血清NT-proBNP在高血压病患者中的表达及其临床意义

Clinical Significance of Serum NT-proBNP Levels in Patients with Hypertension

目的测定高血压病患者血清N端前体脑钠肽(NT-proBNP)的浓度变化,并探讨其临床意义。方法采用电化学发光免疫试验(ECLIA)测定119例高血压患者及50名健康体检者的血清NT-proBNP浓度,超声心动图测定左室射血分数(LVEF)、左心室质量指数(LVMI)、舒张早期速度峰值(E)/晚期速度峰值(A)比值,比较不同NYHA、LVEF、LVMI分级下NT-proBNP水平的差异,并分析它们之间的关系;绘制受试者工作特性(ROC)曲线,计算ROC曲线下面积(AUCROC)。结果高血压病患者的血清LgNT-proBNP水平为3.40,明显高于正常对照组的1.42(P<0.001),不同NYHA、LVEF和LVMI分组下的血清NT-proBNP浓度差异均有统计学意义(P<0.001)。NT-proBNP诊断高血压患者心衰的AUCROC为0.863。多变量相关分析表明,血清NT-proBNP浓度与NYHA分级、LVMI、体重指数(BMI)之间具有良好的正相关性(r=0.581,P<0.001,r=0.437,P<0.001及r=0.352,P<0.001),与LVEF分级、E/A比值之间呈良好的负相关关系(r=-0.361,P<0.001和r=-0.626,P<0.001)。Logistic回归分析显示,NT-proBNP是高血压病患者发生左心室肥厚(LVH)强的预测因子(HR=3.392,P<0.01),并与患者的临床治疗结局密切相关。结论高血压病患者血清NT-proBNP水平随着心力衰竭程度的增加而升高,可用来评价患者的心功能状况,且与临床预后关系密切。

Objective To evaluate the clinical significance of the serum N-terminal pro-brain natriuretic peptide （NT-proBNP） levels in patients with hypertension. Method Serum NT-proBNP concentrations in 119 patients with hypertension and in 50 normal controls were measured by electrochemiluminescence immunoassay （ECLIA）. Echocardiography examination was performed to determine left ventricular ejection function （LVEF）, left ventricular mass index（LVMI） and the ratio of early diastolic E and late diastolic A（E/A）. The correlation between NT-proBNP and New York Heart Association （NYHA） functional classifications, LVEF, LVMI, and E/A were analyzed. A receiver operating characteristic （ROC） curve was drawn and area under the curve （AUC^ROC） was calculated. Result The serum LgNT-proBNP concentrations of cardiovascular diseases group was 3.40, significantly higher than 1.42 of normal controls （P〈0.001）. The NT-proBNP levels in different NYHA, LVEF, LVMI subgroups were also showed significant differences （P〈0.001）. The AUC^ROC of NT-pmBNP for heart failure diagnosis was 0.863. Multivariable regression analysis showed that NTproBNP level was correlated positively with NYHA （r=0.581, P〈0.001 ）, LVMI （r=0.437, P〈0.001）, BMI（r=0.352, P〈0.001） ; and negatively with LVEF classes （r=-0.361, P〈0.001）, and E/ A （r=-0.626, P〈0.001 ）. Logistic regression analysis showed that NT-proBNP level was a strong indicator of left ventricular hypertrophy （HR=3.392, P〈0.01 ） and was correlated with treatment results. Conclusion The serum levels of NT-pmBNP varied significantly with the increasing severity of heart failure and could be used to assess the patients＇ cardiac function, which might provide intimate insights to clinical prognosis,