腹型肥胖B型钠尿肽水平及其对评估慢性心功能不全的影响  

Level of B-type Natriuretic Peptide and Its Impact on Evaluating of Chronic Ventricular Dysfunction in Patients with Abdominal Obesity

作　　者：凌丹芸[1] 曹国良[1] 王传慧[1] 乔红梅[1] 施惠华[1] 韩江[1] 冯月英[1] 戴蓉芳[1] 

机构地区：[1]上海交通大学医学院附属第三人民医院老年科,上海201900

出　　处：《医学临床研究》2011年第4期640-643,共4页Journal of Clinical Research

摘　　要：【目的】探讨腹型肥胖患者血浆B型钠尿肽（BNP）水平及其对评估慢性心功能不全的影响。【方法】本院内科收治的慢性心功能不全患者158例，根据腰臀比（WHR）分为两组：腹型肥胖组（男性WHR≥0．85或女性WHR≥0．8）62例和非腹型肥胖组（男性WHR〈0．85或女性WHR〈0．8）96例；ELISA法测定血浆BNP浓度；超声心动图测定舒张末期室间隔厚度（IVST）、左室后壁厚度（LVPW）、左室舒张末内径（LVEDd）、舒张早期速度峰值（E）与舒张晚期速度峰值（A）的比值（E／A）和左室射血分数（LVEF）；比较两组血浆BNP水平及超声心动图测量结果、以BNP100pg／mL为切点评估心脏功能时的诊断敏感性；将血浆BNP测定值进行对数转换后，与BMI进行线性回归分析。【结果】腹型肥胖纽中血浆BNP水平（306．88±225．46pg／mL）明显低于非腹型肥胖组[（548．31±353．22）pg／mL，P〈0．051；以BNP100pg／mL为切点，对心脏舒张功能不全的诊断敏感性腹型肥胖组（83．3％）低于非腹型肥胖组（93．1％），对心脏收缩功能不全的诊断敏感性腹型肥胖组（90．0％）低于非腹型肥胖组（97．4％），但降低程度均无显著性差异（P〉0．05）；LogBNP与BMI之间存在负相关（r=-0．276，P〈0．05）。【结论】腹型肥胖会影响血浆BNP水平，BMI与血浆BNP呈负相关，对腹型肥胖患者进行心功能评价时应考虑‘该因素的影响。[Objective] To explore the level of B-type natriuretic peptide（BNP） and its impact on evaluating chronic ventricular dysfunction in patients with abdominal obesity. [Methods] Totally 158 patients with chronic ventricular dysfunction were enrolled in this study. According to waist/hip ratio（WHR）, patients were divided into abdominal obesity group（male WHR≥0.85 or female WHR≥0.8, n=62） and non-abdominal obesity group （male WHR〈0. 85 or female WHR〈0.8, n =96）. The plasma concentration of BNP was measured by ELISA. Interventricular septum thickness at enddiastole（IVST）, left ventricular posterior wall（LVPW）, left ventricular end-diastolic dimension（LVEDd）, E/A ratio and left ventricular ejection fraction（LVEF） were measured by echocardiography. Concentration of BNP and parameters measured by echocardiography were compared between two groups. Sensitivity of cutoff 100pg/ml of BNP to diagnose ventricular function was also compared. Linear regression analysis was used to investigate the relationship between Log BNP and BMI. [Results] Plasma concentration of BNP in the abdominal obesity group（306.88± 225.46pg/mL） was obviously lower than that in the non-abdominal obesity group（548.31 ± 353.22pg/mL） （ P 〈0. 05）. BNP100pg/mL was set as the cutoff to evaluate ventricular function. Sensitivity of determining diastolic dysfunction in the abdominal obesity group（83.3 % ） was lower than that in the non-abdominal obesity group（93.1% ）. Sensitivity of determining systolic dysfunction in the abdominal obesity group （90.0%） was lower than that in non-abdominal obesity group （97.4%）. Log BNP was reversely correlated with BMI（r= -0. 276, P 〈0. 05）. [Conclusion] Plasma concentration of BNP can be affected by abdominal obesity. BMI is reversely correlated with plasma BNP. The influence of abdominal obesity must be considered as heart function is assessed.

关 键 词：肥胖症 心钠素 心力衰竭 充血性 

分 类 号：R589.2[医药卫生—内分泌]