心脏做功指数联合血浆脑钠素水平对肥厚性心肌病心室功能状态的评价

Plasma brain natriuretic peptide combined with Tei index in assessment of heart function in patients with hypertrophic cardiomyopathy

目的探讨心脏做功指数(Tei指数)在评价肥厚性心肌病(HCM)心室功能状态中的价值,以及HCM患者的血浆脑钠素(BNP)水平与Tei指数的关系。方法共选择42例HCM患者(HCM组)和20名健康者(对照组),按照美国超声协会的标准进行传统的M型超声及二维超声检查,采用酶联免疫吸附试验测定血浆BNP水平。结果 HCM组的Tei指数为0.55±0.11,显著高于正常对照组的0.35±0.07(P<0.001);等容舒张期(IRT)、等容收缩期(ICT)分别为(118±25)、(44±31)ms,显著长于对照组的(78±18)、(29±16)ms(P值均<0.001)。Tei指数与血浆BNP水平的相关性较弱(r=0.33,P=0.02)。但在非梗阻型HCM亚组患者中,这种相关性比较明显(r=0.75,P<0.0001);对年龄进行校正后,血浆BNP水平与Tei指数的相关性仍然存在(r=0.63,P<0.0001)。多元逐步回归分析发现,非梗阻型HCM亚组患者的二尖瓣前向血流E/A比值(r=0.49,F=13.1)和Tei指数(r=0.37,F=7.6)是血浆BNP水平增高的独立预测因子。结论 HCM患者的Tei指数异常反映了其收缩及舒张功能均异常。血浆BNP水平在非梗阻型HCM患者中增高的程度与Tei指数相关。

Objective To clarify the value of Tel index in eveluating ventricular function of hypertrophic cardiomyopathy （HCM） patients and the correlation between Tei index and the plasma brain natriuretic peptide （BNP）. Methods The value of Tel index and plasma BNP were obtained and compared betweeen 42 HCM patients and 20 normal control subjects. Results The HCM patients had a significantly higher value of Tel index （0.55±0. 11 vs. 0. 35 ±0.07, P 〈 0. 001 ）, longer isovolumic relaxation, and contraction times than control subjects. The plasma BNP level was correlated with Tel index in non-obstructive HCM （n = 32, r = 0.75, P〈 0. 000 1）, although the correlation was mild when all HCM patients were included （r = 0.33, P = 0.02）. The correlation was still significant after adjusting for age, and the extent and severity of left ventricular hypertrophy. Multiple stepwise regression analysis identified mitral E/A ratio （ r = 0.49, F = 13. 1 ） and Tel index （ r = 0.37, F =7.6） as independent predictors of higher plasma BNP level in non-obstructive HCM. Conclusion Myocardial performance index is abnormal in HCM patients, indicating that both systolic and diastolic dysfunction exists in the patients. Plasma BNP level increase is correlated with Tel index in non-obstructive HCM patients.