N末端脑钠肽前体在左室射血分数正常心力衰竭的临床意义

Clinical significance of N-terminal pro-brain natriuretic peptide in heart failure with normal left ventricular ejection fraction

目的探讨N末端脑钠肽前体(NT-proBNP)在左室射血分数正常心力衰竭(心衰)患者中的变化规律及临床意义,协助临床诊断及治疗。方法收集2017年6月至2019年6月于首都医科大学附属北京佑安医院收治的102例左室射血分数正常的心衰患者(研究组)。根据其心脏功能、超声心动图指标E/A(二尖瓣舒张早期血流速度峰值/舒张晚期血流速度峰值)、E/E’(二尖瓣舒张早期血流速度峰值/二尖瓣环根部舒张早期运动速度峰值)不同分级进行分组,并与25例同期住院无心衰患者做匹配对照(对照组)。分析各组间NT-proBNP水平与心功能分级、E/A、E/E’比值的相关性。结果研究组患者血浆NT-proBNP水平与心功能分级(506.56±192.886,725.34±80.335,952.39±195.366,P=0.000)、E/A(553.59±211.665,659.78±152.568,989.56±198.663,P=0.000)、E/E’(289.56±125.633,589.63±114.552,956.93±158.963,P=0.000)比值有很好相关性,差异均有统计学意义(P<0.05)。结论 NTproBNP水平变化结合超声心动图指标E/A、E/E’能较好判断射血分数正常的心衰患者心功能状态,对于患者病情严重程度判断具有积极价值。

Objective To discuss the change rules and clinical significance of N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with heart failure with normal left ventricular ejection fraction(HFNEF), and to assist clinical diagnosis and treatment. Methods HFNEF patients(n=102, study group) were chosen from Beijing You’an Hospital of Capital University of Medical Sciences from June 2017 to June 2019. The patients were divided into groups according to grading of heart function and conventional echocardiographic parameters including ratio of peak value of mitral early diastolic flow velocity to peak value of late diastolic flow velocity(E/A) and ratio of peak value of mitral early diastolic flow velocity to peak value of early diastolic motion velocity at mitral annulus root(E/E’). Other patients without HF(n=25) hospitalized at the same time were chosen as controls(control group). The correlation among level of NT-proBNP, grades of heart function and E/A and E/E’ were analyzed in all groups. Results In study group, the level of NT-proBNP was significantly correlated to grades of heart function(506.56±192.886, 725.34±80.335, 952.39±195.366, P=0.000), E/A(553.59±211.665, 659.78±152.568, 989.56±198.663, P=0.000) and E/E’(289.56±125.633, 589.63±114.552, 956.93±158.963, P=0.000) and the difference had statistical significance(P<0.05). Conclusion The changes of NT-proBNP level combined with E/A and E/E’ can well review the heart function status in HFNEF patients, which have positive value to assess the severity of patients’ conditions.