左卡尼汀对老年非ST段抬高型心肌梗死患者内皮素和脑钠肽水平的影响
发布时间：2018-12-29 18:58
【摘要】：目的:急性冠脉综合征(acute coronary syndrome,ACS)包括不稳定型心绞痛(unstable angina,UA)、非ST段抬高型心肌梗死(non-ST-elevated myocardial infarction,NSTEMI)和ST段抬高型心肌梗死(ST-elevated myocardial infarction,STEMI),临床上对于ACS的生化诊断标志物已经进行了大量的研究。本文主要探讨左卡尼汀对老年NSTEMI患者内皮素(Endothelin-1,ET-1)和脑钠肽(brain natriuretic peptide,BNP)水平的影响,旨在为NSTEMI的诊治提供新的理论依据。方法:选择2013-10~2014-08在发病后6小时内入住承德市中心医院老年病科和心内科、入院后确诊为NSTEMI的年龄大于60岁的患者60例作为治疗组,随机分为左卡尼汀组(A组)和常规治疗组(B组),所有患者入院后即刻及入院后分别在发病6h、12h、24h、3d、7d、14d六个时段均留取血标本测定血清ET-1及BNP水平。选择承德市中心医院健康体检中心体检健康的60周岁以上老年人30例作为对照组。抽取空腹血标本测定血清ET-1及BNP水平。对三组之间ET-1和BNP水平进行统计学分析。结果:血清BNP、ET-1水平的组间比较:左卡尼汀组、常规治疗组和对照组三组相比,血清BNP水平和ET-1水平在每一个时间点各组间均有明显差异(各P值均0.05),且表现为常规治疗组左卡尼汀组对照组的大小关系。血清BNP、ET-1水平的动态变化:(1)血清BNP水平的动态变化:常规治疗组患者血清BNP呈双峰分泌,第一峰峰值高于左卡尼汀组,出现时间为12.50±0.70h,第二峰出现时间为156.60±7.34h。而左卡尼汀组血清BNP浓度只有一个峰值,出现时间为15.84±0.98h。(2)血清ET-1水平的动态变化:左卡尼汀组和常规治疗组血清ET-1水平动态变化均存在一个峰值。常规治疗组峰值较高,其出现时间7.90±0.21h。左卡尼汀组峰值出现时间为16.70±1.30h。结论:1左卡尼汀组及常规治疗组患者血清BNP水平和ET-1水平均高于对照组,说明在NSTEMI后病情演变过程中存在血清BNP、ET-1水平的升高。2左卡尼汀组患者血清BNP水平和ET-1水平低于常规治疗组,说明左卡尼汀能降低NSTEMI患者血清BNP、ET-1升高程度。3根据血清BNP及ET1水平的变化,说明应用左卡尼汀治疗可使NSTEMI患者ET-1、BNP水平降低,说明左卡尼汀对NSTEMI发病后神经内分泌激活有抑制作用,此作用有利于患者恢复。
[Abstract]:Objective: acute coronary syndrome (acute coronary syndrome,ACS) includes unstable angina pectoris (unstable angina,UA), non-ST segment elevation myocardial infarction (non-ST-elevated myocardial infarction,NSTEMI) and ST segment elevation myocardial infarction (ST-elevated myocardial infarction,STEMI). A great deal of research has been done on the biochemical diagnostic markers of ACS. The effect of levacarnitine on the levels of endothelin (Endothelin-1,ET-1) and brain natriuretic peptide (brain natriuretic peptide,BNP) in elderly patients with NSTEMI was studied in order to provide a new theoretical basis for the diagnosis and treatment of NSTEMI. Methods: sixty patients with NSTEMI over 60 years old who were admitted to Department of Geriatrics and Cardiology in Chengde Central Hospital within 6 hours after onset were selected as treatment group. The patients were randomly divided into two groups: group A (group A) and group B (routine therapy). The serum ET-1 and BNP levels were measured immediately after admission and at 6 hours after the onset of the disease. Thirty elderly people over 60 years of age were selected as control group. Serum levels of ET-1 and BNP were measured in fasting blood samples. The levels of ET-1 and BNP in the three groups were analyzed statistically. Results: compared with the control group, the serum BNP and ET-1 levels in the Levocarnitine group, the routine treatment group and the control group were significantly different at each time point (P < 0. 05). The relationship between the size of the control group and the levocarnitine group in the routine treatment group was also presented. Dynamic changes of serum BNP,ET-1 level: (1) dynamic changes of serum BNP level: the serum BNP secretion of patients in routine treatment group was double peak, the first peak value was higher than that of levocarnitine group, the time of occurrence was 12.50 卤0.70 h. The time of the second peak was 156.60 卤7.34 h. However, there was only one peak value of serum BNP in levocarnitine group (15.84 卤0.98 h). (2) the dynamic change of serum ET-1 level: there was a peak value of serum ET-1 level in levocarnitine group and routine treatment group. The peak value of routine treatment group was higher, the time of occurrence was 7.90 卤0.21 h. The peak time of L-carnitine group was 16.70 卤1.30 h. Conclusion: 1 the serum BNP and ET-1 levels of patients in levocarnitine group and routine treatment group are higher than those in control group, indicating the presence of serum BNP, in the course of disease development after NSTEMI. The level of serum BNP and ET-1 in levocarnitine group was lower than that in routine treatment group, which indicated that levocarnitine could decrease the increase of serum BNP,ET-1 in NSTEMI patients. 3 according to the changes of serum BNP and ET1 levels, levocarnitine could decrease the level of serum BNP,ET-1 in patients with NSTEMI. The results suggest that levacarnitine can decrease the level of ET-1,BNP in patients with NSTEMI, and that levocarnitine can inhibit the neuroendocrine activation after the onset of NSTEMI, which is beneficial to the recovery of patients with NSTEMI.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.22
本文编号：2395254
[Abstract]:Objective: acute coronary syndrome (acute coronary syndrome,ACS) includes unstable angina pectoris (unstable angina,UA), non-ST segment elevation myocardial infarction (non-ST-elevated myocardial infarction,NSTEMI) and ST segment elevation myocardial infarction (ST-elevated myocardial infarction,STEMI). A great deal of research has been done on the biochemical diagnostic markers of ACS. The effect of levacarnitine on the levels of endothelin (Endothelin-1,ET-1) and brain natriuretic peptide (brain natriuretic peptide,BNP) in elderly patients with NSTEMI was studied in order to provide a new theoretical basis for the diagnosis and treatment of NSTEMI. Methods: sixty patients with NSTEMI over 60 years old who were admitted to Department of Geriatrics and Cardiology in Chengde Central Hospital within 6 hours after onset were selected as treatment group. The patients were randomly divided into two groups: group A (group A) and group B (routine therapy). The serum ET-1 and BNP levels were measured immediately after admission and at 6 hours after the onset of the disease. Thirty elderly people over 60 years of age were selected as control group. Serum levels of ET-1 and BNP were measured in fasting blood samples. The levels of ET-1 and BNP in the three groups were analyzed statistically. Results: compared with the control group, the serum BNP and ET-1 levels in the Levocarnitine group, the routine treatment group and the control group were significantly different at each time point (P < 0. 05). The relationship between the size of the control group and the levocarnitine group in the routine treatment group was also presented. Dynamic changes of serum BNP,ET-1 level: (1) dynamic changes of serum BNP level: the serum BNP secretion of patients in routine treatment group was double peak, the first peak value was higher than that of levocarnitine group, the time of occurrence was 12.50 卤0.70 h. The time of the second peak was 156.60 卤7.34 h. However, there was only one peak value of serum BNP in levocarnitine group (15.84 卤0.98 h). (2) the dynamic change of serum ET-1 level: there was a peak value of serum ET-1 level in levocarnitine group and routine treatment group. The peak value of routine treatment group was higher, the time of occurrence was 7.90 卤0.21 h. The peak time of L-carnitine group was 16.70 卤1.30 h. Conclusion: 1 the serum BNP and ET-1 levels of patients in levocarnitine group and routine treatment group are higher than those in control group, indicating the presence of serum BNP, in the course of disease development after NSTEMI. The level of serum BNP and ET-1 in levocarnitine group was lower than that in routine treatment group, which indicated that levocarnitine could decrease the increase of serum BNP,ET-1 in NSTEMI patients. 3 according to the changes of serum BNP and ET1 levels, levocarnitine could decrease the level of serum BNP,ET-1 in patients with NSTEMI. The results suggest that levacarnitine can decrease the level of ET-1,BNP in patients with NSTEMI, and that levocarnitine can inhibit the neuroendocrine activation after the onset of NSTEMI, which is beneficial to the recovery of patients with NSTEMI.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.22
【引证文献】
相关期刊论文 前1条
1 任春萍;孙春艳;施保环;;左卡尼汀治疗老年非ST段抬高型心肌梗死的效果[J];实用临床医药杂志;2016年05期
，本文编号：2395254
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2395254.html
最近更新
教材专著
