血清N端脑钠肽和红细胞分布宽度心脏再同步化治疗前后的变化和分析

发布时间：2018-05-05 12:50

本文选题：心脏再同步化治疗 + 慢性心力衰竭　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:观察心脏再同步化治疗(CRT)前后心力衰竭患者血清氨基末端B型脑钠肽前体(NT-proBNP)及红细胞分布宽度(RDW)浓度,探讨RDW和NT-proBNP反应对CRT预后的价值。方法:选取2015年04月~2016年04月因慢性心力衰竭(CHF)在我院住院的患者20例,男9例,女11例,年龄53~78(68.3±7.81)岁。检测CRT术前、术后6个月的血液学参数与超声心动图参数.定义随访终点为全因死亡(包括心脏移植)或心衰再住院。定义对CRT有反应为术后6个月超声心动图检测左室收缩末期容积(LVESV)≥15%。所得数据采用SPSSl6.0统计软件进行统计分析:计量资料用均数±标准差表示,组间比较采用独立样本t检验或,组内比较采用配对样本t检验;计数资料采用Fisher确切概率法,两变量之间采用线性相关分析(r)。以p=0.05为检验水准,p0.05即为差异有显著性。结果:所有患者手术顺利,术中无急性左心衰竭、心律失常等情况发生,术后定期门诊程控起搏器状态,均工作正常。根据心超指标将患者分为CRT有反应组和CRT无反应组,有反应组14例(70%),无反应组6例(30%),两组在年龄、性别、心力衰竭的病因、吸烟史、高血压、糖尿病、高血脂史、NYHA心功能分级、临床用药(ARB/ACEI类、利尿剂、β-受体阻滞剂、洋地黄类)等方面无明显差异(p0.05)。心脏再同步化治疗前,左室功能参数(LVEF、LVESV、LVEDD)、血清NT-pro BNP、RDW水平,在有反应组和无反应组之间无明显的差异(p0.05)。CRT治疗后6个月,两组参数均有明显差异(p0.05)。在CRT有反应组,左室功能参数(LVEF、LVESV、LVEDV)、血清NT-pro BNP水平,治疗前、后差异均有统计学意义(P0.05),RDW水平较术前无明显变化(p0.05)。在CRT无反应组,左室功能参数(LVEF、LVESV、LVEDV)、血清NT-pro BNP水平,治疗前、后差异均无差异(P0.05),RDW水平较术前明显增高,差异有统计学意义(p0.05)。血清NT-pro BNP水平与LVESV、LVEDD呈正相关(r值分别为0.719、0.923;p0.01),与LVEF呈负相关(r=-0.897;p0.01)。血清RDW水平与LVESV、LVEDD呈正相关(r值分别为0.759、0.617;p0.01),与LVEF呈负相关(r=-0.740;p0.01)。血清RDW水平与NT-proBNP呈正相关(r=0.513;p0.01)。结论:通过检测患者术前及术后血清中RDW、NT-pro BNP水平变化可以对心脏再同步化治疗临床疗效做出评价。
[Abstract]:Objective: To observe the concentration of serum amino terminal B type natriuretic peptide precursor (NT-proBNP) and red cell distribution width (RDW) in patients with heart failure before and after cardiac resynchronization therapy (CRT), and to explore the value of RDW and NT-proBNP reaction to the prognosis of CRT. Methods: 20 cases of chronic heart failure (CHF) hospitalized in our hospital from 04 month ~2016 year, 2015, and 9 men 9 were selected. Cases, 11 women, age 53~78 (68.3 + 7.81) years of age. The hematological parameters and echocardiographic parameters were measured before CRT operation and 6 months after operation. The end point of follow-up was defined as all causes of death (including heart transplantation) or heart failure and rehospitalization. The CRT was defined by 6 months after 6 months of echocardiography to determine the left ventricular end systolic volume (LVESV) more than 15%. by S Statistical analysis of PSSl6.0 statistical software: measurement data were expressed with mean standard deviation of mean number, independent sample t test or paired sample t test were used in groups, and Fisher exact probability method was used for counting data and linear correlation analysis (R) between the two variables. P=0.05 was used as the test level and P0.05 was significant difference. Result: all patients were operated smoothly, without acute left heart failure and arrhythmia, and regular pacemaker state was normal after operation. According to the heart super index, the patients were divided into CRT reaction group and CRT non reaction group, 14 cases (70%), 6 cases (30%), and two groups in age, sex, heart failure. Smoking history, hypertension, diabetes, hyperlipidemia, NYHA cardiac function classification, clinical medication (ARB/ACEI, diuretic, beta blocker, digitalis), and so on, there were no significant differences (P0.05). Before cardiac resynchronization therapy, left ventricular function parameters (LVEF, LVESV, LVEDD), serum NT-pro BNP, RDW level, no obvious between the reaction group and the non reaction group. 6 months after.CRT treatment, the parameters of the two groups were significantly different (P0.05). In the CRT reaction group, the left ventricular function parameters (LVEF, LVESV, LVEDV), the serum NT-pro BNP level, before the treatment, the difference was statistically significant (P0.05), RDW level than before the operation (P0.05). There was no difference in serum NT-pro BNP level before treatment (P0.05), and the level of RDW was significantly higher than that before operation (P0.05). The serum NT-pro BNP level was positively correlated with LVESV and LVEDD (r value was 0.719,0.923; P0.01). 759,0.617; P0.01) has a negative correlation with LVEF (r=-0.740; P0.01). Serum RDW level is positively correlated with NT-proBNP (r=0.513; P0.01). Conclusion: the changes in NT-pro BNP level can be used to evaluate the clinical efficacy of cardiac resynchronization by detecting RDW in the sera before and after the operation.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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