直接胆红素在先天性心脏病合并肺动脉高压患者的临床观察
发布时间：2018-07-26 11:07
【摘要】：研究背景和目的肺动脉高压是由一种或多种已知及未知病因引起的肺动脉压力异常升高的病理生理状态。作为一种严重威胁人类生命的疾病于1973年在日内瓦被世界卫生组织(WHO)第一次系统描述并命名。其病因中先天性心脏病是常见原因之一,先天性心脏病是心脏及大血管在胎儿时期受到遗传及环境等多种因素导致的发育异常的疾病。先天性心脏病合并肺动脉高压是指由体-肺分流型的先天性心脏病所引起的肺动脉压力异常升高的病理状态,属于毛细血管前型的肺高压。先天性心脏病合并肺动脉高压早期可行介入封堵和外科手术矫正治疗,但很多患者发现时已经丧失手术机会。未经矫正治疗的先天性心脏病合并肺动脉高压至晚期可发展为艾森曼格综合征,平均寿命(32.5±16.0)岁,死亡率极高[1]。晚期可以出现栓塞、出血、红细胞增多症、感染、心律失常、猝死、肝肾功能异常和骨骼疾病等并发症。患者的主要死因是心源性猝死、心力衰竭和咯血[2],随着人类对肺动脉高压的进一步研究,一系列的诊断方法、治疗方法被发现,使先天性心脏病合并肺动脉高压的患者的生存率与生活质量都得到了不同水平的提高和改善,但仍未让人们满意。我国是先天性心脏病合并肺动脉高压的高发国,此病每年给国家造成了巨大的经济负担。因此,针对该疾病诊断及治疗的研究具有广阔的研究前景,并且愈来愈多的研究者们为致力于寻找到新的、有效的、方便的诊断与治疗方法而努力。目前针对先天性心脏病合并肺动脉高压的研究较多,但因其病变过程和机制复杂,仍有许多机制尚未完全明确。众多机制中氧化应激作为导致先天性心脏病合并肺动脉高压的重要影响因素之一越来越受到重视[3-5]。通过研究氧化应激的反应过程发现其参与物和生成物对先天性心脏病合并肺动脉高压的诊断与治疗具有重要意义。在氧化应激反应过程中,胆红素是其中一个重要指标。经研究发现胆红素具有较强的的还原性,做为内源性的抗氧化因子,能够有效地清除氧自由基[6]。直接胆红素做为胆红素的一种,同样具有抵抗氧化作用,因此我们设计出本试验,探讨直接胆红素水平与先天性心脏病合并肺动脉高压疾病程度的关系。希望进一步揭示先天性心脏病合并肺动脉高压形成的的机制。实验方法收集我院2014年1月至2017年1月明确诊断为先天性心脏病合并肺动脉高压的患者46例,其中包括动脉导管未闭12例,室间隔缺损10例,房间隔缺损24例。所有入选患者行心电图、超声心动图、血常规、血生化等检查。根据患者病情严重程度行WHO分级,将患者分为I/II、III、IV组;根据肺动脉收缩压分级将患者分为轻度、中度、重度3组;根据右心扩张程度(RV/LV)分级将患者分为未扩张、轻度、中度、重度4组。采用SPSS21.0数据分析系统对直接胆红素平与上述分组和肺动脉收缩压力值、RV/LV值进行非参数秩-和检验、卡方检验及相关性分析处理。分析DBIL在各分组之间的差异和相关指标的相关性,结合患者疾病程度对患者病情进行评估。实验结果1.在先天性心脏病合并肺动脉高压的患者各分组中,年龄和性别与WHO分级、右心扩张程度分级、肺动脉高压收缩压分级无统计学差异。2.直接胆红素与WHO分级、肺动脉收缩压分级分组之间存在统计学差异。3.在WHO分级中Ⅰ/Ⅱ级与Ⅳ级比较χ2=17.473,P0.001;Ⅲ级与Ⅳ级比较χ2=10.386,P=0.001。在肺动脉收缩压分级中轻度与重度比较χ2=8.685,P=0.003。随着分级的升高直接胆红素水平有升高趋势,并且当疾病程度较重时相关性越显著。4.肺动脉收缩压与直接胆红素相关系数r=0.390,P=0.007,差异有统计学意义,呈正相关。RV与LV比值与直接胆红素相关系数r=0.323,P=0.028,差异有统计学意义,呈正相关。实验结论直接胆红素水平与肺动脉收缩压、心功能、右心扩张程度水平有关,初步研究结果认为直接胆红素可以用来评估先天性心脏病合并肺动脉高压患者疾病严重程度,对临床医生选择相对应对临床治疗方案具有一定的临床指导意义。
[Abstract]:Background and objective pulmonary hypertension is the pathophysiological state of abnormal elevated pulmonary arterial pressure caused by one or more known and unknown causes. As a serious threat to human life, the first system of the WHO (WHO) was described and named in Geneva in 1973. Congenital heart disease is common in the cause of the disease. One of the reasons is that congenital heart disease is a developmental disorder caused by a variety of factors such as heredity and environment in the fetal period. Congenital heart disease combined with pulmonary hypertension refers to the pathological state of abnormal increase of pulmonary arterial pressure caused by the congenital heart disease of the body and lung shunt, which belongs to the pre capillary type. Pulmonary hypertension. Congenital heart disease combined with pulmonary hypertension, early intervention closure and surgical correction, but many patients have been found to have lost the operation opportunity. Uncorrected congenital heart disease combined with pulmonary hypertension can develop into Eisen Mange's syndrome, the average life span is (32.5 + 16) years, and the death rate is very high [1]. late may appear embolism, hemorrhage, erythrocytosis, infection, arrhythmia, sudden death, abnormal liver and kidney function and bone disease. The main cause of death is cardiac sudden death, heart failure and hemoptysis [2]. With the further study of human pulmonary hypertension, a series of diagnostic methods, treatment methods are found, innate The survival rate and quality of life of the patients with sexual heart disease and pulmonary hypertension have been improved and improved, but they are still not satisfied. There are broad prospects for research, and more and more researchers are trying to find new, effective and convenient methods for diagnosis and treatment. At present, there are many studies on congenital heart disease with pulmonary hypertension, but many mechanisms are still not completely clear because of the complicated process and mechanism. Stress is one of the most important factors leading to congenital heart disease combined with pulmonary hypertension. [3-5]. has been paid more and more attention to the reaction process of oxidative stress. It is important for the diagnosis and treatment of congenital heart disease with pulmonary hypertension. In the process of oxidative stress, bilirubin It is one of the important indicators. It has been found that bilirubin has strong reducibility and is an endogenous antioxidant factor. It can effectively remove the oxygen free radical [6]. direct bilirubin as a kind of bilirubin and also resist oxidation. Therefore, we designed this experiment to explore direct bilirubin level and congenital heart. The relationship between disease and the degree of pulmonary hypertension. We hope to further reveal the mechanism of congenital heart disease combined with pulmonary hypertension. 46 cases of congenital heart disease combined with pulmonary hypertension were diagnosed in our hospital from January 2014 to January 2017, including 12 cases of patent ductus arteriosus and 10 cases of ventricular septal defect. 24 cases of atrial septal defect. All selected patients were examined by electrocardiogram, echocardiography, blood routine, and blood biochemistry. According to the severity of the patient's WHO, the patients were divided into I/II, III, and IV groups; the patients were divided into mild, moderate, and heavy groups according to the systolic pressure of pulmonary artery, and the patients were divided into non expansion according to the right heart dilatation degree (RV/LV) classification. 4 groups, mild, moderate, and severe. The SPSS21.0 data analysis system was used to perform non parametric rank sum test, chi square test and correlation analysis on the value of direct bilirubin leveling with the above group and the systolic pressure of pulmonary artery, RV/LV value, chi square test and correlation analysis. The correlation of the differences between the groups and the related indexes of the DBIL was analyzed, and the patient's disease degree was combined with the patient's disease degree. Results 1. in the group of patients with congenital heart disease and pulmonary hypertension, age and sex with WHO classification, right heart dilatation grade, pulmonary hypertension systolic pressure classification,.2. direct bilirubin and WHO classification, pulmonary systolic pressure classification groups between the statistical difference.3. in WHO score Grade I / II was compared with grade IV (2=17.473, P0.001), and grade III was compared with grade IV 2=10.386, and P=0.001. was compared to severe and severe in pulmonary systolic pressure by X 2=8.685. P=0.003. increased the level of direct bilirubin with the increase of classification, and the more significant the correlation was when the degree of disease was heavier, the more significant the correlation of.4. pulmonary systolic pressure and direct bile duct pressure. Erythropoietin correlation coefficient r=0.390, P=0.007, the difference has statistical significance, positive correlation.RV and LV ratio and direct bilirubin correlation coefficient r=0.323, P=0.028, the difference has statistical significance, positive correlation. Experimental conclusion direct bilirubin level is related to pulmonary systolic pressure, cardiac function, right heart dilatation level, preliminary results think direct gallbladder Erythropoietin can be used to assess the severity of the disease in patients with congenital heart disease combined with pulmonary hypertension. It is of certain clinical significance for clinicians to choose relative clinical treatment options.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.1;R544.1
[Abstract]:Background and objective pulmonary hypertension is the pathophysiological state of abnormal elevated pulmonary arterial pressure caused by one or more known and unknown causes. As a serious threat to human life, the first system of the WHO (WHO) was described and named in Geneva in 1973. Congenital heart disease is common in the cause of the disease. One of the reasons is that congenital heart disease is a developmental disorder caused by a variety of factors such as heredity and environment in the fetal period. Congenital heart disease combined with pulmonary hypertension refers to the pathological state of abnormal increase of pulmonary arterial pressure caused by the congenital heart disease of the body and lung shunt, which belongs to the pre capillary type. Pulmonary hypertension. Congenital heart disease combined with pulmonary hypertension, early intervention closure and surgical correction, but many patients have been found to have lost the operation opportunity. Uncorrected congenital heart disease combined with pulmonary hypertension can develop into Eisen Mange's syndrome, the average life span is (32.5 + 16) years, and the death rate is very high [1]. late may appear embolism, hemorrhage, erythrocytosis, infection, arrhythmia, sudden death, abnormal liver and kidney function and bone disease. The main cause of death is cardiac sudden death, heart failure and hemoptysis [2]. With the further study of human pulmonary hypertension, a series of diagnostic methods, treatment methods are found, innate The survival rate and quality of life of the patients with sexual heart disease and pulmonary hypertension have been improved and improved, but they are still not satisfied. There are broad prospects for research, and more and more researchers are trying to find new, effective and convenient methods for diagnosis and treatment. At present, there are many studies on congenital heart disease with pulmonary hypertension, but many mechanisms are still not completely clear because of the complicated process and mechanism. Stress is one of the most important factors leading to congenital heart disease combined with pulmonary hypertension. [3-5]. has been paid more and more attention to the reaction process of oxidative stress. It is important for the diagnosis and treatment of congenital heart disease with pulmonary hypertension. In the process of oxidative stress, bilirubin It is one of the important indicators. It has been found that bilirubin has strong reducibility and is an endogenous antioxidant factor. It can effectively remove the oxygen free radical [6]. direct bilirubin as a kind of bilirubin and also resist oxidation. Therefore, we designed this experiment to explore direct bilirubin level and congenital heart. The relationship between disease and the degree of pulmonary hypertension. We hope to further reveal the mechanism of congenital heart disease combined with pulmonary hypertension. 46 cases of congenital heart disease combined with pulmonary hypertension were diagnosed in our hospital from January 2014 to January 2017, including 12 cases of patent ductus arteriosus and 10 cases of ventricular septal defect. 24 cases of atrial septal defect. All selected patients were examined by electrocardiogram, echocardiography, blood routine, and blood biochemistry. According to the severity of the patient's WHO, the patients were divided into I/II, III, and IV groups; the patients were divided into mild, moderate, and heavy groups according to the systolic pressure of pulmonary artery, and the patients were divided into non expansion according to the right heart dilatation degree (RV/LV) classification. 4 groups, mild, moderate, and severe. The SPSS21.0 data analysis system was used to perform non parametric rank sum test, chi square test and correlation analysis on the value of direct bilirubin leveling with the above group and the systolic pressure of pulmonary artery, RV/LV value, chi square test and correlation analysis. The correlation of the differences between the groups and the related indexes of the DBIL was analyzed, and the patient's disease degree was combined with the patient's disease degree. Results 1. in the group of patients with congenital heart disease and pulmonary hypertension, age and sex with WHO classification, right heart dilatation grade, pulmonary hypertension systolic pressure classification,.2. direct bilirubin and WHO classification, pulmonary systolic pressure classification groups between the statistical difference.3. in WHO score Grade I / II was compared with grade IV (2=17.473, P0.001), and grade III was compared with grade IV 2=10.386, and P=0.001. was compared to severe and severe in pulmonary systolic pressure by X 2=8.685. P=0.003. increased the level of direct bilirubin with the increase of classification, and the more significant the correlation was when the degree of disease was heavier, the more significant the correlation of.4. pulmonary systolic pressure and direct bile duct pressure. Erythropoietin correlation coefficient r=0.390, P=0.007, the difference has statistical significance, positive correlation.RV and LV ratio and direct bilirubin correlation coefficient r=0.323, P=0.028, the difference has statistical significance, positive correlation. Experimental conclusion direct bilirubin level is related to pulmonary systolic pressure, cardiac function, right heart dilatation level, preliminary results think direct gallbladder Erythropoietin can be used to assess the severity of the disease in patients with congenital heart disease combined with pulmonary hypertension. It is of certain clinical significance for clinicians to choose relative clinical treatment options.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.1;R544.1
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