房室同步性对血浆氨基末端脑钠素前体水平的影响  

Effects of atrioventricular asynchrony on the plasma level of N-terminal pro-brain natriuretic peptide

作　　者：潘文志[1] 宿燕岗[1] 舒先红[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《中国心脏起搏与心电生理杂志》2008年第6期492-495,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(项目编号:30671999)

摘　　要：目的探讨缓慢心律失常和房室同步性对血浆氨基末端脑钠素前体(NT-proBNP)水平的影响。方法将120例无明确结构性心脏疾病患者按缓慢心律失常情况分为三组:A组为病窦综合征组(n=52),B组为Ⅱ度房室传导阻滞(AVB)组(n=29),C组为Ⅲ度AVB组(n=39)。另选42例无明确结构性心脏疾病、无心律失常者为D组。测定各组术前及术后第2天血浆NT-proBNP水平,分析血浆NT-proBNP水平及其与房室同步性、年龄、性别、体重指数、QRS波时限、左房内径(LAD)、左室射血分数(LVEF)、高血压和糖尿病的关系。结果在校正年龄后,A、B、C和D组血浆lg(NT-proBNP)水平分别为2.175±0.391,2.574±0.476,2.903±0.635和1.869±0.333 ng/L。血浆NT-proBNP水平:A、D组<B组<C组(P<0.01)。多元逐步回归分析显示房室同步性和年龄是血浆NT-proBNP水平的独立影响因素(P<0.001),而性别、心率、体重指数、高血压、糖尿病、QRS波时限、LAD及LVEF与血浆NT-proBNP水平无关(P>0.10)。在置入心脏起搏器后,房室同步性改善患者的NT-proBNP水平术后较术前降低(2.37±0.43 ng/L vs 2.73±0.53 ng/L,P<0.01),房室同步性不变的患者术后与术前无差异(P>0.05),而房室同步性恶化的患者较术前升高(2.61±0.57 ng/L vs 2.38±0.61 ng/L,P<0.05)。多元回归显示,房室同步性的改变情况是血浆NT-proBNP水平变化值的独立影响因素(P<0.001)。结论缓慢心律失常患者随房室失同步加重,血浆NT-proBNP水平依次升高,房室失同步可导致NT-proBNP升高。Objective To investigate the effects of bradyarrhythmia and atrioventricular asynchrony on plasma level of N-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods 120 patients without defined structural heart disease were enrolled in this study ： group A, 52 patients with sick sinus syndrome ; group B, 29 patients with Ⅱ° atrioventricular block （AVB） ; group C, 39 patients with Ⅲ° AVB; group D, 42 patients without arrhythmia. The plasma level of NT- proBNP was determined and compared and stepwise multi-valuables regression performed to define the independent determinants of them. Results The logarithm of NT-proBNP levels in group A, B, C and group D were 2. 175 ± 0.391,2. 574 ±0. 476, 2. 903 ±0. 635 and 1. 869 ± 0. 333 ng/L, respectively. The plasma levels of NT-proBNP in theses groups in order was D, A 〈 B 〈 C （ P 〈 0.01 ）. Stepwise multi-valuables linear regression revealed that age and the severity of atrioventricular asynchrony rather than heart rate, body mass index, sex, hypertension, diabetes, widening QRS duration, left artial diameter and left ventricular eject fraction were independent determinants of the plasma level of NT-proBNP （ P 〈 0. 001 ）. After pacemaker implantation, NT-proBNP level increased in patients with aggravation of atrioventricular asynchrony （ 2.61± 0.57 ng/L vs 2.38 ± 0.61 ng/L, P 〈 0.05）, decreased in patients with reduction of atrioventricular asynchrony （2.37 ± 0.43 ng/L vs 2.73 ± 0.53 rig/L, P 〈 0.01 ） and remained unchanged in patients without changes of atrioventricular asynchrony. Multivariate analysis showed the change of severity of atrioventrieular asynchrony was the determinant of the change of NT-proBNP levels （P 〈 0. 001 ）. Conclusion The plasma level of NT-proBNP in patients with bradyarrhythmia increases with aggravation of atrioventricular synehrony. Atrioventricular asynchrony can increase NT-proBNP level.

关 键 词：心血管病学 氨基末端脑钠素前体 房室失同步 缓慢心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]