BNP水平联合心脏结构指标对高血压伴HFREF的临床预测价值

Clinical prediction value of BNP combined with LAD and LVEDD in hypertension patients with heart failure

目的探讨血浆脑钠肽(BNP)水平与心脏结构指标对高血压伴射血分数(LVEF)减低的心力衰竭(HFREF)的临床预测价值。方法高血压患者320例,按照心脏彩超结果,分为对照组(高血压患者无心脏结构改变组)52例、室间隔增厚组48例、左室壁增厚组40例、左房增大组46例、左室肥大组66例、左房左室增大组68例。记录研究对象的一般资料、BNP水平、心脏彩超测量的左房内径(LAD)、室间隔厚度(IVS)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室后壁厚度(LVPW)。比较6组患者各指标的差异性,分析这些指标与高血压患者心脏结构与功能改变、心力衰竭发生的相关关系。结果心脏重构各组的BNP水平、LAD、LVEDD均高于对照组,BNP、LAD、LVEDD随着心脏重构的严重程度不同发生相应的变化(P<0.05);LVEF与BNP水平、LAD、LVEDD呈负相关性(r=-0.584,-0.430,-0.764,P<0.001,P<0.001,P<0.001);ROC曲线分析显示,BNP水平、LAD、LVEDD单独及联合诊断LVEF减低的心力衰竭(HFREF)的ROC曲线下与坐标轴围成的面积分别为0.845、0.725、0.940、0.954,联合检测高于各指标单独检测,联合诊断的敏感度为94.6%,特异度为89.5%,均高于各个指标单独检测。结论BNP水平对高血压伴LVEF减低的心力衰竭有临床预测价值,联合BNP、LAD、LVEDD可以提高诊断价值。

Objective To investigate clinical prediction value of BNP combined with cardiac structural index in hypertension patients with heart failure.Methods 320 patients with hypertension were divided into control group(n=52),septal thickening group(n=48),left ventricular wall thickening group(n=40),left atrial enlargement group(n=46),left ventricular hypertrophy group(n=66),left atrial and left ventricular enlargement group(n=68).General data,BNP level,left atrial diameter(LAD),interventricular septal(IVS),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and left ventricular posterior wall(LVPW)were recorded.The differences of each index in six groups were compared,and the correlation among these indexes,the changes of cardiac structure and the occurrence of heart failure in patients with hypertension was analyzed.Results BNP,LAD and LVEDD in each group of cardiac remodeling were higher than those in the control group.BNP,LAD and LVEDD increased with the severity of cardiac remodeling(P<0.05).The correlation analysis of LVEF with BNP and cardiac structure showed that LVEF was negatively correlated with BNP,LAD and LVEDD(r=-0.584,-0.430,-0.764,P<0.001,P<0.001,P<0.001).ROC curve analysis showed that the area under the curve of BNP,LAD,LVEDD alone and combined diagnosis of HFREF was 0.845,0.725,0.940 and 0.954,respectively.The sensitivity and specificity of combined detection of BNP,LAD and LVEDD for HFREF were 94.6%and 89.5%respectively,which were higher than that of single detection of each index.Conclusion The plasma BNP level has a good clinical predictive value for the changes of cardiac structure and function in patients with hypertension.Combining BNP,LAD and LVEDD can improve the diagnosis of HFREF in hypertension patients.