不同海拔慢性心力衰竭TNF-α、AngⅡ和BNP差异及其对心力构型影响.pdfVIP

青海大学硕士学位论文 摘要 摘要 目的：研究不同海拔慢性心力衰竭(CHF)患者血清肿瘤坏死因子 α （TNF-α ）、 血管紧张素Ⅱ(Ang Ⅱ)和 B 型钠尿肽（BNP ）的变化，探讨肾素-血管紧张素系统 （renin-angiotensinsystem, RAS ）、促炎性细胞因子 （proinflammatory cytokines ） 海拔差异性对心室重构的影响。 方法：对入选的 110 例（2260 m 62 例、3300-3500 m 48 例）CHF 患者测定 了血清 TNF-α、Ang Ⅱ和 BNP 水平，超声心动图测量左室射血分数(LVEF)，评 价心功能；计算左心室质量指数（LVMI ）和室壁应力（MWS ）；同时选择各海 拔 27 例正常人作为对照组。 结果：随着海拔升高，CHF 患者心功能恶化，血清 TNF-α、Ang Ⅱ和 BNP 水平以及 MWS 和 LVMI 逐渐升高；海拔 3300 mCHF 组患者血清 TNF-α、Ang Ⅱ和 BNP 水平以及 MWS 和 LVMI 显著高于 2260 m CHF 组 （P0.01) ；CHF 患 者 MWS 和 LVMI 与 TNF-α、Ang Ⅱ和 BNP 水平呈正相关(P0.01) 。 结论：高海拔 CHF 患者 TNF-α、Ang Ⅱ和 BNP 水平升高促进了心室重构的 生理病理过程并使其加重化。 关键词：心力衰竭；肿瘤坏死因子-α ；血管紧张素Ⅱ；B 型钠尿肽；心室重 构 I 青海大学硕士学位论文 Abstract Abstract Objective: The altitude difference(2260 m, 3300-3500 m) of serum tumer necrosis factor-α(TNF-α),angiotensin Ⅱ( Ang Ⅱ),B-type natriuretic peptid(BNP) in the elderly patients (≥65 years old)with congestive heart failure(CHF) was to study, and to evaluate the effect on left ventricular mass index(LVMI), mean wall stress(MWS) and cardiac function. Methods: Serum TNF-α, Ang Ⅱ and BNP in 48 CHF patients from high altitude (3300-3500 m)were studied and compared with 62 CHF patients from moderate altitude (2260 m) , Left ventricular ejection fraction (LVEF) by echocardiography, LVMI and MWS were calculated. Results: The levels of TNF-α, Ang Ⅱ, BNP ）and LVMI, MWS in CHF patients lived at 3300-3500 m were higher than those, Ang Ⅱ, BNP and LVMI, MWSat 2260 m. With the increase of disease severity, the levels of TNF-α, Ang Ⅱ,BNP and LVMI,MWS significantly incre