本文選題：腦利鈉肽N端前體肽 + 低氧血癥��； 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：背景和目的：氨基末端B型利鈉肽前體（NT-proBNP）在心室容量負荷和（或）室壁壓力增加時，可由心室肌細胞（左心室為主）合成和分泌，國內(nèi)外研究多集中于NT-proBNP與左心功能的關系，并已證實在充血性心力衰竭（CHF）時血漿NT-proBNP濃度明顯升高，而在一些呼吸系統(tǒng)疾病如慢性阻塞性肺疾病、肺動脈高壓、間質(zhì)性肺疾病、肺栓塞等血漿NT-proBNP濃度也可見升高。由于這些疾病常并發(fā)心功能不全和低氧血癥，故NT-proBNP濃度升高的原因尚不十分明確。本研究通過分析低氧血癥患者在不同心功能情況下血漿NT-proBNP濃度的變化，探討血漿NT-proBNP與低氧血癥之間的關系及其可能機制。 方法：回顧性分析453例同時行NT-proBNP、動脈血氣分析及超聲心動圖檢查的住院患者臨床資料，根據(jù)氧合指數(shù)分為低氧血癥組和無低氧血癥組，比較兩組患者血漿NT-proBNP濃度變化，并分別比較在左心室收縮功能不全、肺動脈高壓、左心室收縮功能不全合并肺動脈高壓以及心功能正常情況下血漿NT-proBNP濃度的變化。將心功能正常條件下的低氧血癥組患者根據(jù)氧合指數(shù)分為Ⅰ（301~400mmHg）、Ⅱ（201~300mmHg）、Ⅲ（≤200mmHg）三個亞組，分析低氧程度與血漿NT-proBNP濃度的關系。分別對比在低氧血癥或無低氧血癥情況下，左心室收縮功能不全與肺動脈高壓患者、肺動脈高壓與心功能正�；颊哐獫{NT-proBNP濃度差異；以及單純左心室收縮功能不全、單純肺動脈高壓、單純低氧血癥患者三者間血漿濃度變化關系。分別以PaCO240和50mmHg為截斷值，分析PaCO2與血漿NT-proBNP的關系，并采用Spearman相關分析，分析左心室功能相關指標、肺動脈收縮壓（PASP）、氧合指數(shù)、PaCO2與血漿NT-proBNP的相 關性。 結(jié)果：①低氧血癥組患者血漿NT-proBNP濃度高于無低氧血癥組（P＜0.01）。在左心室收縮功能不全、肺動脈高壓、心功能正常三種情況下低氧血癥組患者NT-proBNP濃度均高于無低氧血癥組（P＜0.05）。②在心功能正常條件下的低氧血癥組中，Ⅲ組患者的血漿NT-proBNP水平高于Ⅰ和Ⅱ組，Ⅱ、Ⅲ組高于對照組（P＜0.05）。③在低氧血癥或無低氧血癥情況下，左心室收縮功能不全患者血漿NT-proBNP濃度高于肺動脈高壓患者，肺動脈高壓患者血漿NT-proBNP濃度高于心功能正�；颊�；單純左心室收縮功能不全、單純肺動脈高壓患者血漿NT-proBNP濃度均高于單純低氧血癥患者（P＜0.05）。④Spearman相關分析示NT-proBNP與LVEDD、LVESD、PASP成正相關，與LVEF、FS、氧合指數(shù)呈負相關，差異均有統(tǒng)計學意義（P＜0.05），，而與LVPW、PaCO2、心率不相關（P＞0.05）。 結(jié)論低氧血癥可能是導致血漿NT-proBNP濃度升高的一個獨立因素，并且與缺氧程度成正相關。
[Abstract]:Background & AIM: NT-proBNP can be synthesized and secreted by ventricular myocytes (left ventricle) when ventricular volume load and / or wall pressure increase. Most studies have focused on the relationship between NT-proBNP and left ventricular function. The plasma NT-proBNP level was significantly increased in congestive heart failure (CHF), but also in some respiratory diseases such as chronic obstructive pulmonary disease, pulmonary hypertension, interstitial pulmonary disease, pulmonary embolism and other plasma NT-proBNP levels. As these diseases are often associated with cardiac insufficiency and hypoxemia, the reasons for the increase in NT-proBNP concentrations are unclear. This study was to investigate the relationship between plasma NT-proBNP and hypoxemia and its possible mechanism by analyzing the changes of plasma NT-proBNP in patients with hypoxemia under different cardiac function. Methods: the clinical data of 453 inpatients with NT-proBNP, arterial blood gas analysis and echocardiography were retrospectively analyzed. According to the oxygenation index, the patients were divided into hypoxemia group and hypoxemia group. The plasma NT-proBNP concentrations were compared between the two groups. The changes of plasma NT-proBNP concentrations in patients with left ventricular systolic dysfunction pulmonary hypertension left ventricular insufficiency complicated with pulmonary hypertension and normal cardiac function were compared. Patients with hypoxemia with normal cardiac function were divided into three subgroups according to oxygenation index: 鈪

本文編號：2079295