先天性心脏病相关肺动脉高压介入封堵前后血清同型半胱氨酸变化及其临床意义

发布时间：2018-05-17 23:34

本文选题：先天性心脏病相关肺动脉高压(PAH-CHD) + 血清Hcy　；参考：《南昌大学》2016年硕士论文

【摘要】：目的:研究先天性心脏病相关肺动脉高压(PAH-CHD)患者介入封堵前后血清同型半胱氨酸(Hcy)浓度变化及其与血流动力学参数相关性,综合评价血清Hcy对于PAH-CHD诊断的临床意义。方法:收集南昌大学第二附属医院心血管内科住院部2015年1月到2015年12月在心内科心导管室成功行CHD介入封堵术的左向右分流的CHD患者104例,按照术中平均肺动脉压力将其分成四组:先天性心脏病未合并肺动脉高压组(CHD-NPAH组)27例;先天性心脏病合并轻度肺动脉高压组(CHD-LPAH组)32例;先天性心脏病合并中度肺动脉高压组(CHD-MPAH组)26例;先天性心脏病合并重度肺动脉高压组(CHD-SPAH组)19例;收集同期体检中心30名健康患者作为正常对照组,收集纳入对象的临床资料,超声心动图测量心室腔大小;使用右心导管检查术获得血流动力学参数;采用速率法测定血清HCY浓度。结果:(1)术前PAH-CHD患者(CHD-LPAH组、CHD-MPAH组及CHD-SPAH组)血清Hcy浓度显著高于正常对照组及CHD-NPAH组患者,P均0.05,有显著统计学意义;组间多重比较,CHD-LPAH组、CHD-MPAH组、CHD-SPAH组各组之间比较均有统计学差异(P0.05);CHD-NPAH组患者血清Hcy水平高于正常对照组,但是差异无统计学意义(P0.05);(2)CHD患者血清Hcy浓度高于正常对照组,P0.01;但是ASD、PDA、VSD各组之间Hcy浓度虽然有差异,却没有统计学意义(P0.05);(3)术前PAH-CHD患者血清Hcy浓度与PASP、MPAP、PVR呈正相关(r分别为0.283,P0.05;0.374,0.347,P0.01);(4)血清Hcy浓度为16.84umol/L时,对CHD-SPAH有一定的识别作用,敏感度为79.3%,特异性为58.9%,ROC曲线下面积为0.778,P0.01;(5)介入封堵术后PAH-CHD患者血清Hcy浓度及肺动脉压力均下降,术后Hcy浓度与PASP仍存在一定正相关(r为0.315,P0.01)。结论:1.PAH-CHD患者血清Hcy浓度明显升高。2.PAH-CHD患者血清Hcy水平整体上与PASP、MPAP、PVR存在一定正相关的关系,并且Hcy在诊断CHD-SPAH上有较强的敏感性,故检测血清Hcy浓度可作为一种评估PAH-CHD患者严重程度的辅助手段。3.介入封堵术后患者的PASP及血清Hcy浓度明显下降,两者仍存在线性关系,故介入封堵术是治疗PAH-CHD的有效手段,检测血清Hcy浓度有望成为PAH-CHD患者重要的随访指标。
[Abstract]:Objective: to study the changes of serum homocysteine cysteine (Hcy) concentration and its correlation with hemodynamic parameters in patients with congenital heart disease associated pulmonary hypertension (PAH-CHD) before and after interventional occlusion, and to evaluate the clinical significance of serum Hcy in the diagnosis of PAH-CHD. Methods: a total of 104 patients with left to right shunt CHD who were successfully performed CHD interventional closure from January 2015 to December 2015 in Department of Cardiovascular Medicine, second affiliated Hospital of Nanchang University, were collected. According to the mean pulmonary artery pressure during operation, the patients were divided into four groups: 27 cases in CHD-NPAH group without congenital heart disease complicated with pulmonary hypertension, 32 cases in CHD-LPAH group with congenital heart disease complicated with mild pulmonary hypertension. There were 26 cases of CHD-MPAH in congenital heart disease with moderate pulmonary hypertension and 19 cases of CHD-SPAH in congenital heart disease with severe pulmonary hypertension. Ventricular cavity size was measured by echocardiography, hemodynamic parameters were obtained by right cardiac catheterization, and serum HCY concentration was measured by rate method. Results (1) the serum Hcy levels of PAH-CHD patients with CHD-LPAH and CHD-SPAH were significantly higher than those of normal control group and CHD-NPAH group (P < 0.05). There was significant difference between CHD-MPAH group and CHD-SPAH group. The serum Hcy level of CHD-MPAH group was higher than that of normal control group. However, there was no significant difference in serum Hcy concentration between the two groups. However, there was a significant difference in the concentration of Hcy between the two groups. However, there was no statistical significance between serum Hcy concentration and PASP MPAPPVR in patients with PAH-CHD before operation. The positive correlation between serum Hcy concentration and PASP MPAPPVR was 0.283 P0.05 ~ 0.374 ~ 0.347 ~ 0.347 ~ 0.37 ~ (1) ~ (-1) 16.84umol/L. The serum Hcy concentration could recognize CHD-SPAH in a certain degree, but it had a significant effect on the recognition of CHD-SPAH when the serum Hcy concentration was 16.84umol/L (P _ (0.05) P _ (0.05) P ~ (0.01). The sensitivity was 79.3, the specificity was 58.9 and the area under the ROC curve was 0.778g / P0.01g / 5) after interventional occlusion, the serum Hcy concentration and pulmonary artery pressure decreased in patients with PAH-CHD. There was still a positive correlation between Hcy concentration and PASP after interventional occlusion. Conclusion the serum Hcy level in patients with PAH-CHD was significantly higher than that in patients with PAH-CHD. 2. There was a positive correlation between the serum Hcy level of patients with PAH-CHD and the Hcy of PASP-MPAPP, and Hcy had a strong sensitivity in the diagnosis of CHD-SPAH. Therefore, the detection of serum Hcy concentration can be used as an auxiliary method to evaluate the severity of PAH-CHD patients. The concentration of PASP and serum Hcy decreased significantly after interventional closure, and there was still a linear relationship between them. Therefore, interventional occlusion is an effective method for the treatment of PAH-CHD. The detection of serum Hcy concentration is expected to be an important follow-up index for PAH-CHD patients.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.1;R544.1

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