基于“治未

发布时间：2018-01-20 16:40

  本文关键词： 治未病 房性早搏 心房颤动 血清标志物　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：心房颤动是临床上最常见的心律失常,部分患者有严重的临床症状,而且发生缺血性卒中、心肌梗死、心力衰竭等并发症风险较高,因此尽早防治房颤有重要意义。房颤主要的病理表现是心房重构,而房性早搏可能是心房重构的早期表现。本研究通过系统评价,以评估现有临床研究中房性早搏预测心房颤动的效应；并通过回顾性研究,以探讨房性早搏和心房颤动血清标志物的相关性；以中医“治未病”理念综合探讨房颤早期的“未病”状态,提供房性早搏是心房重构早期表现的依据,为进一步预防房颤“已病”状态的发生带来启发。方法：通过全面的文献复习,详细了解心房颤动与房性早搏、心房颤动与血清标志物的关系以及中医“治未病”的概念；再通过对房性早搏预测心房颤动的临床观察性队列研究进行系统评价和meta分析,系统地提取各项研究的基本特征,使用Newcastle-Ottawa Scale评价研究质量,应用stata软件对相关研究报道的危险比(HR)进行统计合成,同时应用敏感性分析、meta回归和亚组分析寻找异质性来源；通过病例回顾,对完善病史、辅助检查的患者进行统计分析,用房早数量分布的中位数定义频发与非频发房早患者,注重比较两组患者之间心房内径、CRP、尿酸等指标的差异,基于“治未病”理念对房性早搏与房颤前状态的关系进行讨论。结果：1.目前的研究认为心房颤动需要早期干预,其中房性早搏是新兴的危险因素之一,同时,心房颤动的发生与血清标志物如CRP和尿酸等密切相关,基于中医“治未病”理念对房性早搏、心房颤动、血清标志物进行探讨,具有重要意义；.2.对房性早搏预测房颤的研究进行系统评价和meta分析,最终纳入11个研究进行系统评价和质量评估,其中选择6项研究进行meta分析,共涉及9519例对象和782例房颤患者。总体上频发房早与房颤发生风险增高相关(HR=3.13[95%CI 1.92-5.11], P=0.007)。纳入meta分析研究的异质性较大(T2=68.8%)。研究人群类型差异、不同的随访时程和频发房早定义不同是造成异质性的因素；3.病例回顾研究发现,在纳入的122例研究病例中,房性早搏数量中位数为24/24h,以此相对界定“频发”与“非频发”房早,对比两组(“频发”房早组vs“非频发”房早组)患者血清CRP水平(7.1±14.8 vs 2.7±5.2 mg/L,P=0.013)、血清尿酸水平(410.0±115.8 vs 363.5±96.3μmol/L, P=0.018).左房内径(35.0±5.7 vs 32.0±4.8mm,P=0.002)、右房上下径(47.8±6.7vs 45.3±5.2mm,P=0.011)、右房左右径(36.8±5.1 vs 34.2±3.9mm,P=0.002),提示频发房早患者可能存在心房重构的病理解剖改变；而两组在年龄、性别、基础病史和服药史方面则无统计学差异。此外,“频发”房早组证候要素包含气虚、阴虚和血瘀的比例较“非频发”房早组多(P0.05),具有统计学差异。结论：房性早搏与心房颤动具有明确相关性,其也与房颤血清标志物相关。基于中医“治未病”理念,房颤为己病,而房早则是相对的未病状态,伴有房颤血清标志物升高的房早可能是心房重构的早期表现。及早关注房早,与血清标志物相结合,早期进行预防,以中医“治未病”和中医理论作指导,开发更多改善心房重构的药物,对防止或延缓房颤的发生有重要意义。
[Abstract]:Objective: atrial fibrillation is the most common clinical arrhythmia, some patients had serious clinical symptoms, and the incidence of stroke, myocardial infarction, heart failure and other complications in high risk, so early prevention and treatment of atrial fibrillation has important significance. The main pathological manifestation is atrial fibrillation and atrial premature atrial remodeling, may be an early manifestation of atrial remodeling this study. Through the system evaluation, to evaluate the predictive effect of atrial fibrillation on the existing clinical arrhythmias; and through retrospective study, to investigate the premature atrial and atrial serum markers associated with fibrillation; Chinese "disease" concept for the study of atrial fibrillation early "disease". For atrial premature atrial remodeling is the early performance of the basis, provide inspiration for further prevention of atrial fibrillation has disease state. Methods: through a comprehensive literature review, a detailed understanding of the atrium Fibrillation and atrial premature beat, and the relationship between the concept of "preventive treatment of disease" signs and serum atrial fibrillation; then through the systematic review and meta analysis on prediction of atrial premature atrial fibrillation clinical observational cohort, systematically study the basic feature extraction, using the quality evaluation on Newcastle-Ottawa Scale, Using Stata software the relevant research reports of the hazard ratio (HR) for statistical synthesis, at the same time the application of sensitivity analysis, meta regression and subgroup analysis for sources of heterogeneity; through case review, to improve the statistical analysis of history, auxiliary examination of patients, the median real number distribution is defined by early frequent and non frequent atrial premature patients, pay attention to the comparison between the two groups of patients with atrial diameter, CRP, uric acid difference index, based on the concept of "prevention of disease" of premature atrial and atrial fibrillation state before the relationship with results discussed. 1.: the present study considers the need for early intervention including atrial fibrillation, atrial premature beat is one of the emerging risk factors at the same time, the occurrence of atrial fibrillation by CRP and uric acid were closely related with serum markers, TCM "disease" concept of atrial premature atrial fibrillation, based on serum markers, are discussed, with the significance of.2. on atrial premature beat; prediction of atrial fibrillation of system evaluation and meta analysis, a total of 11 studies of system evaluation and quality evaluation, the selection of the 6 study meta analysis, involving a total of 9519 cases and 782 cases of patients with atrial fibrillation. The frequent atrial premature and increased risk of atrial fibrillation related (HR=3.13[95%CI 1.92-5.11], P=0.007). In meta analysis of heterogeneity (T2=68.8%). The study population type differences, different follow-up duration and frequent atrial premature definition are caused by the different factors of heterogeneous; 3.鐥呬緥鍥為【鐮旂┒鍙戠幇,鍦ㄧ撼鍏ョ殑122渚嬬爺绌剁梾渚嬩腑,鎴挎，

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