左室射血分数正常心力衰竭患者血浆N末端B型利钠肽原水平变化及其临床意义

Changes and Clinical Significance of Plasma N-terminal Pro-brain Natriuretic Peptide Level in Heart Failure Patients with Normal Left Ventricular Ejection Fraction

目的探讨左室射血分数正常心力衰竭(HFNEF)患者血浆N末端B型利钠肽原(NT-pro BNP)水平变化及其临床意义。方法连续选择2013年2月—2014年2月湖北医药学院附属太和医院心内科门诊及住院的慢性心力衰竭患者128例,根据超声心动图测定的左室射血分数(LVEF)将患者分为LVEF降低组(LVEF<50%,n=69)和LVEF正常组(LVEF≥50%,n=59),另选择同期健康体检者60例作为对照组。比较各组受试者入院时和随访1个月后血浆NT-pro BNP水平、纽约心脏病协会(NYHA)心功能分级及左室舒张末期内径(LVIDd),并分析LVEF正常组患者NT-pro BNP水平与NYHA心功能及LVIDd的关系。结果入院时和随访1个月后LVEF降低组和LVEF正常组患者血浆NT-pro BNP水平高于对照组、LVIDd大于对照组,LVEF正常组患者血浆NT-pro BNP水平、NYHA心功能分级低于LVEF降低组,LVIDd小于LVEF降低组(P<0.05)。随访1个月后LVEF降低组和LVEF正常组患者血浆NT-pro BNP水平、NYHA心功能分级分别低于入院时,LVIDd小于入院时,且LVEF正常组患者上述指标下降更明显(P<0.05)。直线相关分析结果显示,LVEF正常组患者NT-pro BNP水平与LVEF呈负相关(r=-0.354,P=0.037),与NYHA心功能分级(r=0.524,P=0.041)和LVIDd(r=0.624,P=0.031)均呈正相关。结论 HFNEF患者血浆NT-pro BNP水平较正常人升高,较LVEF降低心力衰竭患者降低,且与LVEF、NYHA心功能分级及LVIDd有关,可反映患者病情严重程度。

Objective To observe the changes of plasma N-terminal pro-brain natriuretic peptide（ NT-proBNP） level in heart failure patients with normal left ventricular ejection fraction（ LVEF）,to explore its clinical significance. Methods From February 2013 to February 2014,a total of 128 heart failure patients were continuously selected in outpatient clinic and in-patient department of Taihe Hospital Affiliated to Hubei University of Medicine,and they were divided into groups A（ with LVEF﹤50%,n=69）and B（with LVEF≥50%,n=59）according to LVEF;a total of 60 healthy cases were selected as control group at the same time. Plasma NT-proBNP level,NYHA heart function classification and left ventricular internal diastolic diameter（ LVIDd） were compared among the three groups at admission and followed up for 1 month, and the correlations between plasma NT-proBNP level and NYHA heart function classification and LVIDd in B group were analyzed. Results At admission and followed up for 1 month,plasma NT-proBNP level and LVIDd of groups A and B were statistically significantly higher than those of control group, respectively （ P ﹤0. 05 ）;plasma NT-proBNP level, LVIDd and NYHA heart function classification of B group were statistically significantly lower than those of A group （ P﹤0. 05 ）. Plasma NT-proBNP level and NYHA heart function classification and LVIDd in A and B group after 1 months of follow - up were lower than those of at admission,and above index in A group decreased more significantly （ P ﹤0. 05 ）. Linear correlation analysis showed that, plasma NT-proBNP level was negatively correlated with LVEF（r= -0. 354,P=0. 037）,was positively correlated with NYHA heart function classification（r=0. 524,P =0. 041）,LVIDd（r =0. 624,P =0. 031）,respectively. Conclusion Plasma NT-proBNP level of heart failure patients with normal LVEF is higher then normal people,lower than heart failure patients with reduced LVEF,and is correlated with LVEF,NYHA heart function classification and LVIDd,can reflect the illness severity.