射血分数保留的老年慢性心力衰竭患者的N末端脑钠肽前体水平及超声特点

Level of N-terminal pro-brain natriuretic peptide and ultrasonic characteristics in elderly patients with heart failure with preserved ejection fraction

目的分析射血分数保留的老年慢性心力衰竭患者的N末端脑钠肽前体(NT-pro BNP)水平及超声特点。方法连续入选2013年3月~2016年5月于廊坊市第四人民医院心内科住院治疗的老年慢性心力衰竭(CHF)患者186例,分为射血分数保留的心力衰竭(HFp EF)组和射血分数降低的心力衰竭组(HFrEF组)。两组受试者均进行一般资料采集、实验室检测及超声检查。结果 1HFp EF组血浆NT-pro BNP水平低于HFrEF组(P<0.05)、总胆固醇水平高于HFrEF组(P<0.05)。2HFp EF组左室舒张末内径(LVEDD)、左房内径(LAD)、左室舒张末容积(LVEDV)、二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度(E/A)小于HFrEF组(P均<0.05),室间隔厚度(VST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)大于HFrEF组(P均<0.05)。3HFp EF组血浆NT-pro BNP水平与HYHA分级、LVEDD、LAD呈正相关,相关系数分别为0.216、0.307、0.253(P均<0.05);与LVEF呈负相关,相关系数为-0.197(P<0.05)。结论 NT-pro BNP及超声指标与HFp EF严重程度密切相关,二者联合应用能够为HFp EF的诊断及病情评估提供重要依据。

Objective To analyze the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and ultrasonic characteristics in elderly patients with heart failure with preserved ejection fraction (HFpEF). Methods The elderly patients with chronic heart failure (CHF, n=186) were continuously chosen from the Department of Cardiology in the Fourth People’s Hospital of Langfang City from Mar. 2013 to May 2016, and then divided into HFpEF group and group of heart failure with reduced ejection fraction (HFrEF group). The data collection,laboratory detection and ultrasonic testing were carried out in 2 groups. Results ①The level of plasma NT-proBNP was lower (P<0.05), and level of total cholesterol (TC) was higher (P<0.05) in HFpEF group than that in HFrEF group. ②The left ventricular end-diastolic inner diameter (LVEDd), left atrial diameter (LAD), left ventricular end-diastolic volume (LVEDV) and E/A ratio of mitral flow spectrum were lower (all P<0.05), and interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) were higher in HFpEF group than those in HFrEF group (all P<0.05). ③In HFpEF group, the level of plasma NT-proBNP was positively correlated to HYHA classification, LVEDd and LAD (r=0.216, r=0.307, r=0.253,all P<0.05), and negatively correlated to LVEF (r=-0.197, P<0.05). Conclusion The level of plasma NT-proBNP and ultrasonic indicator are closely correlated to severity of HFpEF, and their combined application can provide the important evidence for diagnosis and review of HFpEF.