摘要
目的:本研究测定左室舒张功能障碍的患者血浆BNP浓度,旨在探讨BNP在左室舒张功能障碍中的变化规律,了解左室舒张功能障碍的病理生理,为早期诊断左室舒张功能障碍提供依据。
方法:1.正常对照组
20例。其中男11例,女9例。平均年龄57±15岁,选自河北医科大学第三医院2002年12月至2003年6月的健康查体者,行心电图、超声心动图、胸部X线等系统检查排除心、脑、肝、肾、肺等疾病。
2.左室舒张功能障碍组
入选条件:①有易致舒张功能障碍的基础病,如高血压病、冠心病、肥厚性心肌病等②超声心动图舒张指标异常,收缩指标正常。
51例符合条件的患者(其中男27例,女24例,平均年龄为62±11岁, 原发性高血压34例,高血压病合并冠心病12例,冠心病4例,肥厚性心肌病1例)定为左室舒张功能障碍组。
3.舒张性心力衰竭组
符合第六届全国心力衰竭学术会(2001年5月,无锡)修订的左室舒张障碍性心力衰竭的诊断标准。(14例,其中男8例,女6例,平均年龄65±10岁, 原发性高血压4例,高血压病合并冠心病9例,肥厚性心肌病1例)。
所有患者均选自河北医科大学第三医院2002年12月至2003年6月住院患者。排除继发性高血压、心脏瓣膜病、肾功能衰竭、肝硬化、淀粉样变、甲状腺疾病、循环中糖皮质激素过多、慢性肺部疾病等。
本研究采用固相免疫放射分析法检测血浆BNP浓度。BNP试剂盒由法国CIS公司生产,天津新四方科技有限公司提供。
超声心动图指标由超声室专业人员统一检测,采用美国HP5500彩色多普勒超声诊断仪,探头频率为2.5HZ。患者左侧卧位,平静呼吸。①利用2D超声于左室长轴切面测量舒张期主动脉瓣瓣口(AO)内径、左房(LA)内径、左室(LV)内径、室间隔(IVS)、左室后壁(LVPW)的厚度、左室射血分数(EF%)。②利用脉冲多普勒测定二尖瓣舒张早期最大血流速度(E峰)、舒张晚期的最大血流速度(A峰)并算出E/A的比值。③采用组织多普勒速度成像技术(TDI)于心尖四腔心切面,取样框位于二尖瓣瓣环水平间隔处心肌、侧壁处心肌分别测量舒张早期、舒张晚期的速度峰值(Em间,Am间;Em侧,Am侧)并计算得出Em/Am值(Em/Am间;Em/Am侧);于心尖两腔心切面取样框位于二尖瓣瓣环水平前壁处心肌、下壁处心肌,分别测量舒张早期、舒张晚期的速度峰值(Em前,Am前;Em下,Am下),分别计算得出Em/Am值(Em/Am前;Em/Am下)(注:脚注间代表左室间隔,侧代表左室侧壁,前代表左室前壁,下代表左室下壁)。
所有数据均输入计算机,用SPSS11.0统计软件包进行处理。p<0.05为差异显著性标准。
结果:1.左室舒张功能障碍组血浆BNP浓度比正常对
照组(27.01±32.97pg/ml V 13.33±15.93pg/ml)升高(p<0.05),有显著差异,具有统计学意义;舒张性心力衰竭组血浆BNP浓度比正常对照组升高(98.61±109.69pg/ml V 13.33±15.93pg/ml)(p<0.001),有显著差异,具有统计学意义;舒张性心力衰竭组与左室舒张功能障碍组比较(98.61±109.69pg/ml V 27.01±32.97pg/ml),血浆BNP浓度升高(p<0.001),有显著差异,具有统计学意义。
2.左室舒张功能障碍组血浆BNP浓度分别与年龄(r=0.32,p=0.02)、 脉压(r=0.32,p<0.01)成正相关,与舒张压成负相关(r=-0.28,p=0.05)。
3.舒张性心力衰竭组血浆BNP浓度与Em间(r=-0.82,p<0.001)、Em/Am间(r=-0.70,p<0.01)、Em前(r=-0.60,p<0.05)、Em/Am前(r=-0.61,p=0.02)、Em下(r=-0.63,p<0.05)、Am下(r=-0.59,p<0.05)、Em/Am下(r=-0.53,p=0.05)成负相关。
结 论:1.左室舒张末压升高、室壁张力的增大、动脉顺应性减低、局部心肌舒张功能减退均可促进BNP的释放。
2.左室舒张功能障碍的患者血浆BNP浓度升高,且随着疾病程度加重而升高越明显。BNP可作为左室舒张功能障碍的诊断标准,其升高程度可提示疾病的严重性。
3.随着年龄的增长, 血浆BNP浓度也随之升高。随着脉压升高,血浆BNP浓度也升高。随着舒张压降低,血浆BNP浓度反而增加。
4.血浆BNP浓度比超声心动图更早期预测左室舒张功能障碍。组织多普勒(TDI)比超声多普勒敏感,能早期检测出局部心肌组织的舒张功能受损情况。
Objective: The purpose of our research is to understand the regularity of the variation of the plasma BNP in the patients of left ventricular diastolic dysfunction and failure, therefore,we can explore the pathophysiology of left ventricular diastolic dysfunction and search for an evidence to diagnose them earlierly.
Methods: 1.The control group
From December 2002 to July 2003,20 persons who had been proved to be healthy through health examination in the third hospital of Hebei medical university were selected as a control group(11 men,9 women, average 57±15 years).
2. Left ventricular diastolic dysfunction group(LVDD)
The selected criteria are①There are basic diseases lead to left ventricular diastolic dysfunction,such as essential hyper- tension,coronary heart disease or hypertrophic cardiomyopathy②There are some abnormal parameters of diastolic function in the echocardiography,while systolic parameters is normal.
51 patients were selected( 27 men,24 women,average 62±11 years,34 essential hypertension,12 essential hypertension combined with coronary heart disease,4 coronary heart disease,1 hypertrophic cardiomyopathy)as a group of LVDD.
3. Diastolic heart failure group
The patients correspond to the diagnostic criteria of the left ventricular diastolic heart failure,which was passed by the National sixth heart failure conference(2001 year,Wuxi) (8 men,6 women,average 65±10 years,4 essential hypertension,9 essential hypertension combined with coronary heart disease, 1 hypertrophic cardiomyopathy).
All patients were hospitalized the third hospital of Hebei medical university.
All patients had been excluded secondary hypertension﹑valvular heart disease,renal failure,hepatic cirrhosis,thyroid disease,excessive circulating glucocorticoid and chronic pulmonary disease et al.
The plasma BNP was determined by solid-phase immunoradiometric assay.BNP reagent box was produced by CIS company in France and was bought from Tianjin XinSiFang company.
M-mode,two-dimensional, and pulsed wave Doppler echocardiographic examinations were performed by only one person. HP5500 echocardiography(made in USA) equipped with 2.5MHz was used.Arterial dimension,left atrial dimension,left ventricular chamber dimension,left ventricular septal and posterior wall thickness,left ventricular ejetion fraction,peak early transmitral filling velocity(E wave),peak atrial filling velocity(A wave),ratio of peak early and atrial filling velocity(E/A) were measured.Furthermore, tissue
Doppler imaging technique was used to measure the diastolic function of myocardial segments.In the apical four-chamber view, peak velocity of the early diastolic wave(Em) and peak velocity of the late diastolic wave(Am) of the septal and lateral myocardial segment were measured at the mitral annulus.In the apical two-chamber view, peak velocity of the early diastolic wave(Em) and peak velocity of the late diastolic wave(Am) of the anterior and inferior myocardial segment were measured at the mitral annulus.Em/Am was calculated respectively.
All data were inputted into computer and statistically analyse with Software pakage of SPSS Ver 11.0.A value of p<0.05 was considered statistically significanct.
Result: 1.Compared with the control group,the plasma BNP of LVDD group was increased(27.01±32.97pg/ml versus 13.33±15.93pg/ml) (p<0.05);the plasma BNP of the diastolic heart failure group was increased too(98.61±109.69pg/ml versus 13.33±15.93pg/ml)(p<0.001);furthermore the plasma BNP of diastolic heart failure group was higher than LVDD group(p<0.001).
2.The plasma BNP of left ventricular dysfunction group was positive correlation with age(r=0.32,p=0.02)、pulse pressure(r=0.32,p<0.01),was negative correlation with diastolic blood pressure(r=-0.28,p<0.05).
3.The plasma BNP of diastolic heart failure group was negative correlation with Em间(r=-0.84,p<0.001),Em/Am间(r=-0.70,p<0.01),Em前(r=-0.60,p<0.05),Em前(r=-0.61,p=0.02),
Em下(r=-0.63,p<0.05),Am下(r=-0.59,p<0.05) and Em/Am下(r=-0.53,p=0.05).
Conclusion:1.It can stimulate BNP s
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