大内皮素-1与肥厚型梗阻性心肌病患者心脏重构的相关性分析

Correlation Study Between Blood Level of Big Endothelin-1 and Cardiac Remodeling in Patients With Hypertrophic Obstructive Cardiomyopathy

目的:探讨血浆大内皮素-1(Big ET-1)水平与肥厚型梗阻性心肌病(HOCM)患者心脏重构的相关性。方法:入选自2015-01至2016-05于我院住院治疗的HOCM患者167例,测定血浆Big ET-1、N末端B型利钠肽原(NT-pro BNP)水平等指标,完善心电图、动态心电图、超声心动图(UCG)及心脏磁共振成像(CMR)检查,进行相关统计学分析。结果:在167例HOCM患者中,相关性分析及多元线性回归发现Ln Big ET-1与Ln NT-pro BNP(r=0.35,P=0.000)、左心房前后径(r=0.169,P=0.019)及心率(r=0.141,P=0.037)呈正相关,与血红蛋白(r=-0.173,P=0.013)及室间隔厚度/左心室后壁厚度比值(r=-0.165,P=0.017)呈负相关。基于Big ET-1与左心房前后径呈正相关的发现,将研究对象分为左心房正常组74例及左心房增大组93例。与左心房正常组比,左心房增大组患者血浆Big ET-1水平显著增高(P=0.001);UCG测量的左心室舒张末期内径较大(P=0.024),室间隔较厚(P=0.003),左心室射血分数偏低(P=0.001);CMR测量的左心室舒张末期容积(P=0.002)及室间隔厚度(P=0.002)较大;伴发心房颤动的比率增加(P=0.004);存在二尖瓣中-大量反流(P=0.011)及纽约心脏协会(NYHA)心功能Ⅲ或Ⅳ级(P=0.022)的患者增多。结论:在HOCM患者中,Ln Big ET-1与Ln NT-pro BNP、左心房内径呈正相关。左心房增大的HOCM患者血浆Big ET-1水平显著升高,心脏结构重构更明显,伴发心房颤动的比率增加。Big ET-1可能在HOCM患者的心脏重构中发挥作用。

Objective：To explore the relationship between big endothelin-1（big ET-1） and cardiac remodeling in patients with hypertrophic obstructive cardiomyopathy（HOCM）.Methods：A total of 167 consecutive HOCM patients admitted in our hospital from 2015-01 to 2016-05 were enrolled.Blood levels of big ET-1 and NT-pro BNP were measured;electrocardiogram（ECG）,dynamic ECG,echocardiography（UCG） and cardiovascular magnetic resonance（CMR） were examined for relevant statistical analysis.Results：In all 167 HOCM patients,blood level of Big ET-1 was positively related to NT pro-BNP（r=0.35,P=0.000）,left atrial（LA） diameter（r=0.169,P=0.019） and heart rate（r=0.141,P=0.037）;negatively related to hemoglobin（r=-0.173,P=0.013） and the ratio of interventricular septum（IVS）/posterior wall of left ventricle（r=-0.165,P=0.017）.Based on the finding of positive correlation between Big ET-1 and LA diameter,the patients were divided into 2 groups：Normal LA group,n=74 and Enlarged LA group,n=93.Compared with Normal LA group,Enlarged LA group had the higher blood level of Big ET-1（P=0.001）;increased left ventricular end-diastolic diameter（LVEDD）（P=0.024）,thicker IVS（P=0.003）,lower LVEF（P=0.001）;enlarged LVED volume（P=0.002） and IVS（P=0.002）;elevated ratio of atrial fibrillation（AF）;more patients withmoderate to severe mitral regurgitation（MR） and NYHA functional class III/IV.Conclusion：Blood level of Big ET-1 was positively related to NT pro-BNP and LA diameter in HOCM patients;the patients with enlarged LA had increased Big ET-1,more obvious cardiac remodeling and the higher incidence of AF occurrence which implied that Big ET-1 might play the role in cardiac remodeling in HOCM patients.