心力衰竭患者脉搏波传导速度与脑钠肽相关性的临床研究

STUDY ON THE RELATIONSHIP BETWEEN PULSE WAVE VELOCITY IN PATIENTS WITH HEART FAILURE AND B-TYPE NATRIURETIC PEPTIDE

目的通过对心力衰竭(CHF)患者脉搏波传导速度(PWV)的测量,评价心力衰竭患者脉搏波传导速度与脑钠肽(BNP)以及心功能不全的关系。评价动脉僵硬度对心功能的影响,对临床工作给予一定的理论指导。方法选取CHF患者103例,使用VP-1000动脉硬化测定仪测量患者脉搏波传导速度,使用多普勒超声心动图测定CHF组左室舒张末期内径(LVEDD)及左室射血分数(LVEF),评价患者心功能,应用微粒子酶联免疫化学发光法(MEIA)测定BNP,收集数据完成后,使用SPSS12.0统计软件进行统计分析。结果CHF患者血浆BNP水平(4200±160)pg/ml,较对照组(600±20)pg/ml明显升高(P<0.01);不同心功能患者血浆BNP水平差异亦有统计学意义,依次为Ⅳ级>Ⅲ级>Ⅱ级>Ⅰ级(P<0.01);LVEDD≥60mm时的BNP与LVEDD<60mm时比较差异有统计学意义(P<0.01);LVEF<40%时的BNP与LVEF≥40%时比较差异有统计学意义(P<0.01);CHF组BNP水平升高与心力衰竭程度、LVEDD呈正相关(r=0.87、r=0.67,P<0.01);与LVEF呈负相关(r=-0.53,P<0.01)。PWV是心功能的独立影响因素(P<0.01)。结论BNP与用多普勒心脏超声所评估的心脏功能参数LVEDD、LVEF具有相关性,对于CHF患者是一种危险因素。PWV对于BNP和心脏功能是独立决定因素。

Objective To evaluate the relationship between heart failure in patients with pulse wave velocity and the BNP in heart failure. To evaluate arterial stiffness on cardiac function. Methods We selected 103 patients with congestive heart failure, VP- 1000 was used to measure pulse wave velocity in patients with atherosclerosis. Plasma BNP con- centration was detected by MEIA method. Doppler echocardiography was performed to determine the left ventricular end - dias- tolie diameter（LVEDD）and the left ventricular ejection fraction（LVEF）. Data collection is completed, SPSS12. 0 was used for statistical analysis. Results The level of plasma BNP in treatment group （4 200 ± 160） pg/ml was signif- icantly higher than that （600 ＋ 20） pg/ml in control group （P〈0.01）. There has significant difference in patients with different degrees of cardiac function in the levels of BNP, with the sequence of Ⅳ 〉 Ⅲ〉 Ⅱ〉 Ⅰ （P〈0.01）. The increasd BNP level in treatment group was correlated positively to the degree of CHF, LVEDD （r = 0. 87, r = 0.67, P〈 0. 01）. The plasma brain natriuretie peptide level was negatively correlated with LVEF（r = - 0.53, P〈0. 01） . The BNP level was significantly decreased （P〈0.01） and the LVEDD and LVEF were obviously improved （P〈0. 05） after candesartan treatment. Conclusion Brachial- ankle PWV was associated with plasma BNP levels independent of age. Our previous study demonstrated a significant association between the brachial - ankle PWV and the cardiac diastolic function. We simultaneously evaluated the relationship of PWV with parameters of atherosclerosis and parameters of risk for heart dysfunction. The results show that PWV was significantly related to cardiac diastolic function and plasma BNP level. It is suggest that increased PWV is a possible risk factor for diastolic heart failure.