骨髓增殖性肿瘤患者心脏结构与功能改变及其临床意义

发布时间：2018-05-04 20:17

本文选题：骨髓增殖性肿瘤 + 真性红细胞增多症　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的分析骨髓增殖性肿瘤(Myeloproliferative neoplasms,MPN)患者心脏多功能彩色超声心动仪检查参数,探讨MPN患者心脏结构和功能改变及其特点。方法收集我院2011年9月至2016年9月诊治的MPN患者临床资料及心脏多功能彩色超声心动仪检查参数,与同期我院收治的非血液病对照组患者(性别、年龄、主要心血管高危因素与MPN患者匹配)进行比较。对MPN出现的心脏结构和功能改变与MPN临床特征(血细胞计数、JAK2 V617F基因突变、病程)进行相关分析。结果1.MPN组患者初诊时白细胞、中性粒细胞、嗜碱性粒细胞、单核细胞、红细胞(Red blood cell,RBC)、红细胞压积(Hematocrit,Hct)、血红蛋白(Hemoglobin,Hb)、血小板计数明显高于对照组(P0.05)。两组之间性别、年龄、主要心血管危险因素、甘油三酯(Triglyceride,TG)、胆固醇(Cholesterol,CHO)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL)、高敏C反应蛋白(High-sensitivity c-reactive protein,hs-CRP)差异均无统计学意义(P0.05)。2.MPN组患者左房内径(37.60±6.64mm)明显高于对照组(35.01±4.37mm),两组间差异有统计学意义(P=0.016)。MPN组患者左室舒张末期内径、左室收缩末期内径、右室内径、主动脉根部内径、左室射血分数、肺动脉收缩压均在正常值范围;除左室射血分数外,均高于对照组(P0.05)。3.MPN伴异常心脏结构患者54.17%,明显高于对照组患者(32.29%),两组间差异有统计学意义(P0.05)。异常心脏结构以左室肥厚(34.38%)、主动脉瓣增厚(即主动脉瓣退行性变,27.08%)、左心扩大(12.50%)为主,发生率明显高于对照组(分别为17.71%,11.45%,4.17%),均有统计学差异(P0.05)。伴2项、3项及以上异常心脏结构发生率分别为17.71%、5.21%,明显高于对照组(6.25%,0%),均有统计学差异(P0.05)。4.MPN伴异常心脏功能患者81.25%,明显高于对照组患者(64.58%),两组间差异有统计学意义(P0.05)。主要表现为左室舒张功能减退(75%)、肺动脉高压(pulmonary arterial hypertension,PAH)(11.45%)、左室收缩功能减退(12.50%),其中PAH、左室收缩功能减退发生率明显高于对照组(分别为0%,2.08%),差异均有统计学意义(P0.05)。2项心脏功能异常发生率为16.67%,明显高于对照组(2.08%),均有统计学差异(P0.05)。5.单因素相关分析:初诊时RBC、Hct、Hb与左室舒张末期内径(分别为r=0.281,P=0.001;r=0.374,P=0.000;r=0.343,P=0.000)、左室收缩末期内径(分别为r=0.203,P=0.013;r=0.330,P=0.000;r=0.334,P=0.000)、右室内径(分别为r=0.268,P=0.001;r=0.291,P=0.001;r=0.312,P=0.000)成正相关。Logistic多因素回归分析显示初诊时Hct及Hb升高预示主动脉瓣退行性变风险增加(β=0.436,OR=1.229;β=0.186,OR=0.831)。6.病程5年以上MPN患者左房内径值(39.69±7.55mm)大于病程5年以内MPN患者(36.43±5.82mm),差异有统计学意义(P0.05);同时伴PAH患者(20%)明显多于病程5年以内患者(6.56%),两组间差异有统计学意义(P0.05)。结论1.MPN患者可出现心脏结构及功能的异常,主要表现为左心房扩大、左室肥厚、主动脉瓣膜退行性变、左室收缩及舒张功能减退、PAH等。2.左室舒张末期内径、左室收缩末期内径、右室内径与初诊时RBC、Hct、Hb水平有关;初诊时Hct、Hb增高是MPN患者发生主动脉瓣退行性变风险的独立危险因素。3.MPN更易发生多种心脏结构及功能异常;病程越长,左心房扩大、PAH发生率越高。
[Abstract]:Objective to analyze the parameters of cardiac multi-function color echocardiography in patients with Myeloproliferative neoplasms (MPN) and to explore the changes and characteristics of cardiac structure and function in MPN patients. Methods the clinical data and cardiac multi-function color echocardiography of MPN patients in our hospital from September 2011 to September 2016 were collected. Compared with the non hematologic disease control group (sex, age, major cardiovascular risk factors matched with MPN patients) in our hospital during the same period, the changes in the cardiac structure and function of the MPN were correlated with the clinical features of MPN (blood cell count, JAK2 V617F gene mutation, and the course of disease). Results the leukocyte in the group 1.MPN patients was initially diagnosed. Granulocyte, basophil, monocyte, red blood cell (Red blood cell, RBC), red blood cell pressure (Hematocrit, Hct), hemoglobin (Hemoglobin, Hb), platelet count was significantly higher than that of the control group (P0.05). The sex, age, major cardiovascular risk factors, triglycerides (Triglyceride, TG), cholesterol (Cholesterol, RBC), high density between the two groups High density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (Low density lipoprotein cholesterol, LDL), and high sensitivity C reactive protein (35.01 + 4) were significantly higher than those of the control group (35.01 + 4). .37mm), the differences in the two groups were statistically significant (P=0.016) in group.MPN, left ventricular end diastolic diameter, left ventricular end systolic diameter, right ventricle diameter, aortic root diameter, left ventricular ejection fraction, pulmonary systolic pressure in normal range, except left ventricular ejection fraction, were higher than that of control group (P0.05).3.MPN with abnormal heart structure in 54.17%, Ming Significantly higher than the control group (32.29%), there was significant difference between the two groups (P0.05). Abnormal cardiac structure with left ventricular hypertrophy (34.38%), aortic valve thickening (that is, aortic valve degeneration, 27.08%) and left heart enlargement (12.50%) were significantly higher than those in the control group (17.71%, 11.45%, 4.17%). There were statistically significant differences (P0.05). 2, 3 The incidence of abnormal cardiac structure was 17.71% and 5.21%, which was significantly higher than that of the control group (6.25%, 0%). There were statistically significant differences (P0.05).4.MPN with abnormal cardiac function (81.25%), significantly higher than those in the control group (64.58%). The difference between the two groups was statistically significant (P0.05). The main manifestations were the left ventricular diastolic dysfunction (75%) and pulmonary hypertension ( Pulmonary arterial hypertension, PAH) (11.45%), left ventricular systolic function decreased (12.50%), and the incidence of PAH and left ventricular systolic dysfunction was significantly higher than that of the control group (0%, 2.08%). The difference was statistically significant (P0.05).2 term cardiac dysfunction was 16.67%, significantly higher than that of the control group (2.08%), with statistical difference (P0.05).5. Single factor correlation analysis: RBC, Hct, Hb and left ventricular end diastolic diameter at first visit (r=0.281, P=0.001; r=0.374, P=0.000; r=0.343, P=0.000), and the end systolic inner diameter of left ventricular (r=0.203, P=0.013; r=0.330). IC multivariate regression analysis showed that the increase of Hct and Hb at first diagnosis indicated the increase of the risk of aortic valve degeneration (beta =0.436, OR=1.229; beta =0.186, OR=0.831) and the left atrial diameter (39.69 + 7.55mm) of MPN patients more than 5 years in the course of MPN (36.43 + 5.82mm) within 5 years of the disease course, and the difference was statistically significant (20%). Compared with patients within 5 years (6.56%), there was significant difference between the two groups (P0.05). Conclusion 1.MPN patients could have abnormal cardiac structure and function, including left atrium enlargement, left ventricular hypertrophy, aortic valve degenerative change, left ventricular systolic and diastolic function reduction, PAH and.2. left ventricular end diastolic diameter, and left ventricular end systolic diameter, The internal diameter of the right ventricle is related to the level of RBC, Hct and Hb at the first diagnosis. The higher Hct and Hb at first diagnosis are the independent risk factors for the risk of degenerative aortic valve degeneration in MPN patients..3.MPN is more likely to occur in many kinds of cardiac structural and functional abnormalities; the longer the course, the enlarged left atrium, and the higher the incidence of PAH.

【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.3

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