NT-proBNP结合组织多普勒技术评估舒张性心力衰竭的研究

Evaluation of NT-proBNP and tissue Doppler imaging in patients with diastolic heart failure

目的:探讨N末端脑利钠肽前体(NT-proBNP)结合二尖瓣舒张早期血流峰速度/二尖瓣环舒张早期运动峰速度(E/Ea)在诊断和评估舒张性心力衰竭(DHF)中的作用。方法:将我科收治的80例DHF患者作为DHF组,同时根据NYHA心功能分级分为NYHAⅡ级、NYHAⅢ级、NYHAⅣ级3个亚组,另选取同期住院或体检心功能正常者23例为对照组。分别对各组行血流频谱多普勒及组织多普勒超声心动图检测。同期检测血清NT-proBNP浓度、血清高敏C反应蛋白(hs-CRP)、血脂等,并对结果进行统计学处理。结果:与对照组相比,DHF组患者E/Ea、NT-proBNP显著升高(P<0.001)。随着心力衰竭程度的加重,NT-proBNP浓度和E/Ea比值逐渐升高。多元回归分析显示,lg NT-proBNP水平与左室E/Ea独立相关(β=0.267,P<0.01),与LVEF明显负相关(β=-0.440,P<0.001)。NT-proBNP联合E/Ea比值诊断DHF时特异度、阳性预测值、阳性拟然比均较单独应用NT-proBNP或E/Ea时高。结论:血清NT-proBNP浓度检测结合组织多普勒超声检测E/Ea值,可协助诊断DHF和评价左室功能。

Objective ：To investigate the role of （NT-proBNP） combined with the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity （E/Ea） in the diagnosis and evaluation of patients with di- astolic heart failure （DHF）. Metbod： A total of 80 hospitalized patients with DHF were divided into NYHA Ⅱ group,NYHAⅢ group and NYHA Ⅳ group according to NYHA heart function. In the same period, 23 patients with normal heart function were selected as control group. Conventional and tissue Doppler imaging was tested by echocardiography. NT-proBNP, high-sensitive C reactive protein （hs-CRP） and lipids were detected in blood. Result ： Compared with control group, both E/Ea and NT-proBNP were significantly higher in DHF group （both P〈 0. 001）, and increased gradually with the severity of heart failure. Multiple regression analysis showed that lg NT-proBNP level was independently associated with left ventricular E/Ea （β=0. 267, P〈0.01）, while was obviously and negatively correlated with LVEF （β= -0. 440, P〈0. 001）. The specificity, positive predictive value, and positive likelihood ratio to diagnose DHF were higher by using NT-proBNP and E/Ea combinedly than application separately. Conclusion ： Serum NT-proBNP detecting, combined with E/Ea ratio testing by tissue Doppler ultrasound, could be helpful to diagnose DHF and evaluate left ventricular function.