采用非配对t检验,计数资料采用卡方检验。分析血清hs-crp及cysc水平与左室重构各指标进行相关性,采用spearman法。将性别、年龄、hs-crp、cysc、ck-mb、tc、tg、高血压、糖尿病等临床指标与与心室重构进行logistic回归分析。结果采用双侧检验,p0.05为差异有统计学意义。结果(1)ami组患者血清hs-crp水平为7.41±1.85mg/l,血清cysc水平为1.68±0.35mg/l;对照组的血清hs-crp水平为1.46±0.23mg/l,血清cysc水平为0.44±0.12mg/l;ami组患者血清hs-crp及cysc均显著高于对照组,差异有统计学意义(p0.05,见表1、图1);(2)ami组患者发病后1周lvef57.3±7.8%,lvedv96.7±15.4ml,lvedd46.3±6.2mm;对照组lvef68.2±9.4%,lvedv78.4±13.2ml,lvedd40.5±3.7mm;两组间各参数比较,差异均有统计学意义(p均0.05,见表1、图1)。(3)ami组患者随访末(12个月)复查超声心动图,lvef48.69±6.53%,lvedv108.4±14.8ml,lvedd52.74±8.28mm;根据随访末(12个月)△lvedv%的大小将ami组患者分为心室重构组(△lvedv≥20%)和非重构组(△lvedv20%):心室重构组:19例,男性12例,女性7例,年龄62.58±8.31(41~78)岁。非重构组:61例,男性39例,女性22例,年龄64.92±9.16(45~78)岁(见表2)。两组间年龄、性别、体重、血脂、糖尿病、梗死部位、治疗方法(保守治疗、溶栓治疗、pci治疗)差异均无统计学意义(p0.05,见表2)。心室重构组患者血清hs-crp水平为9.46±1.72mg/l,血清cysc水平为1.98±0.33mg/l;非重构组患者血清hs-crp水平为4.15±1.25mg/l,血清cysc水平为1.32±0.21mg/l;心室重构组患者血清hs-crp及CysC均显著高于非重构组,差异有统计学意义(P0.05,见表2、图2);心室重构组患者LVEF 44.7±6.4%,LVEDV128.4±13.2ml,LVEDD60.5±7.1mm;非重构组患者LVEF 59.3±7.8%,LVEDV90.7±15.4ml,LVEDD42.3±5.8mm;两组间各参数比较,差异均有统计学意义(P均0.05,见表2、图2)。(4)血清Hs-CRP与LVEDD(r=0.75,P0.05)、LVEDV(r=0.58,P0.05)呈显著正相关;与LVEF(r=-0.73,P0.05)呈显著负相关(表3、图3-5)。血清CysC与LVEDD(r=0.48,P0.05)、LVEDV(r=0.75,P0.05)呈显著正相关;与LVEF(r=-0.52,P0.05)呈显著负相关(表4、图6-8)。(5)将性别、年龄、Hs-CRP、CysC、CK-MB、血脂、高血压、糖尿病等临床指标与心室重构做Logistic回归分析,结果显示Hs-CRP和CysC进入回归方程,其他指标被剔除,说明在本研究中Hs-CRP和CysC与心室重构独立相关,是预示心室重构的可靠指标。结论1、在心肌梗死急性期,血清Hs-CPR、CysC浓度有不同程度的升高,在心肌梗死早期及晚期均发生心室重构;2、急性心肌梗死后第一天血清Hs-CPR、CysC含量水平与心室重构程度呈显著的、独立的相关性,提示血清Hs-CPR、CysC含量水平是预测AMI后心室重构程度的可靠指标,对病情评估、预测预后有一定的临床指导意义。
[Abstract]:Objective to acute myocardial infarction (AMI) is a severe clinical type, is a common and severe coronary heart disease, with high hospitalization rates, high mortality and serious harm to human health. Ventricular remodeling after acute myocardial infarction is the result of the development of disease, caused by heart failure, an important factor of malignant arrhythmia even suddencardiac death. At present, many studies have shown that inflammation plays an important role in the pathogenesis of AMI, but in AMI the specific role of ventricular remodeling and the mechanism is still unclear. In this study, through the detection of AMI patients in the hospital when the serum high-sensitivity C reactive protein (Hs-CRP) and cystatin C (CysC) level, with 1 weeks after admission and at the end of follow-up (12 months) of the echocardiography. The correlation of ventricular remodeling on serum Hs-CRP level and the first AMI and CysC after the treatment of AMI in clinical practice, the assessment of disease severity and prognosis To provide a scientific basis for prediction. Methods included in October 2013 -2015 year in October, in the hospital within 24h treatment for the first time in the diagnosis of disease in patients with acute ST segment elevation myocardial infarction in 80 cases of cardiovascular department of the eighth Affiliated Hospital of Guangxi Medical University, including 32 cases of anterior wall, anterior wall in 13 cases, inferior 24 cases, 11 cases were selected after the wall; are in line with the 2012 American Heart Association (AHA), American Heart Association (ACC), the European Society of Cardiology (ESC) and the World Heart Federation (WHF) jointly formulated and published diagnostic criteria of AMI. The history of old myocardial infarction, vascular and thrombotic diseases, stroke, rheumatic heart disease, thyroid disease, tuberculosis, malignant tumor, acute and chronic infection of patients; patients within 24 hours after admission. Venous blood serum Hs-CRP, CysC and other biochemical indicators in hospital 1 weeks after echocardiographic determination of left ventricular end diastolic diameter (LVEDD), left Left ventricular end diastolic volume (LVEDV), left ventricular ejection fraction (LVEF) and other indicators, choose healthy subjects served as a control group of 80 cases, analysis of the differences between the two groups of parameters. The AMI patients were enrolled in follow-up (12 months) in echocardiography, and detailed records to index. Set the 1 week after the onset of LVEDV is LVEDV0, at the end of follow-up (12 months) when LVEDV was lvedv1, the growth rate of LVEDV lvedv%= (lvedv1-lvedv0) /lvedv0 * 100%. and lvedv% according to the delta size of AMI group were divided into left ventricular remodeling group (LVEDV = 20%, n=19) and non remodeling group (lvedv20%, n=61), compare the differences between the two groups of parameters. The data were analyzed using statistical software SPSS16.0, measurement data with the mean standard deviation of that measurement data between groups were compared using the unpaired t test, count data using chi square test. Analysis of serum hs-CRP and CysC levels and the left ventricular remodeling The correlation index, using the Spearman method. The gender, age, hs-CRP, CysC, CK-MB, TC, TG, hypertension, diabetes and other clinical indicators and ventricular remodeling were analyzed by logistic regression analysis. Results using two-sided test, P0.05 difference was statistically significant. Results (1) hs-CRP level of serum AMI was 7.41 + 1.85mg/l, the level of serum CysC was 1.68 + 0.35mg/l; serum hs-CRP level in control group was 1.46 + 0.23mg/l, the level of serum CysC was 0.44 + 0.12mg/l; hs-CRP and CysC in the patients with AMI were significantly higher than the control group, the difference was statistically significant (P0.05, see Table 1, figure 1); (2) AMI patients after onset 1 weeks lvef57.3 + 7.8%, lvedv96.7 + 15.4ml, lvedd46.3 + 6.2mm; control group lvef68.2 + 9.4%, lvedv78.4 + 13.2ml, lvedd40.5 + 3.7mm; comparing the parameters between the two groups, the differences were statistically significant (P < 0.05, see Table 1, figure 1). (3) patients in the AMI group at the end of follow-up (12 months Super Review) 澹板績鍔ㄥ浘,lvef48.69卤6.53%,lvedv108.4卤14.8ml,lvedd52.74卤8.28mm;鏍规嵁闅忚�挎湥�

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