3TMR成像与血清NT-proBNP、GDF-15联用于冠心病患者心室功能评估的应用价值

Application value of 3T cardiac magnetic resonance combined with serum N-terminal pro-brain natriuretic peptide and growth differentiation factor-15 to review of ventricular function in patients with coronary heart disease

目的探讨3T心脏磁共振(3TMR)成像与血清N末端脑钠肽前体(NT-proBNP)、生长分化因子-15(GDF-15)联用于冠状动脉粥样硬化性心脏病(冠心病,CHD)患者心室功能评估的应用价值。方法选取2018年12月至2019年12月于阜外华中心血管病医院心内科治疗的98例CHD患者为CHD组,另选取同期我院就诊的105例健康体检者为对照组;CHD组患者中NYHA心功能Ⅰ级16例,Ⅱ级29例,Ⅲ级38例,Ⅳ级15例。两组均行3TMR成像检查,测定左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV);利用酶联免疫吸附法(ELISA)测定血清NT-proBNP、GDF-15水平。结果CHD组患者LVEF明显低于对照组(P<0.05),LVEDD、LVEDV及LVESV均显著高于对照组(P<0.05)。NYHA心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级CHD患者LVEF依次降低,LVEDD、LVEDV及LVESV依次升高,差异有统计学意义(P<0.05)。CHD组血清NT-proBNP、GDF-15水平均明显高于对照组(P<0.05)。NYHA心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级CHD患者血清NT-proBNP、GDF-15水平依次升高,差异有统计学意义(P<0.05)。CHD患者LVEF与血清NT-proBNP、GDF-15水平均呈负相关(P<0.05),LVEDD、LVEDV、LVESV与NT-proBNP、GDF-15水平呈正相关(P<0.05)。结论CHD患者血清NT-proBNP、GDF-15水平升高,二者均与左室心功能指标密切相关,3TMR成像联合血清NT-proBNP、GDF-15水平检测在CHD患者左心室功能评估中具有一定应用价值。

Objective To investigate the application value of 3T cardiac magnetic resonance(3TMR)combined with serum N-terminal pro-brain natriuretic peptide(NT-proBNP)and growth differentiation factor-15(GDF-15)to the review of ventricular function in patients with coronary heart disease(CHD).Methods CHD patients(n=98)were chosen into CHD group and healthy controls(n=105)were chosen into control group from Department of Cardiovascular Medicine in Fuwai Huazhong Hospital of Cardiovascular Diseases from Dec.2018 to Dec.2019.CHD group were divided further into NYHA grade I subgroup(n=16),NYHA gradeⅡsubgroup(n=29),NYHA gradeⅢsubgroup(n=38)and NYHA gradeⅣsubgroup(n=15).CHD group and control group were given 3TMR examination for detecting left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDD),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV).The levels of NT-proBNP and GDF-15 were detected by using ELISA.Results LVEF was significantly lower(P<0.05),and LVEDD,LVEDV and LVESV were significantly higher(P<0.05)in CHD group than those in control group.LVEF decreased in turn and LVEDD,LVEDV and LVESV increased in turn in NYHA grade I subgroup,NYHA gradeⅡsubgroup,NYHA gradeⅢsubgroup and NYHA gradeⅣsubgroup(P<0.05).The levels of NT-proBNP and GDF-15 were significantly higher in CHD group than those in control group(P<0.05).The levels of NT-proBNP and GDF-15 increased in turn in NYHA grade I subgroup,NYHA gradeⅡsubgroup,NYHA gradeⅢsubgroup and NYHA gradeⅣsubgroup(P<0.05).In CHD group,LVEF was negatively correlated to levels of NT-proBNP and GDF-15(P<0.05),and LVEDD,LVEDV and LVESV were positively correlated to levels of NT-proBNP and GDF-15(P<0.05).Conclusion The levels of NT-proBNP and GDF-15 increase in CHD patients and they are closely correlated to left ventricular function indexes.3TMR combined with the level detections of NT-proBNP and GDF-15 has some application value in the review of ventricular function.