NT-proBNP在评价高血压患者左室舒张功能中的临床意义

The Clinical significance of plasma NT-proBNP to evaluate left ventricular diastolic function in patients with hypertension

目的探讨血浆NT-proBNP在评价高血压患者左室(LV)舒张功能中的临床意义。方法 121例已控制血压的门诊高血压患者,将其分为2组,LV舒张功能正常组57例和LV舒张功能不全组64例。以欧洲心脏病学学会(ESC)标准为诊断依据,采用即时检测(POCT)系统检测患者血浆NT-proBNP浓度,分析NT-proBNP反映LV舒张功能不全的准确性,并与多普勒超声心动图检测结果进行比较。结果 LV舒张功能不全组患者血浆NT-proBNP浓度显著高于正常组患者,且随LV舒张功能不全的程度加重而增高(P<0.01)。在超声心动图检查参数中,血浆NT-proBNP浓度与E′/A′比值呈中等程度相关(r=-0.36,P<0.01),与E/E′呈显著相关(r=0.77,P<0.01)。ROC曲线表明,NT-proBNP反映LV舒张功能不全的AUC为0.89,与E/E′比值的AUC(0.91)比较差异无统计学意义(P>0.05)。以113 pg/mL为cut off值,NT-proBNP反映LV舒张功能不全的灵敏度为80%,特异性为95%。结论血浆NT-proBNP水平能较准确地反映高血压患者的LV舒张功能,可作为高血压患者LV舒张功能不全的有效筛查指标。

Objective To investigated the clinical significance of plasma NT-proBNP to evaluate left ventricular （LV）diastolic function in patients with hypertension,and without systolic dysfunction. Methods 121 outpatients with controlled hypertension and LV diastolic dysfuction,diagonosed according to the European society of cardiology （ESC） criterion,were enrolled. Plasma concentrations of NT-proBNP were measured by point of care test （POCT）. Conventional Doppler echocardiography was performed simul taneously. Results Plasma levels of NT proBNP in patients with LV diastolic dysfunction were elevated, when compared with healthy controls（P〈0.01） and increased with the severity of the diastolic dysfunction （P%0.01）. Among the indices determined by conventional echocardiography, the plasma levels of NT-proBNP in patients were moderate correlative with E＇/A＇（r=-0.36, P 〈0.01） ,but significant correlative with E/E＇（r=0.77 ,P〈0.01）. According to the receiver operating characteristic curve （ROC）, the AUC of plasma levels of NT-proBNP to diagnose LV diastolic dysfuction was 0.89 and had no statistical difference（P〉0.05）, compared with the AUC of E/E＇. Taking 113 pg/mL as cut off value,the sensitivity and specificity of plasma NT proBNP to diag- nose LV diastolic dysfunction were 800/oo and 95% ,respectively. Conclusion There are closed correlation between plasma levels of NT-proBNP and LV diastolic function in patients with hypertention,and could be useful screening tool of LV diastolic dysfunction in patients with hypertention.