[1]文小霞,魏高利,齐 茗△.后天性心脏瓣膜病患者手术前后心脏功能和心肌相关指标变化及与预后关系分析*[J].陕西医学杂志,2020,49(4):427-430.
　WEN Xiaoxia,WEI Gaoli,QI Ming..Changes of cardiac function and myocardium-realted indexes in patients with acquired valvular heart disease before and after surgery and their relationship with prognosis[J].,2020,49(4):427-430.
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后天性心脏瓣膜病患者手术前后心脏功能和心肌相关指标变化及与预后关系分析*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年4期
页码:
427-430
栏目:
临床研究
出版日期:
2020-04-05

文章信息/Info

Title:
Changes of cardiac function and myocardium-realted indexes in patients with acquired valvular heart disease before and after surgery and their relationship with prognosis
文章编号:
DOI:10.3969/j.issn.10007377.2020.04.010
作者:
文小霞1; 魏高利2; 齐 茗3△
1.陕西省第四人民医院检验科(西安 710043); 2.陕西省第四人民医院心血管内科(西安 710043); 3.延安大学附属医院东关心脑血管病区冠心病二病区(延安 716000)
Author(s):
WEN Xiaoxia; WEI Gaoli; QI Ming.
Clinical Laboratory of the Fourth People's Hospital of Shaanxi Province(Xi'an 710043)
关键词:
后天性心脏瓣膜病;  心脏功能;  血清肌钙蛋白;  可溶性细胞间黏附分子;  预后
Keywords:
Acquired valvular heart disease;  Cardiac function;  Serum troponin;  Soluble intercellular adhesion molecule;  Prognosis
分类号:
R542.5
文献标志码:
A
摘要:
目的:分析后天性心脏瓣膜病患者手术前后心脏功能和心肌相关指标的变化,并探讨其与预后的关系。方法:选择我院收治的行心脏手术的86例后天性心脏瓣膜病患者,检测其手术前1 d和手术后7 d心脏功能指标[左心室射血分数(LVEF)、心脏指数(CI)]、血清肌钙蛋白(cTnI)、可溶性细胞间黏附分子(sICAM-1)水平,并进行术后随访,以术后5年内是否再次手术或死亡为结局指标,分为预后良好组和预后不良组,比较两组LVEF、CI、cTnI和sICAM-1水平,通过ROC曲线分析术前1 d LVEF、CI、cTnI和sICAM-1水平对预后的预测价值,并采用二元Logistic多因素回归分析术前LVEF、CI、cTnI和sICAM-1水平与预后的关系。结果:与手术前1 d相比,手术后7 d患者LVEF、CI水平明显上升(P<0.05),cTnI和sICAM-1水平明显下降(P<0.05)。预后良好组术前1 d LVEF、CI水平显著高于预后不良组(P<0.05),cTnI和sICAM-1水平显著低于预后不良组(P<0.05)。ROC曲线显示术前1 d LVEF、CI、cTnI和sICAM-1最佳截断值为45.76%、1.59 L/(min·m2)、0.32 μg/L和239.70 μg/L,其中LVEF<45.76%组、CI<1.59 L/(min·m2)组、cTnI≥0.32 μg/L组、sICAM-1≥239.70 μg/L组预后不良发生率高于LVEF≥45.76%组、CI≥1.59 L/(min·m2)组、cTnI<0.32 μg/L组、sICAM-1<239.70 μg/L组(P<0.05)。二元Logistic多因素回归分析,显示术前LVEF、CI、cTnI和sICAM-1水平是患者预后影响因素(P<0.05)。结论:后天性心脏瓣膜病患者手术后LVEF、CI水平上升,cTnI和sICAM-1水平下降,术前上述指标水平均与患者手术预后具有相关性。
Abstract:
Objective:To analyze the changes of cardiac function and myocardium-realted indexes in patients with acquired valvular heart disease before and after surgery,and to explore their relationship with prognosis. Methods:A total of 86 patients with acquired valvular heart disease were selected. The levels of cardiac function indexes [left ventricular ejection fraction(LVEF),cardiac index(CI)],serum cardiac troponinI(cTnI)and soluble intercellular adhesion molecule(sICAM-1)were measured on the first day before surgery and seventh day after surgery. The patients were followed up after surgery and divided into good prognosis group and poor prognosis group according to the presence or absence of reoperation or death within 5 years after surgery. The levels of LVEF,CI,cTnI and sICAM-1 were compared between the two groups. The predictive value of LVEF,CI,cTnI and sICAM-1 one day before surgery on prognosis was analyzed by ROC curve. The relationship between preoperative levels of LVEF,CI,cTnI and sICAM-1 and prognosis was analyzed by binary Logistic multivariate regression analysis. Results:Compared with the first day before surgery,the levels of LVEF and CI were increased significantly on the seventh day after surgery(P<0.05),while the levels of cTnI and sICAM-1 were decreased significantly(P<0.05). The levels of LVEF and CI on the first day before surgery in good prognosis group were significantly higher than those in poor prognosis group(P<0.05),while the levels of cTnI and sICAM-1 were significantly lower than those in poor prognosis group(P<0.05). The ROC curve showed that the best cutoff values of LVEF,CI,cTnI and sICAM-1 on the first day before surgery were respectively 45.76%,1.59 L/(min·m2),0.32 μg/L and 239.70 μg/L,and the incidence rate of poor prognosis in LVEF<45.76% group,CI<1.59 L/(min·m2)group,cTnI≥0.32 μg/L group and sICAM-1≥239.70 μg/L group was higher than that in LVEF≥45.76% group,CI≥1.59 L/(min·m2)group,cTnI<0.32 μg/L group and sICAM-1<239.70 μg/L group(P<0.05). Binary Logistic multivariate regression analysis showed that preoperative levels of LVEF,CI,cTnI and sICAM-1 were the influencing factors for prognosis(P<0.05). Conclusion:In patients with acquired valvular heart disease after surgery,the levels of LVEF and CI are increased while the levels of cTnI and sICAM-1 are decreased,and the levels of above-mentioned indexes before surgery are related to the surgical prognosis of patients.

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备注/Memo

备注/Memo:
*陕西省教育厅科研计划项目(12JK0779)
更新日期/Last Update: 2020-04-13