血清CTRP-5水平与急性心肌梗死后左室重构的相关性研究

发布时间：2018-04-14 12:34

本文选题：急性心肌梗死 + 左室重构　；参考：《河北医科大学》2017年硕士论文

【摘要】：背景:急性心肌梗死是心血管内科重症之一,严重威胁人类健康。急性心肌梗死后左室重构(left ventricle remodeling,LVR)是心梗后心衰、猝死等不良预后的病理基础,提升心肌梗死后病人生存质量的必要前提是对LVR做出早期诊断及治疗。因此不断探索、发现与心梗后LVR相关的因子,具有重要的科研意义。目的:通过测定急性心肌梗死后患者血清CTRP5及NT-proBNP水平,结合心脏超声影像学检查结果,研究CTRP5作为评价急性心肌梗死后左室重构程度及预后的生物学标志物,其反映左室重构程度、预测心肌梗死后心力衰竭发生及发展的可靠性。方法:选取2016年2月至2016年10月间就诊于河北医科大学第二医院,首次确诊为急性ST段抬高型心肌梗死的患者66例,对照组为同期就诊于体检中心的排除冠心病的健康体检者22例。详细记录所有研究对象的年龄、性别、饮食等一般情况,并询问高血压、糖尿病、高脂血症等既往史,完善体格检查。完善所有研究对象的生化全项、心肌酶、肌钙蛋白、氨基末端脑钠肽前体(NT-proBNP)、血清CTRP5的测定,随访AMI组1个月后超声心动图,记录左心射血分数(LVEF)、左室舒张末期容积(LVEDV)、二尖瓣舒张早期血流速度峰值与二尖瓣环舒张早期运动速度峰值比值(E/E’)。应用spss 21.0软件进行统计学分析,认定P0.05时,具有统计学意义。结果:AMI组CTRP5水平(210.55±39.82ng/mL)高于对照组CTRP5水平(107.19±11.72ng/mL),差异具有统计学意义(P0.05)。AMI组CTRP5含量与NT-proBNP水平呈正相关(r=0.619,P0.01)。AMI组CTRP5水平与LVEF呈负相关(r=-0.473,P0.01),与LVEDV呈正相关(r=0.543,P0.01)、与E/E’呈正相关(r=0.499,P0.01)。AMI组NT-pro BNP水平与LVEF呈负相关(r=-0.753,P0.01),与LVEDV呈正相关(r=0.705,P0.01)、与E/E’呈正相关(r=0.752,P0.01)。AMI组血清CTRP5浓度中位数为206.23ng/mL,以此为依据,将急性心肌梗死组患者分为低CTRP5组与高CTRP5组。低CTRP5组中衡量左室重构的各项指标,其中NT-prBNP、LVEDV、E/E’水平均低于高CTRP5组,LVEF水平高于高CTRP5组,且差异均具有统计学意义(P0.05)。结论:急性心肌梗死患者血清CTRP5水平明显高于健康人群,并与NT-proBNP变化趋势一致,均与心肌梗死后左室重构呈正相关。提示CTRP5作为一个重要指标,可预测心肌梗死后左室重构程度。
[Abstract]:Background: acute Myocardial Infarction (AMI) is one of the severe cardiovascular diseases, which is a serious threat to human health.Left ventricular remodeling (LVR) after acute myocardial infarction (AMI) is the pathological basis of poor prognosis such as heart failure and sudden death after myocardial infarction. Early diagnosis and treatment of LVR is a necessary prerequisite to improve the quality of life of patients with acute myocardial infarction.Therefore, it is of great significance to explore and discover the factors related to LVR after myocardial infarction.Objective: to study CTRP5 as a biomarker for evaluating the degree of left ventricular remodeling and prognosis after acute myocardial infarction by measuring the serum CTRP5 and NT-proBNP levels and combining with the results of echocardiography.It can reflect the degree of left ventricular remodeling and predict the occurrence and development of heart failure after myocardial infarction.Methods: from February 2016 to October 2016, 66 patients with acute ST-segment elevation myocardial infarction were selected from the second Hospital of Hebei Medical University.The control group consisted of 22 patients who were excluded from coronary heart disease.The age, sex and diet of all the subjects were recorded in detail, and the past history of hypertension, diabetes, hyperlipidemia were inquired, and physical examination was completed.To improve the biochemical parameters of all subjects, including myocardial enzymes, cardiac troponin, NT-proBNPN, NT-proBNPN, and serum CTRP5. After 1 month follow-up, echocardiography was performed in the AMI group.Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEF) and mitral early diastolic velocity ratio (E / E) were recorded.Spss 21 1.0 software was used for statistical analysis, and it was found that P 0. 05 had statistical significance.There was a negative correlation between Ping and LVEF, a positive correlation with LVEDV, a positive correlation with LVEDV, and a positive correlation with E / E'. The median of serum CTRP5 concentration was 206.23ngmL in the group of E / E, 0.752ngmL, 0.752ngmL, 0.752ngmL, and 0.752ngmL, respectively.Patients with acute myocardial infarction were divided into low CTRP5 group and high CTRP5 group.The indexes of left ventricular remodeling in low CTRP5 group were lower than those in high CTRP5 group (P 0.05), and the levels of NT-prBNPP LVEDVV E 'were lower than those in high CTRP5 group.Conclusion: the level of serum CTRP5 in patients with acute myocardial infarction is significantly higher than that in healthy subjects, and it is consistent with the change trend of NT-proBNP, which is positively correlated with left ventricular remodeling after myocardial infarction.As an important index, CTRP5 can predict the degree of left ventricular remodeling after myocardial infarction.
【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】：R542.22

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