舒张功能不全的心房颤动患者超声心动图指标与NT-proBNP的变化及相关性分析

发布时间：2018-10-31 19:57

【摘要】：背景心房颤动是一种常见的心律失常,快速无序的颤动波代替心房规则有序的舒缩活动,其发病率在我国有逐年上升趋势[1]。由于心房失去有效的收缩与舒张,心房的泵血功能受损,加之心室不规律的反应可导致心功能不全,包括舒张功能不全及收缩功能不全。心房不规则的颤动可导致心房肌重构,心房肌的重构也加重心房颤动的进展。有研究表明,NT-proBNP与心房颤动及左心房的结构变化有着密切的关系[2][3]。目前有关心房颤动患者的NT-proBNP的变化研究较多,但是有关舒张功能不全的心房颤动患者研究较少。本研究以舒张功能不全的心房颤动患者作为研究对象,通过分析NT-proBNP与超声心动图指标在研究对象中的变化并探讨其相关性,来评价此类患者的严重程度并为此类患者的精准诊疗做出理论依据。目的探讨超声心动图各参数指标与NT-proBNP在舒张功能不全的心房颤动患者中的变化及相关性。对象与方法选取心血管内科收治入院的所有舒张功能不全的心房颤动患者204例,分为阵发性心房颤动组87例,持续性心房颤动组117例(包含长程持续性心房颤动与永久性心房颤动),另选取收治入院的100例不伴有心房颤动的舒张功能不全患者作为对照组,收集所有入选对象的超声心动图参数(左房内径值、左房容积指数、E/Em、左室射血分数、左室舒张末内径)、NT-proBNP及肾小球滤过率(eGFR)水平,三组间的比较采用方差分析,任意两组间的比较采用LSD-q检验。用两个连续变量间的相关分析检验NT-proBNP与超声心动图各参数及eGFR的相关性。取P0.05有统计学差异。结果1.心房颤动组(包括阵发性心房颤动组和持续性心房颤动组)的左房内径值、左房容积指数、NT-proBNP均高于对照组,且差异有统计学意义(P0.05)。2.三组间任意两组间的左房内径值、左房容积指数、NT-proBNP差异均有统计学意义(P0.05)。3.三组间任意两组间舒张早期二尖瓣口血流峰值速度/二尖瓣环舒张早期运动速度E/Em、左室射血分数、左室舒张末内径、eGFR差异均无统计学意义(P0.05)。4.NT-proBNP与左心房内径(r=0.626,P0.001)、左心房容积指数(r=0.47,P=0.001)相关性分析呈正相关。5.NT-proBNP与E/Em(r=0.295,P=0.102)、左室射血分数(r=-0.216,P=0.158)、左室舒张末内径(r=0.153,P=0.417)、eGFR(r=-0.238,P=0.146)不相关。结论1.舒张功能不全的心房颤动患者的左心房结构出现病理性改变,左心房增大。2.舒张功能不全的心房颤动患者中NT-proBNP增高且与左心房内径、左心房容积指数成正相关。3.可以通过左心房结构改变及NT-proBNP的变化预测房颤的进展。
[Abstract]:Background Atrial fibrillation is a common arrhythmia. The rapid and disordered fibrillation wave replaces the regular and orderly systolic and diastolic activity of the atrium. The incidence of atrial fibrillation is increasing year by year in China [1]. Due to the loss of effective systolic and diastolic function of the atrium, the pump function of the atrium and the irregular response of the ventricle may lead to cardiac insufficiency, including diastolic insufficiency and systolic insufficiency. Irregular atrial fibrillation can lead to atrial remodeling, which also exacerbates the progression of atrial fibrillation. Studies have shown that NT-proBNP is closely related to atrial fibrillation and the structural changes of left atrium [2] [3]. At present, there are more studies on the changes of NT-proBNP in patients with atrial fibrillation, but less on patients with atrial fibrillation with diastolic dysfunction. In this study, atrial fibrillation patients with diastolic dysfunction were studied by analyzing the changes of NT-proBNP and echocardiography indexes in the study subjects and the correlation between them. To evaluate the severity of such patients and to provide a theoretical basis for accurate diagnosis and treatment of such patients. Objective to investigate the relationship between echocardiographic parameters and NT-proBNP in patients with atrial fibrillation with diastolic dysfunction. Participants and methods 204 patients with atrial fibrillation who were admitted to the Department of Cardiovascular Medicine were divided into paroxysmal atrial fibrillation group (n = 87). 117 patients with persistent atrial fibrillation (including long-term persistent atrial fibrillation and permanent atrial fibrillation) and 100 patients with diastolic dysfunction without atrial fibrillation were selected as control group. Echocardiographic parameters (left atrial diameter, left atrial volume index, E / E, left ventricular ejection fraction, left ventricular end-diastolic diameter), NT-proBNP and glomerular filtration rate (eGFR) were collected. ANOVA was used to compare the three groups and LSD-q test was used to compare any two groups. Correlation analysis between two continuous variables was used to test the correlation between NT-proBNP and echocardiographic parameters and eGFR. There was statistical difference between the two groups. Result 1. Left atrial diameter, left atrial volume index and NT-proBNP in atrial fibrillation group (including paroxysmal atrial fibrillation group and persistent atrial fibrillation group) were significantly higher than those in control group (P0.05). There were significant differences in left atrial diameter, left atrial volume index and NT-proBNP between any two groups among the three groups (P0.05). The peak velocity of mitral orifice flow in early diastolic phase and the velocity of mitral annular movement E / E, ejection fraction of left ventricle, diameter of end diastolic of left ventricle, peak velocity of mitral orifice and early diastolic velocity of mitral annulus in any two groups between three groups. There was no significant difference in eGFR (P0.05). There was a positive correlation between 4.NT-proBNP and left atrial diameter (r = 0.626, P 0.001), left atrial volume index (r, 0.47, P ~ 0.001), 5.NT-proBNP and E/Em (r = 0.295, P < 0.05). There was no correlation among left ventricular ejection fraction (RV), left ventricular end-diastolic diameter (RV) and left ventricular end-diastolic diameter (RV). Conclusion 1. In patients with atrial fibrillation with diastolic dysfunction, pathological changes were found in the left atrial structure, and the left atrium was enlarged. In patients with atrial fibrillation with diastolic dysfunction, NT-proBNP was increased and positively correlated with left atrial diameter and left atrial volume index. Changes in left atrial structure and NT-proBNP can be used to predict the progression of atrial fibrillation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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