血浆NT-proBNP水平和慢性心衰患者超声心动图指标的相关性
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摘要
目的:探讨血浆N末端脑利钠肽前体水平(NT-proBNP)与慢性心衰(CHF)患者超声心动图指标的相关性。方法:选择在我院就诊的154例CHF患者为CHF组(NYHAⅡ～Ⅳ级),抽取154例同期在我院健康查体者作为正常对照组。比较两组患者血清NT-proBNP水平、左室射血分数(LVEF)、左心房直径(LAD)、左心室舒张末期内径(LVEDd)、心力衰竭超声指数(HFEI),分析血清NT-proBNP水平与超声心动图各指标间的相关性。结果:与正常对照组比较,CHF组患者血清NT-proBNP、LAD、LVEDd、HFEI均显著增加,LVEF均显著降低,且随着NYHA心功能分级增加,血清NT-proBNP、LAD、LVEDd、HFEI显著增加,LVEF显著降低(P均=0.001)。Pearson相关分析显示,lgNT-proBNP与NYHA分级、LAD、LVEDd、HFEI呈显著正相关(r=0.814～0.877,P均<0.05),与LVEF呈显著负相关(r=-0.807,P=0.009)。结论:NT-proBNP检测结合超声心电图检查是CHF诊断和危险分层的常用方式,且两者具有良好的相关性,值得采用。
Objective: To explore the correlation among plasma level of N terminal pro brain natriuretic peptide(NT-proBNP) and echocardiographic indexes in patients with chronic heart failure(CHF). Methods:Clinical data of 154 CHF patients treated in our hospital were regard as CHF group(NYHA classⅡ～Ⅳ). Another 154 cases undergoing physical examination in our hospital simultaneously were regarded as normal control group. Serum NT-proBNP level, left ventricular ejection fraction(LVEF), left atrial diameter(LAD), left ventricular end-diastolic dimension(LVEDd), and heart failure echocardiographic index(HFEI) were observed and compared between two groups, and correlation among NT-proBNP level and echocardiographic indexes were analyzed. Results:Compared with normal control group, there were significant rise in serum NT-proBNP level, LAD, LVEDd and HFEI, and significant reduction in LVEF in CHF group, and along with NYHA class rose, there were significant rise in serum NT-proBNP level, LAD, LVEDd and HFEI, and significant reduction in LVEF, P=0.001 all. Pearson correlation analysis indicated that lgNT-proBNP was significant positively correlated with NYHA class, LAD, LVEDd and HFEI(r=0.814～0.877, P<0.05 all), and significant inversely correlated with LVEF(r=-0.807, P=0.009). Conclusion:NT-proBNP detection combined echocardiography is a frequent method for diagnosis and risk stratification of CHF, and they are significantly correlated with each other, so it is worth adopting.
Objective: To explore the correlation among plasma level of N terminal pro brain natriuretic peptide(NT-proBNP) and echocardiographic indexes in patients with chronic heart failure(CHF). Methods:Clinical data of 154 CHF patients treated in our hospital were regard as CHF group(NYHA classⅡ～Ⅳ). Another 154 cases undergoing physical examination in our hospital simultaneously were regarded as normal control group. Serum NT-proBNP level, left ventricular ejection fraction(LVEF), left atrial diameter(LAD), left ventricular end-diastolic dimension(LVEDd), and heart failure echocardiographic index(HFEI) were observed and compared between two groups, and correlation among NT-proBNP level and echocardiographic indexes were analyzed. Results:Compared with normal control group, there were significant rise in serum NT-proBNP level, LAD, LVEDd and HFEI, and significant reduction in LVEF in CHF group, and along with NYHA class rose, there were significant rise in serum NT-proBNP level, LAD, LVEDd and HFEI, and significant reduction in LVEF, P=0.001 all. Pearson correlation analysis indicated that lgNT-proBNP was significant positively correlated with NYHA class, LAD, LVEDd and HFEI(r=0.814～0.877, P<0.05 all), and significant inversely correlated with LVEF(r=-0.807, P=0.009). Conclusion:NT-proBNP detection combined echocardiography is a frequent method for diagnosis and risk stratification of CHF, and they are significantly correlated with each other, so it is worth adopting.
引文
[1]罗智敏,李容,赵华云,等.抗阻训练联合有氧训练对慢性心力衰竭患者心功能和运动耐力及生活质量的影响研究[J].中华全科医学,2014,17(13):1490-1494.
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[10]刘颖丽,张舒石,张舒岩,等.血浆脑钠肽和血清肌钙蛋白Ⅰ在老年慢性心力衰竭临床诊断中的意义[J].中国老年学杂志,2015,35(4):882-884.
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[12]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[13]Kurlianskaia EK,Denisevich TL.Prognosis of unfavorable cardiac events in patients with severe chronic heart failure with preserved coronary myocardial reserve[J].Kardiologia,2014,54(10):39-44.
[14]陈以勤,潘高云.N-末端脑钠肽前体在老年慢性心力衰竭患者诊治中的应用[J].中国老年学杂志,2014,34(13):3650-3651.
[15]杨硕,张艳,王思尹,等.血N端B型脑钠肽前体与慢性心力衰竭患者的以后相关性研究[J].世界中西医结合杂志,2015,10(5):676-677,685.
[16]朱伟群,张小明,陶红,等.血清B型脑钠肽水平对慢性心力衰竭诊治价值及其与心功能分级的相关性研究[J].中国基层医药,2017,24(8):1152-1155.
[17]田桂芳,杨秀玲,戴妍妍,等.心力衰竭超声指数及N末端脑钠肽前体对慢性心力衰竭患者心功能的评估价值[J].中国循证心血管医学杂志,2017,9(4):464-466.
[18]马逸宜,蒋燕东,朱栋晓,等.心力衰竭超声指数对心脏瓣膜病变患者的整体心功能评价中的应用价值[J].中国血液流变学杂志,2015,25(3):292-296.
[2]魏梅,刘永升,陈洁,等.螺内酯联合美托洛尔对老年慢性心力衰竭患者左室重构及心功能的影响[J].中国老年学杂志,2015,35(6):1509-1510.
[3]Berliner D,Bauersachs J.Current Drug Therapy in Chronic Heart Failure:the New Guidelines of the European Society of Cardiol (ESC)[J].Korean Circ J,2017,47(5):543-554.
[4]Huang YT,Tseng YT,Chu TW,et al.Corrigendum:N-terminal pro b-type natriuretic peptide (NT-proBNP)-based score can predict in-hospital mortality in patients with heart failure[J].Sci Rep,2017,7:46866.
[5]郑俊华,唐浩然,景丽英,等.芪参益气滴丸联合阿托伐他汀对慢性心力衰竭患者心功能和BNP、TNF-α和IL-6 的影响[J].中华临床医师杂志(电子版),2014,8(16):2972-2975.
[6]赵雅琳,姚宇.舒张性与收缩性心力衰竭N-末端心房利钠肽前体和N末端脑钠肽前体的研究[J].中华老年心脑血管病杂志,2011,13(8):722-723.
[7]陈灏珠,林果为,王吉耀.实用内科学[M].第14版.北京:人民卫生出版社,2013:1341-1352.
[8]王妮,刘伟,毕四锐,等.美托洛尔对心力衰竭患者的TNF-α、IL-1β、IL-6及心功能NYHA分级状况的影响及机制研究[J].中国临床医生杂志,2016,44(7):31-34.
[9]Wang C,Han S,Xu T,et al.Evaluation of myocardial viability in old myocardial infarcted patients with CHF:delayed enhancement MRI vs.low-dose dobutamine stress speckle tracking echocardiography[J].Am J Transl Res,2016,8(9):3731-3743.
[10]刘颖丽,张舒石,张舒岩,等.血浆脑钠肽和血清肌钙蛋白Ⅰ在老年慢性心力衰竭临床诊断中的意义[J].中国老年学杂志,2015,35(4):882-884.
[11]Jensen J,Ma LP,Bjurman C,et al.Prognostic values of NTpro BNP/BNP ratio in comparison with NTpro BNP or BNP alone in elderly patients with chronic heart failure in a 2-year follow up[J].Int J Cardiol,2012,155(1):1-5.
[12]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[13]Kurlianskaia EK,Denisevich TL.Prognosis of unfavorable cardiac events in patients with severe chronic heart failure with preserved coronary myocardial reserve[J].Kardiologia,2014,54(10):39-44.
[14]陈以勤,潘高云.N-末端脑钠肽前体在老年慢性心力衰竭患者诊治中的应用[J].中国老年学杂志,2014,34(13):3650-3651.
[15]杨硕,张艳,王思尹,等.血N端B型脑钠肽前体与慢性心力衰竭患者的以后相关性研究[J].世界中西医结合杂志,2015,10(5):676-677,685.
[16]朱伟群,张小明,陶红,等.血清B型脑钠肽水平对慢性心力衰竭诊治价值及其与心功能分级的相关性研究[J].中国基层医药,2017,24(8):1152-1155.
[17]田桂芳,杨秀玲,戴妍妍,等.心力衰竭超声指数及N末端脑钠肽前体对慢性心力衰竭患者心功能的评估价值[J].中国循证心血管医学杂志,2017,9(4):464-466.
[18]马逸宜,蒋燕东,朱栋晓,等.心力衰竭超声指数对心脏瓣膜病变患者的整体心功能评价中的应用价值[J].中国血液流变学杂志,2015,25(3):292-296.