探讨舒张功能不全患者B型利钠肽与心功能指标的相关性

Correlation of brain natriuretic peptide with parameters of heart function in patients with diastolic heart failure

目的研究舒张性心功能不全（DHF）患者血浆B型利钠肽（BNP）水平与超声心动图所测指标、心电图V1导联P波终末电势（Ptf V1）的相关性。方法将289例住院患者分为心功能正常组（91例）、单纯舒张功能异常组（149例）和舒张合并收缩功能异常（49例）三组，其中又将单纯舒张功能异常组根据二尖瓣舒张期E峰与A峰流速比值（EV／AV）分为三组：DHF1级组EV／AV〈0．75（52例）、DHF2级组EV／AV为0．75—1．5（54例）、DHF3级组EV／AV〉1．5（43例）。采用心力衰竭诊断仪测定每组患者血浆BNP水平，利用超声心动图测定每组患者的左室射血分数、左室舒张末内径及左房内径，常规描记十二导联心电图并计算V1导联P波终末电势，对结果进行统计学处理。结果心功能正常组、DHF1级组、DHF2级组、DHF3级组、舒张合并收缩功能异常组之间全血BNP水平差异有统计学意义（P〈0．01），且随着心功能恶化，BNP水平呈逐渐上升趋势。与单纯舒张功能异常组中左心房前后径（LAD）与BNP呈显著正相关（r=0．711，P〈0．01），PtfV1与BNP呈显著负相关（r=－0．615，P〈0．01）。与舒张合并收缩功能异常组中左室舒张末期内径（LVEDD）与BNP呈显著正相关（r=0．862，P〈0．01），左心室射血分数（LVEF）值与BNP呈显著负相关（r=－0．926，P〈0．01）。结论临床上对舒张性心功能不全患者进行血浆BNP水平测定，并结合EV／AV比值分级、超声心动图测定指标、心电图V1导联P波终末电势，有助于舒张性心功能不全的诊断及对心功能进行综合评估。

Objective To investigate the correlation of plasma B -type natriuretic peptide（BNP） level with echocardiographic functional parameters and P - wave terminal force - V1 （ Ptf V1 ）. Methods Two hundred and eighty - nine consecutive patients in hospital were divided into three groups ： normal heart function group（n =91 ）,diastolic heart failure group（ n = 149）, diastolic and systolic heart failure group （n =49）. According to the results of ratio of mitral annular early diastole to late diastole （EV/AV）, the DHF patients were subdivided into DHF 1 group EV/AV 〈 0. 75 （ n = 52 ）, DHF 2 group EV/AV 0.75 - 1.5 （ n = 54）, DHF 3 group EV/AV 〉 1.5 （ n = 43 ）. Blood BNP levels were determined by BNP Triage test device, LVEF, LVEDD, LAD were examined with echocardiogram, and Ptf V1 were measured by electrocardiogram in five groups in hospital, then made a statistical analysis for the results. Results In five groups,The plasma BNP levels elevated with the worsening of heart failure, with significant differences a- mong the patients with different group. In diastolic heart failure group, the plasma BNP level were significant positively correlated withLAD （ r =0. 711, P 〈0.01 ）, but significant negatively correlated with Ptf VI（ r = -0. 615, P 〈 0. 01 ）. In diastolic and systolic heart failure group, the plasma BNP levels were significant positively correlated with LVEDD （ r =0.862, P 〈0.01 ）, but significant negatively correlated with LVEF （ r = -0.926, P 〈0.01 ）. Conclusions Measuring the plasma BNP level, combined with the ratio of E to A classification, echocardiographic functional parameters and Ptf V1, we can obtain a exact diagnosis of DHF and comprehensive assessment of left heart function in patients with heart failure.