血浆脑钠肽与左室射血分数正常的老年高血压患者左室肥厚及舒张功能不全的关系

Correlation of plasma BNP levels with left ventricular hypertrophy and left ventricular diastolic dysfunction in elderly hypertensive patients with normal left ventricular ejection fraction

目的探讨老年高血压患者血浆B型脑钠肽（BNP）与左室肥厚（LVH）和舒张功能不全（LVDD）的相关性。方法选择我院收治的左室射血分数（LVEF）正常的114例高血压患者，根据左室重量指数（LVMI）标准分为LVH组和正常组，根据LVDD诊断标准分为舒张功能不全组和正常组。测定各组患者BNP水平，并检测其各项心脏超声指标[室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末内径（LVEDd）、LVEF、舒张早期血流播散速率（FPV）、二尖瓣舒张早期血液流速峰值（E）以及舒张晚期流速峰值（A）]，对比分析两组间的各项检测指标，以及BNP水平与各项心脏超声指标的关系。结果LVH组较正常组BNP水平及LVPWT均显著增加（均P〈0．01），E／A及FPV均显著降低（均P〈0．01）；舒张功能不全组较正常组BNP浓度、LVPWT和LVMI均显著升高（均P〈0．01），E／A及FPV均显著降低（均P〈001）；BNP与高血压患者年龄、病程、收缩压、舒张压、LVEDd、IVST、LVEF等无明显相关性（P〉0．05），而与LVPWT和LVMI呈显著正相关（均P〈0．01），与E／A和FPV呈显著负相关（均P〈0．01）。结论EF正常的老年高血压患者合并左室肥厚或左室舒张功能不全时，其血浆BNP水平明显升高，BNP可作为反映LVH和LVDD状态的一种有价值的生化指标，对其进行检测有助于LVH和LVDD的早期诊断和干预治疗。

Objective To investigate the correlation of plasma brain natriuretic peptide （BNP） levels with left ventricular hypertrophy （LVH） and left ventricular diastolic dysfunction （LVDD） in elderly hypertensive patients. Methods One hundred and fourteen elderly hypertensive patients with normal left ventricular ejection fraction （LVEF） were classified as LVH group and control group based on the left ventricular mass index （LVMI）, and also classified as LVDD group and control group. Plasma BNP levels and index of echocardiography, including interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDD）, LVEF, flow propagation velocity （FPV）, mitral early diastolic peak flow velocity（ E）and late diastolic peak flow velocity（A） were detected in all patients. The correlation of plasma BNP levels with cardiac ultrasonographic findings was also examined. Results Compared with control group, the plasma BNP and LVPWT were significantly increased （ P〈 0.01）, ratio of E/A and FPV were decreased （P〈 0.01） in LVH group. Compared with control group, plasma BNP, LVPWT and LVMI in LVDD group were increased （P 〈0.01）; the ratio of E/A and FPV were decreased （P 〈0.01）. There was no correlation of plasma BNP levels with age, disease course, systolic blood pressure, diastolic blood pressure, LVEDD, IVST and LVEF of the patients （P〉0.05）.The BNP levels were positively correlated with LVMI and LVPWT （P〈0.01） and were negatively correlated with E/A and FPV （P〈0.01）. Conclusion Plasma BNP can be used as a biochemical indicator for LVH and LVDD in elderly hypertensive patients with normal LVEF.