左室收缩功能正常的心血管病患者血脑钠肽(BNP)升高相关因素的回顾性分析

Retrospective survey on factors affecting plasma brain natriuretic peptide(BNP) levels in patients with cardiovascular diseases and normal left ventricular systolic function

目的探索左室收缩功能正常的心血管病患者血浆脑钠肽(brain natriuretic peptide,BNP)升高的相关因素及临床意义。方法收集2007年12月至2010年12月本院心内科住院患者共1 112例,所有患者左室射血分数(left ventricular ejection fraction,LVEF)均大于50%,其中626例BNP<80pg/mL,340例80pg/mL≤BNP<400pg/mL,146例BNP≥400pg/mL。比较3组间的临床特点、生化指标及心超参数,采用方差检验、χ2检验、多分类Logistic回归分析BNP升高的因素。结果 3组间的年龄、心率、血尿素氮(blood urea nitrogen,BUN)、血肌酐、血三酰甘油、血总胆固醇、血浆低密度脂蛋白、空腹血糖、左房内径、左室舒张末期内径、左室收缩末期内径、室间隔厚度、左室后壁厚度、LVEF、肺动脉收缩压、纽约心功能分级、糖尿病、房颤、心肌病、瓣膜病、合并肺部疾病等因素的差异有统计学意义。多分类Logistic回归分析发现:左房内径(OR=1.136,95%CI=1.052～1.227,P=0.001),肺动脉收缩压(OR=1.029,95%CI=1.001～1.058,P=0.04),左室舒张末期内径(OR=0.888,95%CI=0.799～0.987,P=0.028),糖尿病(OR=0.202,95%CI=0.068～0.600,P=0.004)是BNP≥80pg/mL的影响因素。左室收缩末期内径(OR=1.239,95%CI=1.010～1.519,P=0.04),室间隔厚度(OR=8.006,95%CI=2.196～29.191,P=0.002),后壁厚度(OR 0.165,95%CI=0.045～0.597,P=0.006),BUN(OR=7.362,95%CI=1.092～1.699,P=0.006)是BNP≥400pg/mL的影响因素。结论左房内径、肺动脉收缩压、左室舒张末期内径、糖尿病是左室收缩功能正常的心血管病患者血浆BNP≥80pg/mL的影响因素。左室收缩末期内径、室间隔厚度、后壁厚度、BUN为左室收缩功能正常的心血管病患者血浆BNP≥400pg/mL的影响因素。

Objective To explore the determinant factors of plasma brain natriuretic peptide （BNP） levels in patients with cardiovascular diseases and normal left ventricular systolic function. Methods We collected the information of 1 112 patients including clinical history, biochemical markers and echocardiographic parameters from Dec. 2007 to Dec. 2010 with left ventricular ejection fraction （LVEF） ≥50%. Thesepatients were divided into 3 groups according to their plasma BNP levels：626 cases of normal BNP （BNP〈80 400 pg/mL） ; 146 cases of severe pg/mL） ;340 cases of moderately increased BNP （80 pg/mL≤BNP〈 ly increased BNP （BNP≥400 pg/mL）. Data analyses were performed with ANOVA or Peason Z2 test. We used multinominal logistic regression model to identify risk factors for BNP levels. Results Significant differences were seen in age, heart rate, blood urea nitrogen （BUN）, blood creatinine, triglyceride level, cholesterol level, low density lipoprotein, fast plasma glucose, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, mtraventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure,the New York Heart Association （NYHA） class, the history of diabetes mellitus, atrial fibrillation, myopathy, valvular disease and pulmonary disease among the 3 groups. On multinominal logistic regression analyses, left atrial diameter （OR = 1. 136,95% CI = 1. 052 - 1. 227, P = 0.001）, pulmonary artery systolic pressure （OR = 1. 029,95 % CI = 1. 001 - 1. 058, P = 0.04）, left ventricular end diastolic diameter （OR = 0. 888,95 % CI = 0. 799 - 0. 987, P = 0. 028）. history of diabetes mellitus （OR = 0. 202,95%CI = 0. 068 - 0.600, P = 0. 004） independently predicted plasma BNP level ≥80 pg/mL. In addition, left ventricular end systolic diameter （OR = 1. 239,95 %CI = 1. 010 - 1.519, P = 0.04）, intraventricular septal thickness （ OR = 8. 006,95 % CI = 2. 196 - 29. 191, P = 0. 002） ,left ventrieular posterior wall thickness （OR = 0. 165,95% CI = 0. 045 - 0. 597, P = 0. 006）, BUN （OR= 7. 362,95% CI= 1. 092 - 1. 699,P = 0. 006） independently predicted plasma BNP level 400 pg/mL. Conclusions Left atrial diameter,pulmonary artery systolic pressure,left ventricular end diastolic diameter and history of diabetes mellitus were independent determinant factors of plasma BNP ≥80 pg/mL in patients with cardiovascular diseases and normal left ventricular systolic function. Left ventricular end systolic diameter, intraventricular septal thickness, left ventricular posterior wail thickness and BUN were independent determinant factors of plasma BNP levels ≥400 pg/mL in patients with cardiovascular diseases and normal left ventricular systolic function.