N-末端脑钠尿肽原诊断急性心肌梗死患者左室舒张功能的价值及其判断预后的意义

Evaluation of NT-proBNP on left ventricular diastolic function after acute myocardial infarction

目的:利用超声心动图,探讨N-末端脑钠尿肽原(NT-proBNP)对急性心肌梗死(AMI)患者左室舒张功能的评价及其意义。方法:入选左室收缩功能正常的AMI患者66例,测定血浆NT-proBNP水平。根据组织多普勒超声(TDI)及二尖瓣血流频谱指标评价的左室舒张功能,将患者分为4组:A组:左室舒张功能正常组(n=16);B组:轻度左室舒张功能减低(LVDD)组(n=21);C组:中度LVDD组(n=24);D组:重度LVDD组(n=5)。对患者随访12个月,临床终点是因心衰加重或再梗所致再住院和心源性死亡。结果:NT-proBNP水平随着LVDD的加重而显著增高(P<0.01)。NT-proBNP能够独立于其它影响因素判断LVDD,当其水平为962.1μg/L时,判断LVDD的敏感性是76%,特异性是75%。12个月后发生终点事件患者的血浆NT-proBNP水平与未发生者相比差异有统计学意义(P<0.05)。结论:AMI后NT-proBNP水平能够独立评价LVDD并判断预后。它可用于对AMI患者危险分层并指导临床治疗。

AIM： To investigate the value of NT-proBNP in evaluating left ventricle （LV） diastolic function （DF） of acute myocardial infarction （AMI） patients by echocardiography. METHODS： Sixty-six AMI patients with normal LV systolic function were enrolled and NT-proBNP was determined. LVDF was evaluated by tissue Doppler imaging （TDI） and mitral inflow pulse Doppler. According to the LVDF evaluated by echo indexes, patients were divided into four groups： group A normal LVDF （n =16）, group B mild LV diastolic dysfunction （DD） （n =21 ）, group C moderate LVDD （n =24）, and group D： severe LVDD （n = 5 ）. Patients were followed-up for 12 months and clinical endpoints were rehospitalization caused by exacerbating heart failure or reinfarction, and cardiac death. RESULTS： With increased degree of LVDD, the level of NT-proBNP was significantly elevated （P 〈 0.01 ）. The NT- proBNP level = 962. 1 μg/L had sensitivity and specificity values of 76% and 73%, respectively, on determining LVDD, independent of other factors. NT-proBNP levels among patients with end events after 12 months and those patients without were significantly different （P 〈 0.05 ）. CONCLUSION ： Postinfarction NT-proBNP level can be used independently to evaluate LVDD and predict prognosis and can be used in the risk stratification of AMI patients and for guidance of clinical management.