| Objective: 1.Cardiac valvular disease patients generally have cardiac dysfunction.Mild patients can be relieved by medical treatment.With the extension of the disease course and the worsening of the disease,symptoms of heart failure will appear.Medical treatment cannot be effectively alleviated.Treatment to restore the normal function of the heart valve.During the perioperative period,because the patient’s condition is generally severe,the condition often changes rapidly,which brings some difficulties to clinical diagnosis and treatment.Nowadays clinical commonly used detection and evaluation methods,such as echocardiography,NYAH(New York Heart function classification)and hematological indicators Nt-Pro BNP(N-terminal brain natriuretic peptide precursor)are widely used in clinical practice,which provides strong support for the evaluation of the condition,surgical risk and prognosis of patients with heart valve disease.2.Patients with valvular heart disease undergo cardiac ultrasonography.Most patients have compensatory hypertrophy of ventricular muscles due to valvular disease.Ventricular remodeling occurs as the disease progresses,and many patients eventually develop congestive heart failure.Galectin-3(Galectin-3)is an independent risk factor for ventricular remodeling.It is considered to be a new type of biological marker that can predict heart failure.The development of heart failure patients has a strong correlation with it.The serum level of Galectin-3 in patients with heart valve replacement can be explored to detect the changes in serum level of Galectin-3 before and after surgery and its clinical significance.3.To explore the correlation between cardiac function changes and biological indicators Galectin-3 before and after cardiac valve replacement surgery.4.To explore the clinical significance of Galectin-3 in patients with heart valve replacement.Methods: 1.Research object: During the one-year period from 2018 to 2019,65 patients who were selected for cardiac valve replacement surgery at the Second Hospital of Hebei Medical University were selected consecutively,including 25 males and 40 females.Age distribution(55.0 ± 11.0)years,disease duration(5.5 ± 1.0)years.2.Selection criteria: Patients with cardiac valve disease diagnosed by ECG,echocardiography,and X-ray related examinations in the Department of Cardiac Surgery of the Second Hospital of Hebei Medical University were selected.3.Exclusion criteria: Patients with severe heart failure before surgery who cannot tolerate surgery with drug treatment,with severe liver and kidney organ dysfunction;immunological diseases,pulmonary hypertension,pulmonary fibrosis,acute myocardial infarction,and malignant tumors.Patients who withdrew from the trial after being unable to tolerate anticoagulation therapy,nausea,cerebrovascular events(including sudden cardiac death,stroke,ventricular fibrillation,etc.)and various reasons.4.Research methods: 4.1 After admission,record the age(years),gender,height(cm),weight(kg)of all patients,and calculate the body surface area.3 ml of fasting venous blood was collected as a sample in the early morning of the second day after admission and placed in a sample bottle,centrifuged at 3000 r Pm for 5 minutes,and 1 ml of plasma was placed in the sample bottle as a sample for this study,and stored in a refrigerator at-30 ° C..The method for sample detection of Galectin-3 and Nt-Pro BNP(precursor of N-terminal brain natriuretic peptide)is an enzyme-linked immunosorbent assay,and the detection machine model is MK3(Finland Leib).The kit used was purchased from Shanghai Jimian Industrial Co.,Ltd.,The specific operation is strictly in accordance with the kit instructions.GE Vivid3 s cardiac ultrasound instrument was used,the ultrasound probe was GE Vivid3 s,the ultrasound frequency was 2.0-3.6Hz,the detection depth was 3.5-5.5cm,the patient took the left supine position,detected and recorded LVDD(left ventricular end-diastolic diameter),IVST(Ventricular septal thickness),PWT(left ventricular posterior wall thickness),LVEF(left ventricular ejection fraction),according to the ventricular mass correction formula(LVM = 0.8x1.04 [(IVST + LVEDD + PWT)3-LVEDD3] + 0.6)Calculate the left ventricular mass.Due to the difference in the patient’s constitution,the application of the ventricular weight index(LVMI = LVM / BSA)can be compared between different individuals.The assessment of left ventricular hypertrophy and hypertrophy is based on the Devereux criteria [4]: Male: Normal: LVMI <125g / m 2,Ⅰdegree≥125 g / m 2,Ⅱdegree≥145 g / m 2,Ⅱdegree≥165 g / m 2;Female: Normal: LVMI <110 g / m 2,Ⅰdegree≥110 g / m 2,Ⅱ degree ≥135 g / m 2,Ⅲ degree ≥155 g / m2.According to the Chinese Expert Consensus on Clinical Application of Nt-Pro BNP,the diagnosis of acute heart failure is stratified according to age: <450Pg / ml for persons under 50 years of age;<900Pg / ml for persons aged 50-70 years;<1500Pg / ml for persons over 70 years of age;exclude acute Heart failure was 300 Pg / ml in an age-independent manner.4.2 Patients were evaluated for their condition and surgical risk after a comprehensive preoperative examination.Those with surgical indications and no obvious surgical contraindications underwent heart valve replacement under general anesthesia.They were discharged after standardized treatment after surgery.The follow-up was performed 6 months after the operation.During the follow-up,the patient was instructed to return to the clinic on an empty stomach in the early morning.3 ml of fasting venous blood in the morning was collected as a sample in a sample bottle,and stored and tested in the same way as the above.The above-mentioned methods were used to detect the relevant indexes of patients’ ultrasound action chart(LVDD,IVST,PWT),and record adverse cardiovascular events(including ventricular tachycardia,ventricular fibrillation,cardiogenic shock,death,etc.)during follow-up.The Galectin-3 serum value is the main observation index.Nt-Pro BNP(N-terminal brain natriuretic peptide precursor)LVM,LVMI,LVDD are secondary observation indicators.Detect and record the follow-up data before and after the operation,in which the measurement data is applied to the normal distribution test,expressed as x ± s,the comparison between groups is tested by t test or chi-square test,and the correlation between Galectin-3 and secondary observation indicators Sexual analysis using Pearson correlation.It was processed by SPSS23.0 statistical software.When the difference was statistically significant,P <0.05.Results: 1.Observing the changes of Galectin-3 levels,it was found that the follow-up results of patients before and after 3 months and 6 months after operation were compared with those before surgery.The changes of Galectin-3 levels were significantly lower than those before surgery.Significance(preoperative: 107.7 ± 54.2ng / ml;3 months after operation: 27.3 ± 30.3ng / ml;6 months after operation: 39.0 ± 29.3ng / ml,P <0.05).2.The changes in Nt-Pro BNP levels found in this study: 2.1 Heart failure was diagnosed in 36 patients included before surgery.2.2 The results of follow-up at 3 months after operation showed that 22 patients were diagnosed with heart failure;the results of follow-up at 6 months after operation showed that 11 patients were diagnosed with heart failure.The patients were significantly lower than before surgery,and the difference was statistically significant(preoperative: 1462.0 ± 1824.0Pg / ml;3 months after operation: 909.2 ± 800.0Pg / ml;6 months after operation: 677.0 ± 693.0Pg / ml,P <0.05).3.Observing the changes of LVMI in the study patients found: 3.1 There were 29 cases of myocardial hypertrophy in preoperative patients,including 16 cases of degree I hypertrophy,5 cases of degree Ⅱ hypertrophy,and 8 cases of degree Ⅲ hypertrophy.3.2 The results of follow-up at 3 months after operation showed that 9 patients had myocardial hypertrophy,and all of them were grade Ⅰ hypertrophy.The results of 6 months follow-up showed that myocardial hypertrophy was found in 3 patients,including 1 degree hypertrophy and 2 cases hypertrophy.Comparison of postoperative and preoperative LVMI showed significant differences,and the difference was statistically significant(preoperative: 116.0 ± 32.0g / m 2;3 months after operation: 93.0 ± 17.0g / m 2;6 months after operation: 89.0 ± 20.0g / m 2,P <0.05).4.Observing the changes of the echocardiographic index LVDD,we found that after surgery,the patients were compared with the follow-up results of LVDD before surgery,3 months after surgery,and 6 months after surgery.Statistical significance(preoperative: 54.4 ± 10.1mm;3 months after operation: 50.0 ± 5.0mm;6 months after operation: 49.0 ± 4.0mm,P <0.05).5.Application of Pearson correlation analysis found: 5.1 The serum level of Galectin-3 in patients before operation showed a positive correlation with Nt-Pro BNP,LVMI,and LVDD(R = 0.581,R = 0.417,R = 0.409,P <0.05).5.2 Analysis of the follow-up results at 3 months after surgery showed that the changes in serum Galectin-3 levels were positively correlated with Nt-Pro BNP,LVMI,and LVDD(R = 0.898,R = 0.822,R = 0.836,P <0.05).5.3 Analysis of the follow-up results at 6 months after operation showed that the changes in serum Galectin-3 levels were positively correlated with Nt-Pro BNP,LVMI,and LVDD(R = 0.883,R = 0.780,R = 0.769,P <0.05).Conclusions: This study concluded that preoperative ventricular muscle hypertrophy and decreased ventricular compliance were common in patients with valvular heart disease,which further affected the systolic and diastolic function of the patient’s heart.Due to a long history or severe heart disease,heart failure can occur if the condition is further aggravated.1.The changes of Galectin-3 levels in patients with heart valve replacement before and after surgery showed that the levels of Galectin-3 before surgery were significantly higher than those after surgery,and the difference was statistically significant.2.Nt-Pro BNP is used as the cornerstone of biological indicators for evaluating changes in cardiac function of patients in clinical diagnosis and treatment.Observation of changes in Nt-Pro BNP levels found that Nt-Pro BNP is still a prominent indicator in this study.The difference between before and after operation was significant and statistically significant.3.Observe the changes of LVMI,LVM,and LVDD in echocardiography,suggesting that the heart structure and function of patients with valvular heart disease have changed,and some patients have different degrees of myocardial hypertrophy before surgery,which can be obvious after surgery.Improving myocardial hypertrophy caused by valvular heart disease,indicating that this type of myocardial hypertrophy is a reversible disease.The degree of myocardial hypertrophy and cardiac function are significantly improved after surgery.4.It is found that Galectin-3 is positively correlated with Nt-Pro BNP,LVMI,and LVDD through analysis,suggesting that changes in intracardiac structure and cardiac function are closely related to plasma Galectin-3 levels.Galectin-3 can be used as a perioperative procedure for heart valve replacement.The reference index for the evaluation of the patient’s condition,surgical risk and prognosis. |
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