氨基末端B型脑钠肽前体与非梗阻性肥厚型心肌病患者左心室舒张功能的相关性研究

Research on the correlation between plasma N-terminal pro-brain natriuretic peptide level and left ventricular diastolic function of patients with hypertrophic non-obstructive cardiomyopathy

目的探讨血浆氨基末端B型脑钠肽前体(NT-proBNP)水平与非梗阻性肥厚型心肌病(HNCM)患者左心室舒张功能的关系。方法选择46例HNCM患者,20名健康体检者作为对照组,电化学发光法检测两组血浆NT-proBNP水平,超声心动图、组织多普勒显像(TDI)检测室间隔厚度、射血分数和反映左心室舒张功能的参数。结果HNCM组患者平均NT-proBNP血浆水平明显高于对照组(P<0.001);NT-proBNP血浆水平与以下左心室舒张功能参数均呈正相关:二尖瓣室间隔侧舒张早期最大运动速度e(r=0.74,P<0.001)、e与二尖瓣室间隔侧舒张晚期最大运动速度a比值e/a(r=0.69,P<0.001)、心房收缩开始至左室流出道内心室收缩期前流速开始的间期A-Ar(r=0.63,P=0.029)、Tei指数(r=0.63,P<0.001)、肺静脉频谱收缩期肺静脉血流速度S与舒张期肺静脉血流速度D的比值S/D(r=0.62,P<0.001)、等容舒张时间(IVRT)(r=0.56,P<0.001)、二尖瓣血流频谱舒张早期充盈峰值速度E(r=0.54,P<0.001)、a(r=0.53,P<0.001)、二尖瓣血流频谱舒张晚期充盈峰值流速A(r=0.36,P=0.02)、E/A(r=0.47,P<0.001)。多因素Logistic回归分析显示,e/a、S/D是NT-proBNP血浆水平的独立影响因素。结论NT-proBNP血浆水平与超声心动图左心室舒张功能参数间存在明显的正相关性,可以作为评价HNCM患者左心室舒张功能不全的客观指标。

Objective To investigate the relationship between N-terminal pro-brain natriuretic peptide（ NT- proBNP） and left ventricular diastolic function of patients with hypertrophic non-obstructive cardiomyopathy （HNCM）. Methods Forty-six patients with HNCM and 20 healthy people as control group were enrolled in the research. The NT-proBNP level was tested with electrochemical radiation, and the thickness of interventricular septum, ejection fraction and the parameters reflecting left ventricular diastolic function were tested with echocardiogram and tissue doppler imaging（TDI）. Results The NT-proBNP level in the HNCM group was higher than that in the control group（P 〈 0. 001 ）, The results showed that NT-proBNP concentration had positive correlation with multi-parameters of left ventrieular diastolic： function helow ： peak early diastolic myocardial velocity（e） （r = 0. 74, P 〈 0. 001 ） ,the ratio of e to peak diastolic myocardial velocity during atrial contraction （a） wave（e/a）（r=0. 69, P 〈0. 001 ）,the transit time from the inflow tract to the outflow tract of the atrial pressure wave （A-Ar） （ r = 0. 63, P = 0. 029 ） , Tel parameter（ r = 0. 63, P 〈 0. 001 ） , peak systolic pulmonary venous flow velocity （ S ） to peak diastolic pulmonary flow velocity （ D ） ratio （ S/D ） （ r = 0. 62, P 〈 0. 001 ）, isovolumic relaxation time（IVRT） （ r =0.56, P 〈 0. 001 ）, peak early transmittal flow velocity（E） （ r = 0. 54, P 〈 0. 001 ）, a（ r = 0. 53,P 〈 0. 001 ）, peak transmittal flow velocity during atrial contraction （A） （r = 0. 36, P = 0. 02）, E/A（r = 0. 47, P 〈 0. 001 ）. Multi-factor logistic regression showed that E/A, S/D were the independent influencing factors of NT-proBNP level. Conclusion NT-proBNP level and the parameters of left ventricle diastolic function have positive correlation and could he considered as the ohjective index evaluating ahnormal left ventricular diastolic function of HNCM patients.