冠状动脉粥样硬化性心脏病患者心功能与血浆N端脑钠素前体浓度的关系

Relationship between cardiac function and plasma concentra-tion of N-terminal-pro-brain natriuretic peptide in patients with coronary atherosclerotic heart disease

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者血浆N端脑钠素前体浓度的变化与心力衰竭严重程度的关系。方法:选择2004-08/2005-02在解放军总医院住院的冠心病患者86例。按美国纽约心脏病学会分级法分组:Ⅰ级活动量不受限制,20例;Ⅱ级体力活动受到轻度限制,32例;Ⅲ级体力活动明显受限,22例;Ⅳ级不能从事任何体力活动,12例。同期选取健康查体志愿受试者10例为正常对照组。所有患者和正常对照组均采用电化学发光双抗体夹心免疫法测定血浆N端脑钠素前体浓度,并采用超声心动图测定不同心功能组患者的心脏结构和功能,分析血浆N端脑钠素前体浓度、超声指标与纽约心脏病学会心功能分级的关系。结果:86例患者均进入结果分析。①血浆脑钠素前体浓度的测定:Ⅱ级、Ⅲ级、Ⅳ级明显高于Ⅰ级和正常对照组犤(198.76±120.46,246.35±140.25,386.72±192.16,78.22±14.71,79.64±11.20)ng/L,F=86.57,P<0.01犦。②超声心动图参数的比较:左心室收缩末径随着心力衰竭的严重程度加重而增大犤(29.02±4.86,34.23±6.85,41.65±7.15,50.12±8.19)mm,F=5.689,P<0.05犦。左心室射血分数随心力衰竭的严重程度加重而降低犤(63.00±9.30,54.00±10.20,43.00±9.70,32.00±12.80)%,F=10.817,P<0.05犦。③血浆N端脑钠素前体浓度与左心室功能参数的相关性比较:血浆N2端脑钠素前体浓度与左心室收缩末径、左心室舒张末径呈正相关(r=0.384,t=3.46,P<0.01;r=0.301,t=2.624,P<0.05),血浆N端脑钠素前体浓度与左心室射血分数、短轴缩短率呈负相关(r=-0.496,t=4.736,r=-0.326,t=3.015,均P<0.01)。结论:冠心病患者血浆N2端脑钠素前体浓度随着心力衰竭严重程度的加重而升高,是评价心功能的敏感指标。

AIM：To explore the correlations of the changes of plasma concentration of N-terminal-pro-brain natriuretic peptide （NT-proBNP） and the severity degree of heart failure in patients with coronary atherosclerotic heart disease. METHODS： Eighty-six patients with coronary heart disease, who were treated in the General Hospital of Chinese PLA from August 2004 to February 2005, were selected. According to the New York Heart Association （NYHA）： In Ⅰ grade, no limitation in ordinary physical activity with 20 cases; In Ⅱ grade, slight limitation during ordinary activity with 32 cases; In Ⅲ grade, marked limitation in activity with 22 cases; In IV grade, severe limitations with 12 cases. Ten healthy testees during the same period were selected as normal control group. All the patients and the people in the normal control group were detected the NT-proBNP by the electrochemiluminescence （ECL） immunoradiometric double-antibody sandwitch protocols. The heart constitution and function in patients of the different cardiac function group were detected by the ultrasonic cardiogram. The relation of NT-proBNP, ultrasound index and New York heart association functional classification was analyzed. RESULTS：Totally 86 patients were involved in the result analysis. ① Detection of NT-proBNP： It was significantly higher in the Ⅱ grade,Ⅲ grade, Ⅳ grade than that in the I grage and the normal control group [（198.76±120.46, 246.35±140.25, 386.72±192.16, 78.22±14.71, 79.64 ±11.20） ng/L, F=86.57, P 〈 0.01].② Comparison of parameter of ultrasonic cardiogram： The end-systolic diameter of left ventricle increased with the severity of heart failure [（29.02±4.86, 34.23±6.85, 41.65±7.15, 50.12 ±8.19） mm, F=5.689, P 〈 0.05]. The ejection fraction of the left ventricle decreased with the severity of heart failure [ （63.00±9.30, 54.00±10.20, 43.00±9.70, 32.00±12.80） %,F=10.817, P 〈 0.05]. ③ Comparison of correlation of NT-proBNP and the function parameter of the left ventricle： It was positive correlation of NT-proBNP, end-systolic dimension and end-relax dimension of the left ventricle （r= 0.384, t= 3.46, P 〈 0. 01; r=0.301,t =2.624, P 〈 0.05）, and it was negative correlation of NT-proBNP, ejection fraction of left ventricle and shortening rate of short axis （r = - 0.496, t =4.736, r=-0.326, t=3.015, P 〈 0.01）. CONCLUSION： The NT-proBNP in patients with coronary heart disease increases with the severity of heart failure, which is a sensitive marker for evaluating heart function.