老年高血压伴退行性瓣膜病患者左室舒张功能及血浆脑钠肽水平研究

Left ventricular diastolic function and level of brain natriuretic peptid in patients with senile hypertension accompanied by degenerative valvular disease

目的探讨老年高血压伴退行性瓣膜病患者左室舒张功能及血浆脑钠肽的水平及意义。方法入选老年高血压患者70例,根据主动脉瓣有无钙化及返流分为单纯高血压组(n=34)及高血压伴退行性瓣膜病组(n=36)。采用超声心动图技术测量二尖瓣瓣尖舒张早期最大血流速度(E)、晚期最大血流速度(A),计算其比值(E/A),以及肺静脉血流相关峰值;所有患者均采用放射免疫法测定脑钠肽(BNP)。比较两组患者超声学指标及血浆BNP水平。结果高血压伴退行性瓣膜病组二尖瓣血流E/A值、肺静脉血流S/D值与单纯高血压组比较均降低,而BNP水平均升高,两组间E/A值、S/D值、BNP水平差别均有显著统计学意义(P均<0.01)。结论老年退行性瓣膜病早期,左室形态学已发生改变,BNP水平可考虑做为动态监测指标。

Objective To investigate the left ventricular diastolic function,level of brain natriuretic peptid（BNP） and their significance in the patients with senile hypertension accompanied by degenerative valvular disease.Methods The senile patients with hypertension（n=70） were divided into the simple hypertensive group（n=34） and hypertension accompanied by degenerative valvular disease group（n=36） according to the calcification and backstreaming of aortic valve.The early peak velocity（E） and later peak velocity（A） of the mitral valve were detected by using untrasonic cardiogram,and the ratio of E to A（E/A） and the relevant peak value of pulmonary venous flow（S/D） were calculated.The level of BNP was detected by using radioimmunoassay.The untrasonic indexes and BNP level were compared between two groups.Results The values of E/A and S/D decreased in the hypertension accompanied by degenerative valvular disease group compared with the simple hypertensive group,and BNP level increased（all P0.01）.Conclusion In the early stage of senile degenerative valvular disease there are morphologic changes of left ventricle of heart.The level of BNP can be taken as an index for dynamic monitoring.