采用超声心动图和组织多普勒显像评估肥厚型心肌病左室舒张功能与血浆脑钠肽前体的相关性

Correlation of left ventricular diastolic function to plasma N-terminal pro-brain natriuretic peptide in patients with hypertrophic cardiomyopathy detected by echocardiogram and tissue Doppler imaging

目的:探讨血浆氨基末端B型脑钠肽前体(NT-proBNP)与超声检测的肥厚型心肌病患者左室舒张功能的关系。方法:①分组:入选2006-02/2007-08于青岛大学医学院附属医院收治的63例肥厚型心肌病患者为肥厚型心肌病组,其中梗阻性17例,非梗阻性46例;20例健康查体者为对照组。②检测指标:应用电化学发光法检测所有受试者血浆NT-proBNP水平;并行超声心动图、组织多普勒显像检测室间隔厚度、射血分数、左室流出道压差和反映左室舒张功能的参数;分析NT-proBNP水平与超声检测的舒张功能指标的相关性。结果:①血浆NT-proBN水平:肥厚型心肌病组高于对照组(P<0.0001);梗阻性肥厚型心肌病患者高于非梗阻性(P=0.016)。血浆NT-proBNP质量浓度与左心室流出道压差正相关(r=0.42,P=0.016)。②相关分析结果:血浆NT-proBNP质量浓度与超声心动图检测的多项左室舒张功能参数呈正相关(P<0.05);多因素Logistic回归分析显示,二尖瓣室间隔侧舒张早期及舒张晚期最大运动速度比值、肺静脉频谱舒张期及收缩期肺静脉血流速度比值是NT-proBNP血浆浓度的独立影响因素。结论:血浆NT-proBN水平与超声心动图左室舒张功能参数间存在明显的正相关,并与左室流出道压差正相关,可以作为评价肥厚型心肌病患者左心舒张功能不全的客观指标。

AIM： To investigate the relationship between N-terminal pro-brain natriuretic peptide （NT-proBNP） and left ventricular diastolic function of hypertrophic cardiomyopathy （HCM） patients. METHODS： （1）Sixty-three HCM patients, including 17 hypertrophic obstructive cardiomyopathy （HOCM） and 46 hypertrophic non-obstructive cardiomyopathy （HNCM）, admitted in the Affiliated Hospital of Qingdao University Medical College between February 2006 and August 2007, and 20 healthy testees as normal control were enrolled in this study.（2）All the subjects were studied via electrochemical radiation to test NT-proBNP levels; Echocardiogram and tissue Doppler imaging were applied to detect thickness of interventricular septum, ejection fraction, pressure gradient of left ventricular outflow tract, and the parameters to reflect left ventricular diastolic function; the correlation of NT-proBNP levels and the diastolic function detected by echocardiogram was also analyzed. RESULTS： （1）Tbe plasma NT-proBNP concentration in the HCM group was higher than that in the control group （P 〈 0.000 1）, higher in HOCM patients than in HNCM patients （P =0.016）. The NT-proBNP concentration was positive related with the pressure gradient of left ventricular outflow tract （r =0.42, P =0.016）.（2）The plasma NT-proBNP concentration have a positive correlation with the multi-parameters of left ventricular diastolic function via echocardiogram （P 〈 0.05）; Multi-factor Logistic regression analysis showed that the early/late diastolic peak velocity ratio of mitral ventricular septum, and the diastolic-systolic velocity ratio of pulmonary venous flow pattern were the independent influenced factors of NT-proBNP concentration. CONCLUSION： NT-proBNP concentration has obviously positive correlations with the parameters of left ventricular diastolic function via echocardiogram, and is positively related to the left ventricular outflow tract gradient, thus it can be considered as the objective index for evaluating the HCM patients in abnormal left ventricular diastolic function.