单纯收缩期高血压患者血浆B型钠尿肽水平与左心室肥厚、舒张功能变化的关系

The Correlation Between the Levels of Plasma B-type Natriuretic Peptide and Change of Left Ventricular Hypertrophy or Diastolic Function in Patients with Isolated Systolic Hypertension

目的观察非高血压病者和单纯收缩期高血压病(ISH)伴或不伴左心室肥厚(LVH)者血浆B型钠尿肽(BNP)水平,及血管紧张素受体阻滞剂(ARB)治疗前后BNP、左心室肥厚及舒张功能变化情况,探讨BNP变化与左心室肥厚、舒张功能改变的关系。方法筛选非高血压病者(正常对照组)33例,ISH患者38例,ISH+LVH患者42例,予高血压病患者口服缬沙坦片80~120 mg/d,治疗前后采用超声心动图测定左心室质量指数(LVMI),E/A比值;放射免疫分析法测定血浆BNP水平。结果高血病各组血浆BNP水平明显高于正常对照组(P<0.01或P<0.05);与ISH组相比,ISH+LVH组LVMI增高(P<0.05),而E/A值降低(P<0.01);经ARB治疗后,血浆BNP水平在高血压病各组中均表现降低(P<0.05或P<0.01),LVMI值在ISH+LVH组表现为下降(P<0.01),而E/A值表现为增高(P<0.01);治疗前,血浆BNP水平与LVMI呈显著正相关(r2=0.61,P<0.01),与E/A值呈显著负相关(r2=0.26,P<0.01)。结论血浆BNP水平可作为判断ISH左心室肥厚、舒张功能改善的敏感指标。

Aim To observe the levels of plasma B-type natriuretic peptide( BNP) in people of non-hypertension( non-HP) and patients of isolated systolic hypertension( ISH) with or without left ventricular hypertrophy( LVH) and the changes of BNP,LVH and diastolic function before and after administration of angiotensin receptor blocker( ARB),and to investigate the associations between the changes of BNP and LVH or diastolic function. Methods Thirty-three were designed to non-HP group,thirty-eight patients with ISH,and forty-two patients with ISH and LVH served as HP groups.Echocardiography was performed to determine left ventricular mass index( LVMI) and E / A ratio,and radioimmunoassay was used to detect plasma BNP levels. Results Plasma BNP was significantly higher in two ISH groups than that in non-HP group( P < 0. 05 or P < 0. 01). LVMI was significantly increased( P < 0. 05) while E / A ratio reduced( P < 0. 01)in patients of ISH with LVH compared with those without LVH. After administration of ARB-valsartan,BNP levels lowered in HP groups( P < 0. 05 or P < 0. 01),and LVMI reduced while E / A ratio increased in patients of ISH with LVH( P< 0. 01). The BNP levels correlated positively with LVMI( r2= 0. 61,P < 0. 01) and negatively with E / A ratio( r2=0. 26,P < 0. 01) before treatment. Conclusion The plasma BNP may be a sensitive biomarker for reverse remodeling in LVH and improvement in diastolic dysfunction.