重度子痫前期合并胎儿生长受限98例临床治疗的分析

目的探讨重度子痫前期合并胎儿生长受限患者的分娩时机及分娩方式。方法对98例重度子痫前期合并胎儿生长受限病例进行回顾性分析。结果 98例患者中利凡诺引产18例,阴道自然分娩10例,剖宫产70例,剖宫产率71.4%,无孕产妇死亡,所有孕产妇均痊愈出院。孕34周后终止妊娠的新生儿窒息率和围产儿死亡率明显低于孕34周前终止妊娠者。重度子痫前期合并胎儿生长受限经促胎肺成熟等治疗后病情稳定,孕周≥34周估计胎儿成活即可终止妊娠。结论对于孕周已达34周以上的重度子痫前期合并胎儿生长受限患者,经促胎肺成熟治疗后选择适当的分娩方式,尽快结束分娩,是抢救母婴的重要措施。剖宫产是重度子痫前期合并胎儿生长受限终止妊娠的有效措施,但并非唯一措施。     

NT-proBNP与慢性充血性心力衰竭预后临床分析

目的：探讨慢性心力衰竭患者血浆N末端B型利钠肽原(NT-proBNP)测定水平与预后的关系。方法40例慢性心力衰竭患者(病程≥1年)于入院时急诊抽血测定血浆NT-proBNP水平,并分为两组院NT-proBNP≥2000pg/ml组26例,NT-proBNP<2000pg/ml组14例,追踪观察26个月再住院率及死亡率。结果 NT-proBNP≥2000pg/ml组患者在正规抗心衰治疗症状明显改善出院后再入院率为80.8%、死亡率为19.2%,NT-proBNP<2000pg/ml组患者再入院率42.9%,死亡率为0%,两组比较,再入院率(P<0.05)、死亡率(P<0.05)有显著的差异性。结论NT-proBNP是慢性充血性心力衰竭最敏感和最重要的标志物,对慢性充血性心力衰竭诊断和预后评估具有重要的临床价值。     

床边快速检测全血NT-proBNP在急诊呼吸困难鉴别诊断中的应用

目的：研究床边快速检测抗凝静脉全血N端脑利钠肽原（NT-proBNP）对急诊心源性呼吸困难和肺源性呼吸困难鉴别诊断的意义。方法：对我院急诊科就诊的158例呼吸困难患者分为心源性组82例,肺源性组76例,另选取58例正常人作为对照组。上述患者入院0.5h内完成床边急诊测定全血NT-proBNP浓度,48h内进行超声心动图检查。结果：①全血NT-proBNP浓度心源性组：（2026.4122.7）pg/ml,显著高于对照组（P〈0.01）;肺源性组：（191.828.12）pg/ml,与对照组无差异（P〉0.05）。②心源性分组,充血性心衰（CHF）按NYHA分级,心功能Ⅱ级（n=15）、Ⅲ级（n=42）、Ⅳ级（n=25）,全血NT-proBNP浓度均值分别为1513、2598、4357pg/ml,NT-proBNP的浓度与心衰的严重程度呈正比。③心功能Ⅱ级、Ⅲ级、Ⅳ级患者全血NT-proBNP水平与左心室射血分数（LVEF）的相关系数分别为r=-0.722（P〈0.05）、r=-0.615（P〈0.01）、r=-0.529（P〈0.01）,NT-proBNP水平与LVEF呈高度负相关。结论：呼吸困难急诊中,床边检测全血NT-proBNP浓度阴性的患者可快速排除心源性呼吸困难。心源性呼吸困难患者全血NT-proBNP浓度明显升高,结合超声心动图检查,提示全血NT-proBNP水平与心功能分级之间有明显的关联,心力衰竭程度越严重全血NT-proBNP越高,全血NT-proBNP测定可作为判断左心功能不全的参考性指标。     

胚胎移植后14天一次血β-hCG值预测妊娠结局的临床价值

目的评估在胚胎移植后14天一次血β-hCG测定对妊娠结局的临床预测价值。方法选择在我中心行胚胎移植后的230例病例,于移植后14d一次查血清β-hCG值。根据不同血清β-hCG值并且结合B超、病理检查或腹腔镜检查进行分组:1.不良妊娠组(生化妊娠组、异位妊娠组、早期自然流产组)、单胎妊娠组、双胎妊娠组,比较不同血清β-hCG值与妊娠结局的相关性;2.血清β-hCG值对妊娠结局的临床预测价值,寻找不良妊娠与继续妊娠的分界值,单胎妊娠和多胎妊娠的分界值。结果 1.A组血清β-hCG值为242.97±33.37,B组为654.05±49.16,A组显著低于B组,其差异有统计学意义。2.A1、A2、A3组与B1、B2组血清β-hCG值的趋势为,A1A2A3B1B2。3.选择100mIU/mL作为不良妊娠(生化+异位妊娠)和继续妊娠的分界点;选择300mIU/ml作为不良妊娠(生化+异位妊娠)与单胎妊娠的分界点;选择600mIU/ml作为自然流产、单胎妊娠与双胎妊娠的分界点;选择1000mIU/ml作为单胎妊娠与双胎妊娠的分界点;各组差异均有统计学意义。结论 1.胚胎移植后14天一次血清β-hCG值能有效的预测妊娠结局,具有重要的临床指导意义。2.β-hCG100mIU/ml不良妊娠(生化+异位)的发生率高;β-hCG≥100mIU/ml继续妊娠的发生率高,但不排除自然流产;β-hCG≥300mIU/ml不良妊娠(生化+异位)的发生率很低,几乎为0%;β-hCG≥300mIU/ml单胎妊娠的发生率高;β-hCG≥600mIU/ml自然流产的发生率低;β-hCG≥1000mIU/ml双胎妊娠的发生率高。     

NT-ProBNP对伴肾功能不全老年患者急性心衰的诊断作用

目的:评价氨基末端脑钠肽前体(NT-proBNP)在伴肾功能不全老年患者急性心衰诊断中的应用价值。方法:收集临床主诉为呼吸困难伴肾功能不全老年患者356例,其中确诊急性心衰患者151例,测定所有患者的血清肌酐(Scr)水平,计算肾小球滤过率(eGFR)后,分为轻度肾功能不全组(n=104,eGFR≥60ml/min/1.73m2)、中度肾功能不全组(n=159,eGFR30-59ml/min/1.73m2)和重度肾功能不全组(n=93,eGFR30ml/min/1.73m2)。检测各组NT-ProBNP,比较各组中急性心衰和非急性心衰患者NT-ProBNP差异,并分析NT-ProBNP与急性心衰的相关性,评价NT-ProBNP诊断伴肾功能不全老年患者急性心衰的临床可接受性。结果:轻度到重度肾功能不全组中急性心衰患者的Log(NT-proBNP)均高于非急性心衰患者(t值分别为9.86、9.82、6.03,P0.01)。NT-proBNP升高是伴肾功能不全老年患者急性心衰的独立预测因子(OR=18.54,P0.01)。应用NT-proBNP诊断轻度到重度肾功能不全组中急性心衰患者的工作特征曲线下面积(AUC)分别为0.915、0.874和0.787,最佳诊断截点分别为800pg/ml、950pg/ml和3000pg/ml,诊断特异性分别为84%、74%和44%;轻、中度肾功能不全急性心衰患者较不按eGFR分组患者的AUC(0.835)高,最佳诊断截点(970pg/ml)低,诊断特异性(68%)高(P0.05或P0.01)。重度肾功能不全组的诊断敏感性比不按eGFR分组的所有患者高(u=3.05,P0.01),但特异性低(u=3.04,P0.01)。结论:NT-proBNP对伴肾功能不全老年患者急性心衰有诊断作用,根据eGFR分组可以提高其对轻、中度肾功能不全患者急性心衰的诊断性能。     

妊娠双胎胎死宫内合并妊高征剖宫产术前后护理一例

病例:我科于2000年6月收治一例孕38w双胎(胎死宫内)合并重型妊高征、心衰的患者。此病例较罕见,现将护理体会如下。 患者李某,24岁,菜农。以妊娠38w双胎(胎死宫内)、孕2产1重度妊高征、心衰急诊入院。查体T36.9℃,P120次/分,R30次/分,BP 18.0/11.0kPa一般情况差,急性危重     

甲亢患者血清NT-proBNP水平的变化

目的:探讨甲状腺机能亢进症(以下简称甲亢)患者NT-proBNP水平的变化及其临床意义.方法:将门诊甲亢患者分为甲亢组(A组,34例),甲亢缓解组(B组,30例)两组,另选取31例健康体检者作为正常对照组(C组).测定上述受检者血清游离T3(FT3)、游离T4(FT4)及N端脑钠肽激素原(NT-proBNP)水平.结果:A、B、C三组NT-proBNP水平分别为89.41pg/ml(21.05～969.30)、36.31 pg/ml(16.95～72.70)、34.43 pg/ml(16.39～77.47).A组NT-proBNP水平明显高于B、C组(P＜0.01),约为B、C组的3倍;而B、C两组比较则无统计学差异(P＞0.05).多元回归分析示甲亢组中NT-proBNP与FT4独立相关(P＜0.01).结论:血清NT-proBNP水平显著受甲状腺激素(TH)影响,TH对NT-proBNP的影响可能是一种直接、正面效应.     

妊娠合并甲状腺功能亢进32例临床分析

目的探讨妊娠合并甲状腺功能亢进的处理原则及对母体造成的影响。方法回顾分析我院2004年1月~2006年12月住院分娩的妊娠合并甲状腺功能亢进32例患者资料。结果妊娠合并甲亢占同期住院分娩数的0.22%。1例患者中因胎盘早剥,大出血,急诊剖宫产术中出现甲亢危象,抢救无效死亡,合并妊娠高血压综合征5例(重度2例),其中发生心衰1例。结论甲亢危象是妊娠合并甲状腺功能亢进患者死亡的主要原因;出血,手术可诱发甲亢危象,去除诱因,合理用药是预防甲亢危象有效的方法;甲亢合并妊娠高血压综合征时注意防治心衰;妊娠期间甲亢治疗首选丙基硫氧嘧啶。     

妊娠合并急性胰腺炎5例分析

目的探讨妊娠合并急性胰腺炎的诊断和处理以及妊娠结局。方法对5例病例的临床症状、体征、实验室检查、手术情况以及新生儿情况进行分析总结。结果发病均以恶心、呕吐、上腹痛等症状为主,上腹部有压痛、有不同程度的腹膜刺激症状。实验室检查,白细胞升高(10.25~14.18×109/L),中性细胞增高,血淀粉酶明显升高4例(1145~3388U/L)为诊断依据,总胆红素增高5例(23.5~29.4μmol/L),直接胆红素增高4例(17.2~23.9μmol/L),胆固醇增高3例(9.4~11.30μmol/L),甘油三脂增高3例(11.45~30.71μmol/L),手术情况剖腹探查3例,开腹所见1例为血性腹水,1例为脓性腹水,胰腺表面坏死,行胰腺部份坏死组织清除,胆囊造瘘(1例)及腹腔引流。病理报告为胰腺局部灶式炎性细胞浸润,另三例保守治疗。妊娠结局1例双胎之一胎死宫内,1例死胎,2例新生儿窒息。结论早期多主张保守治疗,若保守治疗无效,或病情加重,应考虑手术治疗,其关键在于早期诊断及早期治疗极其重要,才能降低围产期孕产妇及胎婴儿死亡率。     

双胎妊娠-胎宫内死亡20例临床分析

目的探讨双胎妊娠-胎宫内死亡的原因、临床处理及预后。方法回顾性分析1994年3月至2008年2月北京大学第三医院双胎妊娠-胎宫内死亡的病例共20例。结果双胎-胎宫内死亡的发生率为3．2％,其中双卵双胎17例,单卵双胎3例。28w前发现-胎宫内死亡者6例,平均期待治疗95．8天,平均分娩孕周为34．4w（32^＋4-39w）;28w后发现-胎宫内死亡者14例,平均期待治疗10．1天,平均分娩孕周为34．6w（29^＋4-39^＋2w）;仅2例新生儿发生轻度窒息。无一例孕妇发生凝血功能障碍。追踪新生儿6月至14年,1例新生儿因合并隐性脊柱裂及早产原因早期死亡,1例患儿3岁时发生运动障碍性脑瘫（分娩孕周为29^＋6w）,4例失访,其余均健康存活。结论双胎妊娠-胎宫内死亡后可采取期待治疗,严密监测存活胎儿宫内状况,尽量延长孕周,可提高存活胎儿的生存质量。     

High circulating levels of N‐terminal pro‐brain natriuretic peptide and interleukin 6 in patients with mixed cryoglobulinemia

Many patients with mixed cryoglobulinemia and chronic HCV infection experience symptoms, such as dyspnea, which sometimes do not seem to indicate the involvement of the liver but rather the symptoms of heart failure. To our knowledge, there has been no other study evaluating the serum levels of N‐terminal pro‐brain natriuretic peptide (NTproBNP) and Interleukin 6 (IL‐6) in such patients. Serum NTproBNP and IL‐6 were assayed in 54 patients with mixed cryoglobulinemia and chronic HCV infection, and in 54 sex‐ and age‐matched controls. Cryoglobulinemic‐patients showed significantly higher mean NTproBNP and IL‐6 levels than the controls (P = 0.005). By defining a high NTproBNP level as a value higher than 125 pg/ml (the single cut‐off point for patients under 75 years of age), 30% of patients with mixed cryoglobulinemia and chronic HCV infection and 7% of controls had high NTproBNP (chi‐square; P < 0.003). With a cut‐off point of 300 pg/ml (used to rule out heart failure in patients under 75 years of age), 5/49 patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi‐square; P < 0.04). With a cut‐off point of 900 pg/ml (used for including heart failure in patients aged between 50 and 75, such as the patients in this study) 3/51 of patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi‐square; P = 0.07). The study revealed high levels of circulating NTproBNP and IL‐6 in patients with mixed cryoglobulinemia and chronic HCV infection. The increase in NTproBNP could indicate the presence of a subclinical cardiac dysfunction. J. Med. Virol. 82:297–303, 2010. © 2009 Wiley‐Liss, Inc.     

NT—proBNP在妊娠高血压心功能评估中的价值

目的探讨N-端脑利钠肽前体（NT—proBNP）在妊娠高血压疾病（PIH）心功能评估中的价值。方法将102例PIH孕妇分为妊娠高血压组37例,轻度子痫前期组33例,重度子痫前期组32例,另外选取正常妊娠组32例及正常未孕育龄妇女32例作为对照组,采用电化学发光法测定患者血清NT—proBNP浓度。结果PIH组、正常妊娠组和对照组的NT—proBNP水平分别为（300．52±134．44）、（83．42±26．26）和（59-83±12．89）pg／ml,三者间比较差异均有统计学意义（P〈0．01）。重度子痫前期组、轻度子痫前期组、妊娠高血压组的NT-proBNP水平分别为（488．56±155．54）、（323．39±148．90）和（185．73±43．78）pg／ml,三者间比较差异均有统计学意义（P〈0．01）。NT—proBNP与孕妇体重指数（BMI）呈正相关（r=0．602）,与新生儿体重呈负相关（r=-0．279）。结论孕后NT-proBNP有所升高,而且是能够用于评估PIH孕妇心功能的敏感指标之一。     

BNP/NT-proBNP: what is the best choice in an emergency laboratory?

BNP and NT-proBNP are both well established as diagnostic and prognostic markers for congestive heart failure (CHF). However it remains for the biologist to choose between these two biomarkers depending on his equipment availability. The aim of this study was to compare results obtained with the Biosite Triage BNP assay and the Dade Behring NT-proBNP assay with regards to the clinical status. One hundred twelve patients (average age 76 +/- 13 years) with acute dyspnea were including and stratified by diagnosis at presentation into 3 groups: patients without acute CHF (group I, n=50), patients with non-cardiac dyspnea and CHF history (group II, n=22) and patients with acute CHF (group III, n=40). Levels of both BNP and NT-proBNP were higher among patients with cardiac dyspnea (group III) than among patients with a non-cardiac dyspnea (BNP=740 pg/mL versus 84 pg/mL; p<0.001 / NT-proBNP=7.502 pg/mL versus 499 pg/mL; p<0.001). ROC analysis for BNP or NT-proBNP were not statistically different in patients with acute CHF (group III) compared with patients with a non-cardiac dyspnea (group I + II) (AUC=0.927 versus AUC=0.930, p=0.90). Neither there was a difference between ROC analysis for BNP or NT-proBNP in patients with cardiac dyspnea (group III) compared to patients with a non cardiac dyspnea (group I) (AUC=0.981 versus AUC=0.975, p=0.76).Measurement of BNP or NT-proBNP is of identical interest for the diagnosis of acute CHF in acute dyspnea. The BNP Biosite assay was faster because analysis is performed on whole blood. With regards to analytical performance, the NT-proBNP Dade Behring assay had a higher accuracy and is highly recommended for the follow-up of CHF treatment.     

N-terminal pro B-type natriuretic peptide and the evaluation of cardiac dysfunction and severity of disease in cirrhotic patients

PURPOSE: Cardiac dysfunction and hyperdynamic systemic circulation may be present in patients with cirrhosis. The purpose of this study was to identify relations between plasma levels of N-terminal-proBNP (NT-proBNP), reflecting early ventricular dysfunction, and the severity of liver disease and cardiac dysfunction in cirrhotic patients. MATERIALS AND METHODS: Sixty-three cirrhotic patients and 15 controls (group 1) were enrolled in this study. Plasma levels of NT-proBNP were determined in echocardiographically examined patients, which were allocated to 1 of 3 groups according to Child-Pugh classification or into 2 groups, i.e., a compensated group without ascites (group 2) and decompensated group with ascites (group 3). RESULTS: Plasma NT-proBNP levels were significantly higher in cirrhotic patients (groups 2 and 3) than in age-matched controls (155.9 and 198.3 vs. 40.3 pg/mL, respectively, p < 0.05). NT-proBNP levels were significantly increased in Child class C patients than in classes B and A (250.0 vs. 168.6 and 119.6 pg/mL, respectively, p < 0.05). Left atrial dimension, wall thickness of left ventricle, and EF or E/E' were significantly increased, and EDT was prolonged in cirrhotic patients than in controls. Increased LVMI and decreased E/A ratio were noted in the group of patients with ascites as compared with the other groups. CONCLUSION: Plasma NT-proBNP levels were high in cirrhotic patients and are likely to be related to the severity of disease. Advanced cirrhosis is associated with advanced cardiac dysfunction, and NT-proBNP levels has predictive value for concomitant cardiac dysfunction and cirrhosis progression.     

床旁快速检测BNP鉴别急性呼吸困难的临床意义

目的：评价床旁快速测定B型钠尿肽（BNP）对呼吸困难患者的鉴别诊断价值。方法：荧光免疫法测定64例以急性呼吸困难为主诉的住院患者血浆BNP水平。结果：①心源性呼吸困难患者血浆BNP水平明显高于非心源性呼吸困难患者[（803±457）pg/ml与（72±34）pg/ml,P〈0.01];②BNP≥100pg/ml诊断充血性心力衰竭（CHF）的敏感性为92.7%,特异性为91.4%,阳性预测值为90.8%,阴性预测值为93.1%;③BNP水平与NYHA心功能分级呈正相关（P〈0.01）。结论：快速测定BNP有助于鉴别心源性呼吸困难与非心源性呼吸困难。     

血浆NT-proBNP水平评价慢性肾病患者左心室功能

目的:血清N-末端脑钠肽前体(N-terminal-pro-B-type natriuretic peptide,NT-proBNP)为诊断心功能衰竭的特异性生物学指标。由于肾脏清除率降低可使NT-proBNP的清除减少,而使肾功衰竭的患者血清NT-proBNP水平升高。本文NT-proBNP水平评估慢性肾脏疾病患者左心室功能。方法:收集慢性肾脏疾病患者60例(男44,女16),检测其左心室射血分数(left ventricular ejection fraction,LVEF),体重指数(body mass index,BMI),血清肌酐(creatinine,Cr),NT-proBNP。结果:NT-proBNP与BMI、年龄、性别均显著相关。NT-proB-NP水平为150.0pg/ml和510.0pg/ml,在诊断慢性肾脏疾病患者左心室功能紊乱的敏感度、特异度分别为93.5%、29.2%和53.2%、88.1%。结论:NT-proBNP水平在510.0pg/ml时对慢性肾脏疾病患者发生心功能衰竭有良好的预测价值。     

Diagnostic values of NT-proBNP in acute dyspnea among elderly patients

The study aims to evaluate a rapid testing of NT-proBNP in differential diagnosis of cardiac and pulmonary dyspnea among elderly emergency patients. Two hundred sixty-eight dyspnea patients with ages of ≥60 years old participated in the study. Based on their clinical diagnosis, the patients were divided into three groups: group A diagnosed with pulmonary dyspnea (PD), group B diagnosed with congestive heart failure (CHF), and group C diagnosed with combined dyspnea (CHF+PD). NT-proBNP levels among the three groups were compared. NT-proBNP levels in group A were significantly lower than those in groups B and C. No significant difference was observed between groups B and C in terms of NT-proBNP levels (P>0.05). Our data showed that NT-proBNP levels in patients with cardiac dyspnea were significantly higher than those in patients with pulmonary dyspnea. Person linear association analysis revealed that NT-proBNP levels were reversely associated with LVEF (r=-0.675, P<0.01), indicating that higher NT-proBNP levels result in lower LVEF and poorer heart functions. NT-proBNP is a valuable biomarker in differential diagnosis of pulmonary and cardiac dyspnea among elderly patients due to the high sensitivity of the testing method and the strong association with the severity of heart failure.     

N-terminal pro-brain natriuretic peptide for detection of cardiovascular stress in patients with obstructive sleep apnea syndrome

Patients with obstructive sleep apnea syndrome (OSAS) have an elevated incidence of cardiovascular events that may be related to an increased ventricular load and hypoxemia caused by apneas and hypopneas. N-terminal pro-brain natriuretic peptide (NTproBNP) appears to be an excellent marker of myocardial stretch and could serve as an indicator of subclinical cardiac stress, thereby identifying a patient population at risk for cardiac effects from OSAS. Adult patients presenting with suspected OSAS and scheduled for nocturnal polysomnography were recruited. Patients with heart or renal failure or severe lung disease were excluded. NTproBNP was measured the evening before and the morning after sleep. Blood pressure (BP) was monitored intermittently throughout the night. Fifteen male and 15 female subjects with a mean +/- SD body mass index of 38.2 +/- 9.8 were studied. Mean Apnea-Hypopnea Index (AHI) was 38.4 +/- 26, with 17 subjects having severe OSAS (AHI > 30). No subject had a significant rise in BP. NTproBNP values overnight decreased in 19 patients and rose in 11 (mean change 3.8 +/- 33 pg mL(-1)), but only one patient had an abnormal morning value. Three patients had an abnormal NTproBNP value prior to sleep, but their levels decreased with sleep. No correlations were detected between the evening baseline or postsleep NTproBNP levels and OSAS. Monitoring pre- and postsleep NTproBNP levels revealed no association with the occurrence or degree of OSAS, making it unlikely that NTproBNP could serve as a marker of cardiac stress in OSAS patients with stable BP and without overt heart failure.     

Prognostic value of plasma N-terminal pro-B-type natriuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergoing surgery for abdominal aortic aneurysm

Introduction

Implantation of an aortic-bifemoral prosthesis is characterised by a high (> 5%) rate of perioperative cardiovascular events. The main aim of the study is to demonstrate the usefulness of the determination of NT-proBNP concentration as a method of risk stratification of left ventricular dysfunction in patients subjected to surgery for aortic-bifemoral prosthesis implantation.

Material and methods

Forty consecutive patients were examined and subjected to aortic-bifemoral prosthesis implantation. The examined patients were divided into two groups: 1) with normal left ventricular systolic function and EF ≥ 58% (group I), 2) with left ventricular systolic dysfunction and EF < 58% (group II).

Results

In group I the median EF before surgery was 69.5% and the concentration of NT-proBNP 141.5 pg/ml. On day 7 after surgery respective values were EF 65.5%, NT-proBNP 498.55 pg/ml. In group II the median EF before surgery was 54%, and NT-proBNP concentration 303.9 pg/ml.

Conclusions

The concentration of plasma NT-proBNP before surgery well correlated with left ventricular ejection fraction. The values of NT-proBNP > 303.9 pg/ml strongly correlated with increased risk of left ventricular systolic dysfunction after surgery and they seem to have high prognostic value for the occurrence of cardiovascular events in this group of patients. The determination of NT-proBNP level on day 7 after surgery strongly correlated with the decrease of left ventricular ejection fraction in patients after the prosthesis implantation. It is a valuable diagnostic and prognostic factor of circulatory system efficiency before making a decision to discontinue hospitalization.     

亚临床甲状腺功能减退对颈动脉粥样硬化和心功能的影响

目的 探讨亚临床甲状腺功能减退对颈动脉粥样硬化和心功能的影响。方法 随机选取2016年5月~2017年8月西安医学院第二附属医院内分泌科收治的286例患者,根据甲状腺紊乱诊断标准随机选取甲状腺功能减退患者50例为研究组,选择甲状腺功能正常患者50例为对照组。比较两组患者的一般临床资料、血脂、血糖、血中同型半胱氨酸,两组心功能检测指标（LVEF、E/E'、NT-proBNP）、斑块积分、脉搏波速度。将血浆促甲状腺激素水平与心功能检测指标、动脉彩色多普勒超声及脉搏速度检测结果进行Pearson线性相关分析。结果 研究组血压高于对照组,差异具有统计学意义（P＜0.05）;血脂各项检测指标及Hcy水平高于对照组,统计学意义显著（P＜0.01）。研究组E/E'值、血浆NT-proBNP水平均高于对照组[（9.85±1.56）vs（11.42±2.34）],[（90.46±10.36）pg/mlvs（145.32±16.61）pg/ml],统计学意义显著（P＜0.01）。血浆TSH水平与E/E'值、血浆NT-proBNP水平呈显著正相关（P＜0.01）。研究组斑块平均积分、PWV均高于对照组,统计学意义显著（P＜0.01）。血浆TSH水平与斑块积分、PWV均呈显著正相关（P＜0.01）。结论 TSH与颈动脉粥样硬化形成、心功能受损明显相关,可能通过引起血脂、血压异常,进一步加大颈动脉粥样硬化及心功能损害的风险。