氨基末端B型脑钠肽前体对于原发性高血压病患者心脏舒张功能不全的诊断价值

Clinical value of plasma N-terminal pro-brain natricuretic peptide for cardiac diastolic function in patients with essential hypertension

目的测定原发性高血压病患者血浆氨基末端B型利脑肽前体（NT-proBNP）浓度，探讨NT-proBNP对于原发性高血压病患者心脏舒张功能不全的诊断价值。方法选取原发性高血压病患者73例（高血压组）及体检健康者41例（对照组），采用ECLIA法测定NT-proBNP浓度，同时采用心脏超声心动图测定左室射血分数，并计算E／A值及e／a值对左室舒张功能进行分级（分为I、Ⅱ、Ⅲ级）。然后对比分析两组对象以及高血压组不同舒张功能分级患者的血浆NT-proBNP浓度。结果高血压组及对照组血浆NT-proBNP浓度为557.24、53.79pg／ml，经对数转换后分别为3.04±2.69、1.89±168，高血压组患者血浆NT-proBNP浓度显著高于对照组（t=2.478，P〈0.01）。高血压组舒张功能I、Ⅱ、Ⅲ级患者血浆NT-proBNP浓度分别为94.32、480.98、1573.25pg／ml，经对数转换后分别为2.04±1.78、2.95±2.52、3.35±2.60，Ⅲ级患者血浆NT-proBNP浓度明显高于Ⅰ级患者（t=1.717，P〈0.05），I级与Ⅱ级患者、Ⅱ级与Ⅲ级患者的血浆NT-proBNP浓度差异均无统计学意义（P〉0.05）。尽管舒张功能I级患者血浆NT-proBNP浓度高于对照组，但差异并无统计学意义（P〉0.05）。结论高血压患者血浆NT-proBNP水平高于正常人群，在心脏收缩功能正常时，随着舒张功能的减退而逐渐升高，NT-proBNP的检测为高血压舒张功能不全的诊断提供了一个新的生化手段。

Objective To investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） levels in essessment of left ventricular diastolic function in patients with essential hypertension. Methods The study included 73 patients with essential hypertension （hypertension group） and 41 healthy individuals （control group）. Plasma levels of NT-proBNP were measured by enzyme-linked immunosorbent assay （ELISA）. The left ventricular ejection fraction, E/A value, e/a value and left ventricular diastolic function were evaluated by color Doppler echocardiography, and the left ventricular diastolic function of hypertensive patients was classified as 3 grades according to results of echocardiography. Results The plasma NT-proBNP levels in hypertension group were 557.24pg/ml, much higher than those in control （53.79pg/ml） （p〈0.01）. Plasma NT-proBNP levels were 94.32 pg/ml, 480.98 pg/ml and 1573.25pg/ml for hypertensive patients with grade I, Ⅱ and Ⅲ left ventricular diastolic function grade respectively. The plasma NT-proBNP levels of grade Ⅲ were higher than those of grade I （P〈0.05）; there were no significant differences between grade I and control, between grade I and grade Ⅱ, grade Ⅱ and grade Ⅲ（P 〉 0.05 ）. Conclusion The plasma NT-proBNP levels can be used to evaluate the cardiac diastolic dysfunction in hypertensive patients with normal left ventricular systolic function.