脑钠肽及Tei指数联合评价高血压性心脏病患者心功能的临床研究

Study on heart function evaluated by Tei index and brain natriuretic peptide in hypertension patients with heart failure

目的探讨脑钠肽(BNP)及Tei指数评价高血压性心脏病患者心功能的临床意义。方法89例高血压性心脏病患者,按照其入院时NYHA心功能分级分为心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组。21例选自本院体检中心的心功能正常者作为对照组。行超声心动图检查测出Tei指数、左室射血分数(LVEF)、左室重量指数(LVMI),并检测血BNP。结果随着心功能分级程度的加重Tei指数与血BNP水平逐渐增加,Tei指数均值在心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为0.40±0.12、0.49±0.09、0.58±0.18和0.69±0.07;BNP均值在心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为42.19±17.51、297.45±21.92、703.12±15.76和912.75±37.16(pg/ml),组间比较P<0.05,差异有统计学意义。除BNP指标在心功能Ⅰ级组与对照组比较差异无统计学意义(P>0.05)外,余指标均明显高于对照组[Tei指数对照组0.31±0.08,BNP对照组(33.12±3.15)pg/ml](P<O.05),差异有统计学意义。随心功能障碍程度的加重,血BNP水平升高,并且和Tei指数、LVMI呈正相关(r分别为0.563,0.368,P<0.05);与左室射血分数(LVEF)呈负相关(r=-0.372,P<0.05)。结论在高血压性心脏病患者中,血BNP水平与Tei指数、心功能以及左室构型之间有较好的相关性,血BNP水平与Tei指数能综合反映心脏的功能。

Objective To investigate the clinical value on heart function evaluated by Tei index and Brain Natriuretic Peptide in hypertension patients with heart failure. Methods According to the NYHA cardiac functional grading method, 89 patients with hypertension patients with heart failure were divided into four classes as follows,grade Ⅰ（24 cases）,grade Ⅱ （20 cases）,grade Ⅲ （23 cases）and grade Ⅳ （22 cases ）.Control group consisted of 21 normal subjects.Tei index, LVEF and LVMI were measured with echocardiography measurement and plasma BNP was detected. Results Tei index and plasma levels of BNP were increased in proportion to the severity of left ventricular dysfunction and increased as compared to the control group. The levels of plasma BNP in the patients with the cardiac function of grade I, 11 , III and IV were 42.19±17.51,297.45±21.92,703.12±15.76 and 912.75±37.16 （pg/ml）,Tei index of the 4 groups were 0.40±0.12,0.49±0.09,0.58±0.18 and 0.69±0.07. There were significant differences in an± two groups （P〈0.05）.In the control group the levels of plasma BNP was 33.12± 3.15 pg/ml and Tei index was 0.31±0.08, There was no significant difference in group grade Ⅰ and the control group about the levels of plasma BNP （P〉0.05）,and there were significant differences in the other groups （P〈 0.05 ）. With the sequence from NYHA functional grade Ⅰ to grade Ⅳ, BNP was gradually increased. BNP was positively correlated with Tei index and LVMI respectively （r=0.563,0.368,P〈0.05） and there was a significant negative correlation between BNP and LVEF（r=-0.372, P〈0.05 ）. Conclusion There was a good correlation between BNP, Tei index, cardiac function and left ventrieular structure, BNP and Tei index can evaluate the heart function generally in the hypertention patients with heart failure.