Kev tshuaj xyuas ntawm cov xwm txheej cuam tshuam ntawm kev ua rau lub raum tsis zoo hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm

Abstract:

Aim Tshawb nrhiav cov yam ntxwv ntawmlub raum ua haujlwmKev hloov pauv hauv cov neeg mob uas muaj lub plawv tsis ua haujlwm (HF) thaum mus pw hauv tsev kho mob. Cov txheej txheem Cov neeg mob uas muaj ischemic HF nyob hauv tsev kho mob hauv Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University thaum Lub Kaum Hli 2013 txog Lub Kaum Ob Hlis 2017 tau rov qab suav nrog. Cov txheeb cais piav qhia tau siv los piav qhia txog cov yam ntxwv ntawm cov neeg mob. Ib tug multivariate Logistic regression qauv tau siv los tshawb txog qhovmuaj feem cuam tshuam ntawm lub raum ua haujlwm tsis zoo(WRF) hauv cov neeg mob ischemic HF. Cov txiaj ntsig tau 797 cov neeg mob uas muaj ischemic HF tau tso npe rau hauv txoj kev tshawb no, nrog lub hnub nyoog nruab nrab ntawm (70. 5 ± 11. 1) xyoo, uas 68. 9 feem pua ​​yog txiv neej. Ntawm lawv, 22. 5 feem pua ​​​​yog HF cov neeg mob uas txo qis sab laug ventricular ejection fraction (LVEF) thiab 57. 6 feem pua ​​yog HF cov neeg mob uas khaws LVEF. Qhov tshwm sim ntawm WRF yog 18. 4 feem pua. Cov yam tseem ceeb uas ua rau WRF suav nrog cov ntshav creatinine siab (OR=1. 953, P<0. 001), history of hypertension (OR = 1. 859, P = 0. 025), low hemoglobin (OR =0. 985, P= 0. 002), high fibrinogen (OR = 1. 241, P = 0. 013), high blood chlorine (OR = 1. 042, P=0. 049),high blood uric acid (OR= 1. 002, P= 0. 039) and using furosemide (OR = 1. 773, P = 0. 033).

Xaus Qhov tshwm sim ntawm WRF hauv cov neeg mob ischemic HF yog siab, thiab muaj ntau yam cuam tshuam; Clinically, nws yog ib qho tsim nyog yuav tsum tau them sai sai rau cov kev hloov pauv ntawm cov neeg mob 'lub raum ua haujlwmthiab tswj cov xwm txheej hauv lub sijhawm, tshwj xeeb tshaj yog qis hemoglobin, siab fibrinogen, ntshav siab chlorine thiab ntshav siab uric acid.

 

Nyem qhov no kom tau txais Tshuaj ntsuab kho mob rau kev txhim kho Renel Function

Nug ntxiv:

wallence.suen@wecistanche.com 0015292862950

 

 

 

[KEY WORDS] ischemic plawv tsis ua hauj lwm;ua rau lub raum ua haujlwm tsis zoo; muaj feem cuam tshuam

 

Lub plawv tsis ua hauj lwm (HF) yog qhov tshwm sim loj heev thiab theem kawg ntawm ntau yam kab mob hauv lub plawv, thiab nws qhov kev nthuav dav nce ntxiv nrog lub hnub nyoog [1]. Nrog rau kev nce qib ntawm cov neeg laus hauv peb lub teb chaws, HF tseem yuav yog ib qho ntawm cov teeb meem uas kuv lub teb chaws txoj kev kho mob thiab kev noj qab haus huv yuav tsum tau kov yeej rau lub sijhawm tseem ceeb rau yav tom ntej. Lub etiology ntawm HF muaj ntau yam, nrog rau cardiomyopathy, txawv txav ntawm lub plawv, arrhythmia, thiab lwm yam.[2]. Ntawm lawv, kab mob plawv yog ib qho ntawm feem ntau ua rau HF, thiab HF tshwm sim los ntawm kab mob plawv (tshwj xeeb tshaj yog ischemic cardiomyopathy) kuj hu ua ischemic HF[3].
Cov neeg mob HF feem ntau ua ke nrog raum tsis zoo, thiab qhov ntau ntawm lub raum tsis txaus hauv cov neeg mob HF yog li 50 feem pua ​​[4]. Nyob rau hauv thiaj li yuav paub ntau rhiab heevlub raum ua haujlwm puasnyob rau hauv tsev kho mob HF cov neeg mob, nws feem ntau tshwm sim los ntawmua rau lub raum ua haujlwm tsis zoo(WRF), uas txhais tau tias yog qhov nce hauv cov ntshav creatinine ntau dua lossis sib npaug li 26.5 μmol / L los ntawm qhov pib thaum mus pw hauv tsev kho mob [5]. Hauv cov kev tshawb fawb yav dhau los, yam muaj feem cuam tshuam nrog WRF hauv cov neeg mob uas muaj HF mob hnyav suav nrog hnub nyoog siab, txiv neej pw, lub raum tsis txaus, ntshav qab zib, ntshav siab lossis qis qis, atrial fibrillation, hyponatremia, koob tshuaj furosemide, thiab lwm yam.[5]. Tam sim no, muaj ob peb txoj kev tshawb fawb ntawm ischemic HF cov pej xeem, thiab tsis muaj kev tshawb fawb tau tshawb xyuas qhov cuam tshuam ntawm WRF hauv cov neeg mob ischemic HF. Txoj kev tshawb no npaj los tshawb txog cov yam ntxwv kho mob ntawm cov neeg mob ischemic HF thiab cov xwm txheej cuam tshuam ntawm WRF, txhawm rau muab cov ntaub ntawv ntau ntxiv rau kev kuaj mob, kev kho mob thiab kev tshawb fawb ntawm ischemic HF.

 

1 Cov ntaub ntawv thiab cov txheej txheem
1.1 Cov khoom tshawb fawb
Txoj kev tshawb no yog ib qho kev tshawb nrhiav rov qab, thiab cov neeg mob uas muaj ischemic HF nyob hauv tsev kho mob hauv Department of Cardiology ntawm Thawj Tsev Kho Mob ntawm Sun Yat-sen University txij lub Kaum Hli 2013 txog Lub Kaum Ob Hlis 2017 tau tshuaj xyuas raws li cov txheej txheem suav nrog thiab cais tawm. Cov txheej txheem kuaj mob ntawm HF xa mus rau "Cov Lus Qhia Suav rau Kev Ntsuas thiab Kev Kho Mob Lub Plawv Tsis Zoo 2014" [6], thiab ischemic HF tau txhais tias HF nrog cov kab mob plawv raws li etiology [3]. Cov txheej txheem suav nrog: (1) cov neeg mob hnub nyoog siab dua lossis sib npaug li 18 xyoo; (2) raws li kev kuaj mob ntawm ischemic HF; (3) ua kom tiav cov ntaub ntawv kho mob, kuaj hauv chav kuaj, kuaj pom thiab cov ntaub ntawv tshuaj thaum mus pw hauv tsev kho mob. Cov txheej txheem cais tawm: (1) cuam tshuam nrog cov qog nqaij hlav malignant; (2) txuam nrog mob hnyav (sepsis); (3) cuam tshuam nrog lub siab tsis txaus (alanine aminotransferase ntau dua 10 npaug ntawm qhov txwv ntawm tus nqi ib txwm muaj); (4) Cov keeb kwm kev kho mob thiab kev kuaj sim, kev kuaj pom thiab cov ntaub ntawv tshuaj thaum mus pw hauv tsev kho mob tau ploj lawm. Txoj kev tshawb no tau ua raws li Kev Tshaj Tawm ntawm Helsinki.

1.2 Sau cov ntaub ntawv kho mob
Cov ntaub ntawv kho mob ntawm cov neeg mob tau sau los ntawm cov ntaub ntawv hauv tsev kho mob, suav nrog hnub nyoog, poj niam txiv neej, keeb kwm ntawm ntshav qab zib, keeb kwm ntawm kev kub siab, keeb kwm ntawm atrial fibrillation, thiab kev kuaj lub cev (lub plawv dhia, systolic ntshav siab, diastolic ntshav siab) los ntawm cov ntaub ntawv nkag; Thaum kuaj ntshav, N-terminal pro-B-type natriuretic peptide precursor (N-terminal pro-B-type natriuretic peptide, NT-proBNP), cardiac troponin T (cardiac troponin T, cTnT), hemoglobin, hematocrit, ntshav dawb cell suav, neutrophil ratio, platelet suav, prothrombin lub sij hawm, activated ib nrab thromboplastin lub sij hawm, thoob ntiaj teb normalized piv, D-dimer, fibrinogen, osmotic siab, ntshav sodium, ntshav potassium, ntshav chloride, ntshav creatinine, ntshav urea nitrogen, random ntshav qabzib, tag nrho bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum albumin, tag nrho cov roj (cholesterol) tag nrho, qis lipoprotein cholesterol (tsis tshua muaj lipoprotein cholesterol, LDLC), siab ceev lipoprotein cholesterol (siab ceev lipoprotein cov roj cholesterol), sab laug ventricular ejection feem (sab laug ventricular ejection feem, LVEF) tau sau los ntawm thawj echocardiographic kuaj nyob rau hauv 24 teev tom qab nkag; Sau cov ntaub ntawv kho mob, xws li cov hlab ntsha thiab qhov ncauj furosemide, spironolactone, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blockade (angiotensin receptor blockade, ARB), receptor blocker statins, amiodarone, digoxin. Tsis tas li ntawd, tag nrho cov ntshav creatinine cov ntaub ntawv thaum mus pw hauv tsev kho mob kuj tau sau los ntawm kev kuaj ntshav los ntsuas seb cov neeg mob puas tsim WRF.

1.3 Kev txheeb cais
Kev hloov pauv tsis tu ncua ua raws li kev faib tawm ib txwm yog sawv cev los ntawm x±s, thiab qhov sib txawv ntawm cov pab pawg tau muab piv nrog cov qauv ywj pheej t test; Qhov sib txawv tsis tu ncua uas tsis ua raws li kev faib tawm ib txwm yog sawv cev los ntawm qhov nruab nrab thiab quartile, thiab qhov sib txawv ntawm cov pab pawg tau muab piv nrog Wilcoxon rank sum test. Categorical variables tau qhia raws li tus naj npawb ntawm cov neeg mob thiab feem pua, thiab chi-square test los yog Fisher qhov tseeb xeem tau siv los sib piv qhov sib txawv ntawm pawg. Cov kev sib txawv nrog qhov sib txawv tseem ceeb hauv kev sib piv ntawm cov pab pawg (cov kev hloov pauv tsis tu ncua uas tsis ua raws li qhov kev faib tawm ib txwm muaj logarithmically hloov mus rau hauv paus ntawm 2) tau suav nrog hauv cov qauv logistic regression multivariate, thiab cov xwm txheej cuam tshuam nrog qhov tshwm sim ntawm WRF tau tshawb xyuas siv. txoj kev rov qab. Kev txheeb cais tau ua tiav siv SPSS 26.0 software. Ob sab P<0.05 was considered statistically significant.

2 kev tshwm sim
2.1 Cov ntaub ntawv soj ntsuam hauv paus ntawm cov neeg mob uas muaj ischemic HF Tag nrho ntawm 797 cov neeg mob uas muaj ischemic HF tau suav nrog hauv txoj kev tshawb no, thiab cov ntaub ntawv kho mob hauv qab tau qhia hauv Table 1. Qhov nruab nrab hnub nyoog ntawm cov kev kawm yog (70. 5 ± 11. 1) xyoo, thiab 68. 9 feem pua ​​yog txiv neej. Qhov nruab nrab LVEF ntawm cov neeg mob yog 54 feem pua. Raws li HF cov qauv kev faib tawm, 22.5 feem pua ​​​​yog cov neeg mob HF nrog txo LVEF, thiab 57.6 feem pua ​​​​yog HF cov neeg mob uas tau khaws cia LVEF. Hais txog cov teeb meem, 44.7 feem pua ​​​​ntawm cov neeg mob tau mob ntshav qab zib mellitus, 70.8 feem pua ​​​​tau nyuaj nrog ntshav siab, thiab 17.8 feem pua ​​​​tau nyuaj nrog atrial fibrillation. Hais txog kev kuaj lub cev, qhov nruab nrab lub plawv dhia ntawm cov neeg mob yog 80.1 neeg ntaus / min, qhov nruab nrab systolic ntshav siab yog 130.6 mmHg, thiab qhov nruab nrab diastolic ntshav siab yog 74.5 mmHg. Hais txog kev kuaj sim, qhov nruab nrab NT-proBNP ntawm cov neeg mob nkag mus rau hauv tsev kho mob yog 2 524. 0 ng / L, qhov nruab nrab cTnT yog 0. 044 ug / L, nruab nrab cov ntshav creatinine yog 106 μmol / L, thiab qhov nruab nrab tag nrho cov roj cholesterol yog 4. 20 mmol / L, nruab nrab LDLC 2. 64 mmol / L. Thaum mus pw hauv tsev kho mob, 80.9 feem pua ​​​​ntawm cov neeg mob siv ACEI / ARB, 91.5 feem pua ​​​​tau siv cov tshuaj beta-blockers, 63.7 feem pua ​​​​tau siv spironolactone, thiab 98.1 feem pua ​​​​tau siv statins. Tsis tas li ntawd, 68. 4 feem pua ​​​​ntawm cov neeg mob siv furosemide qhov ncauj, 47. 8 feem pua ​​​​ntawm cov neeg mob siv furosemide intravenously, 21. 3 feem pua ​​​​ntawm cov neeg mob siv digoxin, thiab 9. 4 feem pua ​​ntawm cov neeg mob siv amiodarone.

Table 1. Cov ntaub ntawv kho mob hauv qab ntawm 797 cov neeg mob uas muaj ischemic HF