缺血性心肌病组织多普勒Tei指数与BNP、TNF—α的关系研究

目的研究组织多普勒（TDI）Tei指数、脑钠肽（BNP）及肿瘤坏死因子-α（TNF-α）在缺血性心肌病（ICM）中的变化及相关性，并探讨其临床意义。方法研究对象为64例ICM患者及30例健康对照者。按NYHA心功能分级标准将ICM患者分为心功能Ⅱ级组（14例）、心功能Ⅲ级组（26例）、心功能Ⅳ级组（24例），常规超声心动图测定LVEF，利用TDI测算二尖瓣环6个位点的Tei指数，其均值作为左室整体作功指数（Tei）；同时检测患者及健康对照者血浆BNP及血清TNF-α浓度。结果ICM组患者Tei指数、血BNP及TNF—α浓度均高于对照组（P均〈0．01），且随着心功能的恶化而升高（P〈0．05，P〈0．01），与LVEF呈负相关（P〈0．01）；Tei指数与血BNP、TNF—α呈正相关（P〈0．01）。结论ICM患者Tei指数与BNP、TNF-α有良好的相关性，Tei指数、BNP及TNF-α均可作为评价ICM患者心力衰竭严重程度的指标。

Objective To study the relationship and significance of Tel - index derived from tissue doppler imaging（TDI） and brain natriuretic peptide （BNP）, tumor necrosis factor-alpha （TNF-α） in the patients with isehemie eardiomyopathy （ICM）. Method 64 patients with ICM and 30 healthy control subjects were enrolled in this study. According to the NYHA function classification, the patients with ICM were graded. 14 patients were in the group with NYHA Ⅱ , 26 patients were in the group with NYHA Ⅲ, 24 patients were in the group with NYHA Ⅳ. Left ventricular ejection fraction （LVEF） was measured by eehoeardiography. Tel - index was calculated at six different sites of the mitral annulus by TDI. The mean value of Tel - index of the six different sites was regarded as left ventricular global function index （Tel）. The concentrations of plasma BNP and serum TNF-α in the patients with ICM and the healthy control subjects were measured and compared at the same time. Result The value of Tel - index, the concentrations of plasma BNP and serum TNF-α were significantly higher in the patients with ICM than those in control group （ P 〈 0. 01 ）, and increased with the heart failure aggravated （ P 〈 0. 05, P 〈 0.01 ）. The value of Tel, the concentrations of plasma BNP and serum TNF-α were negatively correlated to LVEF （ P 〈 0. 01 ）. Tel - index was positively correlated to the concentration of plasma BNP and the concentration of serum TNF-α in the ICM patients（P 〈 0. 01 ）. Conclusion There is a good correlation between Tel - index and BNP, TNF-α. Tel - index, BNP and TNF-α are valuable parameter for the severity degree of heart failure in the patients with ICM.