限制性心肌病患者血浆B型利尿肽水平影响因素分析

Factors influencing plasma brain natriuretic peptide in patients with restrictive cardiomyopathy

目的探讨在限制性心肌病(RCM)患者中血浆B型利尿肽(BNP)的影响因素。方法入选20例经过组织活检确诊为RCM的患者。将临床、超声心动图和右心导管指标与血浆BNP水平进行相关性分析。结果 RCM患者血浆BNP水平为(792.3±1045.9)ng/L。相关性分析显示BNP与年龄、性别、心功能分级和药物治疗无显著相关;而与超声心动图左心室舒张功能指标,即二尖瓣血流峰值速度E/A比值(r=0.46)、二尖瓣E峰减速时间(r=-0.59)、等容舒张时间(r=-0.45)、组织多普勒成像二尖瓣环舒张早期速度(E′)峰值(r=-0.45)和E/E′比值(r=0.86)有显著相关性(P<0.05)。BNP与右心导管测定的右心房压力(r=0.45)、右心室舒张末压力(r=0.56)和肺动脉楔压(r=0.46)显著相关(P<0.05)。多因素回归分析显示二尖瓣E/E′是BNP唯一的独立相关因素(β=0.69,P<0.05)。结论 RCM患者血浆BNP水平升高,而且与多普勒超声心动图的左心室舒张功能指标以及右心导管测定的右心室舒张压力显著相关。

Objective To investigate the factors influencing plasma brain natriuretic peptide （BNP） in patients with restrictive cardiomyopathy （RCM）. Methods Twenty RCM patients diagnosed by biopsy were enrolled. Clinical features, echocardiograph and right heart catheter data were collected in all patients. The plasma BNP levels were determined. The associations between plasma BNP levels and the collected data were analyzed. Results Plasma BNP level was elevated to （792.3 ± 1045.9） ng/L in RCM patients There was no association of BNP with age, gender, NYHA class, and medications in RCM patients. Plasma BNP level was correlated significantly （P 〈 0.05） with echocardiographic parameters, including transmitral E/A ratio （r = 0.46）, E-wave deceleration time （r = -0.59）, isovolumic relaxation time （r = -0.45）, mitral annular lateral early diastolic velocity （E＇） on tissue Doppler imaging （r = -0.45） and E/E＇ ratio（r = 0.86）. BNP levels were correlated significantly （P 〈 0.05） with right atrial pressure （r = 0.45）, right ventricular diastolic pressure（r = 0.56） and pulmonary capillary wedge pressure （r = 0.46） detected by right heart catheterization （P 〈 0.05）. Multivariate regression analysis showed that BNP was correlated independently with mitral E/E＇ ratio （β=0.69, P 〈 0.05）. Conclusion In RCM patients, plasma BNP levels are elevated and correlated with left ventricular diastolic function indices determined by Doppler echocardiographic signs and diastolic pressure determined by right heart catheterization.