左室舒张性心衰患者左室舒张末期压力、肺毛细血管楔嵌压与N-末端脑钠肽前体的相关性研究

Correlation between left ventricular end diastolic pressure,pulmonary capillary wedge pressure and N-terminal brain natriuretic peptide in left ventricular diastolic heart failure

目的：探讨舒张性心衰患者血清N－末端前脑利钠肽（NT－proBNP）与左室舒张末期压力（LVEDP）、肺毛细血管楔嵌压（ PCWP）的相关性及其在不同严重程度舒张性心衰患者中的诊断价值。方法心功能正常患者30例为正常组；心功能异常的患者60例为异常组，并按NYHA心功能分级分为3个亚组，Ⅰ～Ⅲ级各20例。采用6F猪尾导管测定LVEDP，经Swan－Ganz导管检查测定PCWP，电化学发光仪RocheElecsys 2010测定NT－proBNP。分析NT－proBNP与LVEDP、PCWP的相关性。结果随着心功能级别增加，异常组血浆NT－proBNP、LVEDP、PC-WP水平与正常组比较，显著升高（ P＜0．01）。直线相关分析表明LogNT－proBNP与LVEDP呈显著正相关（ r＝0．793，P＜0．01）。 LogNT－proBNP与PCWP亦呈显著正相关（ r＝0．657，P＜0．01）。结论血清NT－proBNP定量检测是左心室舒张功能受损的敏感指标，NT－proBNP对舒张性心衰严重程度具有明确的诊断价值。

Objective To study the correlation between N-terminal brain natriuretic peptide （NT -proBNP） and left ventricular end diastolic pressure （ LVEDP ） and pulmonary capillary wedge pressure （ PCWP ） in diastolic heart failure （ DHF） patients as well as the diagnostic value for patients with varying degrees of diastolic heart failure.Methods The 30 hospitalized patients with normal cardiac function were classified into normal group.The 60 hospitalized patients with ab-normal cardiac function were classified into abnormal group.Besides, based on NYHA cardiac functional grading （ grade I to III） , the 60 patients were divided into 3 subgroups with 20 patients in each subgroup.LVEDP was measured with 6F pigtail catheter, and PCWP was measured with Swan-ganz catheter.Electrochemical luminescence device RocheElecsys 2010 was applied to determine NT-proBNP.Correlation between NT-proBNP and LVEDP and PCWP was analyzed.Re-sults：With the progress in cardiac function grade, the levels of NT-proBNP, LVEDP and PCWP increased significantly （P〈0.01）.According to linear correlation and regression analysis, there was significant positive correlation between LogNT-proBNP and LVEDP （r=0.793, P〈0.01） and between LogNT-proBNP and PCWP （r=0.657, P〈0.01）. Conclusions Serum NT-proBNP quantitative detection is a sensitive indicator of impaired left ventricular diastolic func-tion.NT-proBNP has definite diagnostic value for the severity of diastolic heart failure.