老年心功能不全患者左心室容量参数的应用价值
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摘要
目的探讨老年心功能不全患者左心室容量参数的临床应用价值。方法因冠心病、高血压病、心脏瓣膜病致心功能不全的老年住院患者528例,检测其相关生化指标和氨基末端脑钠肽前体(NT-proBNP)水平及左心室舒张未期容量(LVEDv),左心室收缩未期容量(LVSDv),左心室射血分数(LVEF),比较不同心功能分级组别患者的相关生化指标水平[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、同型半胱氮酸(Hcy)]和NT-proBNP水平与左心室LVEDv、LVSDv及LVEF。结果随着心功能不全等级的升高,患者BUN、Cr、UA、同型半胱氨酸水平呈逐渐上升趋势,心功能Ⅲ、Ⅳ组与心功能Ⅰ、Ⅱ级组比较,差异有统计学意义(P<0.05),TC、TG、HDL-L、LDL-C水平差异无统计学意义(P>0.05)。随着心功能不全程度的加重,患者年龄、NT-proBNP四分位数水平以及LVEDv、LVESv均逐渐增高,组间比较差异有统计学意义(P<0.01);射血分数逐渐下降,组间比较差异有统计学意义(P<0.01)。心功能分级与年龄、BUN、Cr、CA、NT-proBNP、LVEDV、VESV呈正相关(r值分别为0.243、0.240、0.274、0.379、0.693、0.431、0.492,P<0.05),与LVEF呈负相关(r=-0.488,P<0.05)。结论老年心功能不全患者的左心室容量参数能较好反映心力衰竭患者的心脏结和功能变化,对心力衰竭的早期诊断及病情评估具有指导意义。
Objective To explore the clinical application value of left ventricular volume parameters in elderly patients with cardiac insufficiency.Methods A total of 528 elderly patients with heart insufficiency due to coronary heart disease,hypertensive disease or valvular heart disease who were hospitalized and treated in our hospital were enrollled in the study. The left ventricle diastolic end volume(LVEDv), left ventricle systole end volume(LVESv) and left ventricular ejection fraction(LVEF) were detected.Moreover the levels of N-terminal B brain natriuretic peptide precursor(NT-proBNP) and the levels of related biochemical indicators including total cholesterol(TC),triglycerides(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) as well as blood urea nitrogen(BUN),uric acid(UA),creatinine(Cr),homocysteine(HCY) in patients with different heart function grades were observed and compared.Results With the increase of heart function grades of the patients,the levels of BUN,UA,Cr,HCY were increased gradually,there were significanes between heart function gradeⅢ,Ⅳ group and heart function grade Ⅰ,Ⅱ group(P<0.05),however, there were no significant differences in the levels of TC,TG, HDL-C, LDL-C between the groups(P>0.05). With the aggravation of cardiac insufficiency degree, the levels of patient's age,NT-proBNP,LVEDv and LVSDv were increased gradually,however, the levels of ejection fraction were decreased gradually, there were significant differences among groups(P<0.05).In addition the grading of cardiac function was positively correlated with patient's age, the levels of BUN,Cr,CA,NT-proBNP, LVEDv, LVESv, respectively(P<0.05),however,which was negatively correlated with LVEF(P<0.05).Conclusion The parameters of left ventricular volume in elderly patients with cardiac insufficiency can better reflect the changes of heart knots and function in patients with heart failure,which is of directive significance for the early diagnosis and disease assessment of patients with heart failure.
Objective To explore the clinical application value of left ventricular volume parameters in elderly patients with cardiac insufficiency.Methods A total of 528 elderly patients with heart insufficiency due to coronary heart disease,hypertensive disease or valvular heart disease who were hospitalized and treated in our hospital were enrollled in the study. The left ventricle diastolic end volume(LVEDv), left ventricle systole end volume(LVESv) and left ventricular ejection fraction(LVEF) were detected.Moreover the levels of N-terminal B brain natriuretic peptide precursor(NT-proBNP) and the levels of related biochemical indicators including total cholesterol(TC),triglycerides(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) as well as blood urea nitrogen(BUN),uric acid(UA),creatinine(Cr),homocysteine(HCY) in patients with different heart function grades were observed and compared.Results With the increase of heart function grades of the patients,the levels of BUN,UA,Cr,HCY were increased gradually,there were significanes between heart function gradeⅢ,Ⅳ group and heart function grade Ⅰ,Ⅱ group(P<0.05),however, there were no significant differences in the levels of TC,TG, HDL-C, LDL-C between the groups(P>0.05). With the aggravation of cardiac insufficiency degree, the levels of patient's age,NT-proBNP,LVEDv and LVSDv were increased gradually,however, the levels of ejection fraction were decreased gradually, there were significant differences among groups(P<0.05).In addition the grading of cardiac function was positively correlated with patient's age, the levels of BUN,Cr,CA,NT-proBNP, LVEDv, LVESv, respectively(P<0.05),however,which was negatively correlated with LVEF(P<0.05).Conclusion The parameters of left ventricular volume in elderly patients with cardiac insufficiency can better reflect the changes of heart knots and function in patients with heart failure,which is of directive significance for the early diagnosis and disease assessment of patients with heart failure.
引文
1 葛均波,徐永健主编.内科学.第8版.北京:人民卫生出版社,2013.162-167.
2 陈升,白萍,章文杰,等.原发性高血压伴射血分数正常的心功能不全患者血浆脑钠肽水平变化.中国全科医学,2009,12:2260-2261.
3 黄峻.慢性心力衰竭临床研究的新趋势.中华心血管病杂志,2007,35:593-594.
4 Nisho Y,Sato Y,Taniguchi R,et al.Cadiac troponin T vs other biochemical markers in patients with congestive heart failure.Circ J,2007,71:631-635.
5 Su D,Zheng W,Liu Y,et al.Different combinations of right ventricular longitudinal velocity and displacement can be applied effectively for diagnosis of right heart failure in chinese patients.Heart Surg Forum,2016,19:E153-159.
6 Banasik G,Segiet O,Elwart M,et al.LV mechanical dispersion as a predictor of ventricular arrhythmia in patients with advanced systolic heart failure:A pilot study.Herz,2016,41:599-604.
7 Kelly R,Strutbers AD.Are natriuretic peptidps linically usesful as markers of leart failure Ann Clin Bioehem,2001,38:575-583.
8 Ndrepcpa G,Braun S,MehiIli J,el al,Accuracy of N lvrminat probrain nat riuretic peptidc to predict mortality or detect acute lschemia in patients with coronary artery disease.Cardiology,2008,109:249-257.
9 杨继清,袁影,房平,等,老年患者NT-proBNP水平与心功能分级和左心室射血分数的相关性.湖南中医药大学学报,2016,8:276.
10 宋桂仙,阮中宝,朱莉,等.慢性心力衰竭患者彩色多普靳超声心功能参数与血清同型半胱氨酸水平的相关性研究.现代生物学进展,2018,18:3653-3656.
11 江涛,王昌富,李军,等.NT-proBNP对伴肾功能不全老年患者急性心衰的诊断作用.微循环学杂志,2014,24:46-49,54.
12 张金锋.心功能不全患者肾小球滤过率及血浆NT-proBNP水平的变化及意义.中国老年学杂志,2015,35:1141-1142.
13 黄国鹏,安素.N末端B型利钠肽对老年心力衰竭临床应用价值的研究.中国循环杂志,2014,29:698-701.
14 Mahmood SS,Wang TJ.The epidemiology of congestive heart failure:framingham heart study perspective.Global Heart,2013,8:77-82.
15 Smide TD,Hillege HL,Navis G,et al.Impaired renal function in patients with ischemic and nonischemic chronic heart failure:Association with neurohormonal and survival.Am Heart,2004,148:165-172.
16 田琴琴,黄淑田,张丽君,等.慢性心力衰竭患者肾功能、电解质、血脂及血红蛋白水平与心功能的相关性分析.中西医结合心血管病杂志,2014,12:413-414.
17 朱云涛,李亦龙,廖凤,等.慢性心力衰竭住院患者合并肾功能不全80例临床分析.中国现代医生,2009.47:99-100.
2 陈升,白萍,章文杰,等.原发性高血压伴射血分数正常的心功能不全患者血浆脑钠肽水平变化.中国全科医学,2009,12:2260-2261.
3 黄峻.慢性心力衰竭临床研究的新趋势.中华心血管病杂志,2007,35:593-594.
4 Nisho Y,Sato Y,Taniguchi R,et al.Cadiac troponin T vs other biochemical markers in patients with congestive heart failure.Circ J,2007,71:631-635.
5 Su D,Zheng W,Liu Y,et al.Different combinations of right ventricular longitudinal velocity and displacement can be applied effectively for diagnosis of right heart failure in chinese patients.Heart Surg Forum,2016,19:E153-159.
6 Banasik G,Segiet O,Elwart M,et al.LV mechanical dispersion as a predictor of ventricular arrhythmia in patients with advanced systolic heart failure:A pilot study.Herz,2016,41:599-604.
7 Kelly R,Strutbers AD.Are natriuretic peptidps linically usesful as markers of leart failure Ann Clin Bioehem,2001,38:575-583.
8 Ndrepcpa G,Braun S,MehiIli J,el al,Accuracy of N lvrminat probrain nat riuretic peptidc to predict mortality or detect acute lschemia in patients with coronary artery disease.Cardiology,2008,109:249-257.
9 杨继清,袁影,房平,等,老年患者NT-proBNP水平与心功能分级和左心室射血分数的相关性.湖南中医药大学学报,2016,8:276.
10 宋桂仙,阮中宝,朱莉,等.慢性心力衰竭患者彩色多普靳超声心功能参数与血清同型半胱氨酸水平的相关性研究.现代生物学进展,2018,18:3653-3656.
11 江涛,王昌富,李军,等.NT-proBNP对伴肾功能不全老年患者急性心衰的诊断作用.微循环学杂志,2014,24:46-49,54.
12 张金锋.心功能不全患者肾小球滤过率及血浆NT-proBNP水平的变化及意义.中国老年学杂志,2015,35:1141-1142.
13 黄国鹏,安素.N末端B型利钠肽对老年心力衰竭临床应用价值的研究.中国循环杂志,2014,29:698-701.
14 Mahmood SS,Wang TJ.The epidemiology of congestive heart failure:framingham heart study perspective.Global Heart,2013,8:77-82.
15 Smide TD,Hillege HL,Navis G,et al.Impaired renal function in patients with ischemic and nonischemic chronic heart failure:Association with neurohormonal and survival.Am Heart,2004,148:165-172.
16 田琴琴,黄淑田,张丽君,等.慢性心力衰竭患者肾功能、电解质、血脂及血红蛋白水平与心功能的相关性分析.中西医结合心血管病杂志,2014,12:413-414.
17 朱云涛,李亦龙,廖凤,等.慢性心力衰竭住院患者合并肾功能不全80例临床分析.中国现代医生,2009.47:99-100.