心力衰竭患者N末端A、B及C型利钠肽原与超声心动图和心功能对比分析  

Association of plasma amino-terminal pro-A-, B- and C-type natriuretic peptide levels with NYHA grade and echocardiographic derived parameters of cardiac function in heart failure patients

作　　者：赵雪燕[1] 杨跃进[1] 张健[1] 康连鸣[1] 韦丙奇[1] 高晓津[1] 吕蓉 张春玲[2] 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心内科,100037 [2]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院临床检验中心,100037

出　　处：《中华心血管病杂志》2009年第6期486-490,共5页Chinese Journal of Cardiology

基　　金：基金项目：北京市科委重大科技支撑项目（D0906004040291）

摘　　要：目的评价左心衰竭患者的N末端A型利钠肽原（NT—proANP）、N末端B型利钠肽原（NT-proBNP）和N末端C型利钠肽原（NT—proCNP）分别与临床NYHA心功能分级和超声心动图所测指标的相关性。方法使用酶联免疫测定的方法测定112例左心衰竭患者（心衰组）和44例正常人（对照组）的血浆NT—proANP、NT-proBNP和NT—proCNP值，并分别与临床NYHA分级、左房内径（LAD）、左室舒张末内径（LVEDD）和左室射血分数（LVEF）进行相关性分析。结果心衰组的NT-proANP、NT-proBNP、NT-proCNP均显著高于对照组（均为P〈0．05）。心衰患者NT—proANP、NT—proBNP和NT—proCNP均两两相关。NT—proANP与NT—proBNP的相关性最强（r=0．790，P=0．000），而NT-proCNP分别与NT—proBNP（r=0．278，P=0．003）和NT—proANP（r=0．236，P=0．012）相关性较弱。单因素分析NT—proANP、NT-proBNP和NT—proCNP与超声心动图指标相关性的结果显示：NT-proANP、NT-proBNP均分别与LAD、LVEDD呈正相关（均为P〈0．05），与LVEF呈负相关（均为P〈0．05）。但NT—proCNP未见与LAD、LVEDD、LVEF有明显相关性。在心衰组，分别引入包括年龄、性别、NYHA分级、超声心动图所测LAD、LVEDD、LVEF共6个因素进行多元逐步回归分析，结果NYHA、LVEF、LAD、年龄与NT—proANP独立相关，NYHA、LVEF、年龄与NT-proBNP独立相关，而NT—proCNP未见与上述因素的相关性。结论心衰患者血浆NT-proANP、NT—proBNP和NT—proCNP的水平均显著升高，且三者两两相关。不论是单因素还是多元回归分析，NT—proCNP未见与心功能NYHA分级和超声心动图LAD、LVEF、LVEDD的相关性，NT-proCNP不能很好地反映心功能和超声心动图指标。Objective To observe the correlation of plasma amino-terminal pro-A-, B- and C-type natriuretic peptide （NT-proANP, NT-proBNP and NT-proCNP） levels with New York Heart Association （NYHA） functional class and echocardiographic derived parameters of cardiac function in heart failure patients. Methods Data of NYHA grade, echocardiographic derived parameters of cardiac function, plasma levels of NT-proANP, NT-proBNP and NT-proCNP （measured by enzyme immunoassay method） were obtained in 112 heart failure patients and 44 normal control subjects. The correlation analysis was made between NT-proANP, NT-proBNP, NT-proCNP and NYHA functional class, left atrium diameter （LAD）, left ventricular end-diastolic diameter （LVEDD） and left ventricular ejection fraction （LVEF）, respectively. Results The plasma concentrations of NT-proANP, NT-proBNP and NT-proCNP in heart failure patients were significantly higher than in control group（ all P 〈 0.05 ）. Correlation analysis revealed a strong correlation between NT-proANP and NT-proBNP （ r = 0. 790, P = 0. 000 ） and a weak correlation between NT-proCNP and NT-proBNP （r = 0. 278, P = 0. 003 ） as well as between NT-proCNP and NT- proANP （r =0. 236,P = 0. 012） in heart failure patients. Univariant analysis showed that NT-proANP and NT-proBNP were positively correlated to LAD, LVEDD and negatively correlated to LVEF （ all P 〈 0. 05 ） while there was no significant correlation between NT-proCNP and echocardiographic derived parameters of cardiac function in heart failure patients. Multivariate stepwise regression analysis including age, gender, NYHA classification, LAD, LVEDD and LVEF revealed that NYHA classification, LVEF, LAD and age were independent predictors of NT-proANP; while NYHA classification, LVEF and age were independent predictors of NT-proBNP while there was no association among these factors and NT-proCNP. Conclusion In heart failure patients, the plasma concentration of NT-proANP, NT-proBNP and NT-proCNP were significantly in

关 键 词：心力衰竭 充血性 心室功能 左 N末端A型利钠肽原 N末端B型利钠肽原 N末端C型利钠肽原 

分 类 号：R686[医药卫生—骨科学]