脑钠肽与二尖瓣E/E’比值在收缩性心力衰竭患者的临床应用  

Usefulness of plasma B-type natriuretic peptide and E/E' ratio of mitral annulus in patients with systolic heart failure

作　　者：叶小钧[1] 王勇[1] 李爱莉[1] 姜红[1] 杨屹云[1] 

机构地区：[1]中日友好医院心内科,北京100029

出　　处：《中日友好医院学报》2013年第1期3-7,共5页Journal of China-Japan Friendship Hospital

摘　　要：目的:探讨收缩性心力衰竭(SHF)患者脑钠肽(BNP)水平异质性中舒张功能的作用及两者的预后价值。方法:128例SHF患者住院后行常规超声及组织多普勒检查(TDI),计算舒张早期二尖瓣口血流速度(E)/二尖瓣环峰值运动速度(E’),并测定入院及出院时BNP水平。随访联合终点事件定义为心源性死亡及因心衰失代偿再入院。结果:lnBNP与NYHA分级、左室射血分数、TDI参数、E/E’比值等均明显相关,BNP水平随NYHA心功能分级及舒张功能异常程度加重逐渐上升(组间两两比较均P<0.01),多元回归分析表明仅E/E’比值及舒张功能异常程度分级与入院时及出院前lnBNP独立相关。随访中35例患者发生联合终点事件,多变量分析显示出院前lnBNP(RR:2.79,P<0.05)和E/E’(RR:1.25,P<0.05)为联合终点事件的独立预测因子。结论:SHF患者中BNP异质性与舒张功能、E/E’相关,动态观察BNP、常规检测E/E’可用于判断预后、指导治疗。Objective：To explore the contribution of left ventricular diastolic function to plasma B-type natriuretic peptide（BNP）,and the prognostic value of the two indexes in patients with systolic heart failure（SHF）. Methods：In 128 patients with symptomatic SHF（LVEF0.45）,we measured plasma BNP and underwent conventional two-dimensional/Doppler echocardiography and tissue Doppler imaging（TDI）.Early transmitral flow velocity（E）/early diastolic velocity of mitral annulus（E＇）were measured in all patients.A cardiac event（death and hospitalization due to de-compensated HF）was defined as the combined study endpoint in follow-up.Results：We found significant correlations（P〈0.05）between lnBNP and NYHA function class（r=0.69）,LVEF（r=0.17）,TDI indexes（r=0.34）,E/E＇（r=0.50）et al.Plasma BNP levels were elevated with greater severity of NYHA function class and diastolic dysfunction in all（P〈0.01 between every two groups）.In multiple linear regression analysis,overall diastolic stage and E/E＇ ratio were independent predictors of the levels of lnBNP at admission and discharge（P〈0.05,P〈0.01）.Thirty five patients suffered from the combined study endpoint.Stepwise multivariate analysis identified lnBNP at discharge（RR：2.79,P〈0.05）and E/E＇（RR：1.25,P〈0.05）as the only independent predictors of a combined event.Conclusion：Heterogeneity of BNP levels in patients with SHF was related to diastolic abnormality,E/E＇ ratio.To monitor changes of BNP and measure routinely E/E＇ may provide incremental information in assessment of risk and therapy optimization.

关 键 词：脑钠肽 组织多普勒 超声心动扫描技术 心力衰竭 

分 类 号：R541.61[医药卫生—心血管疾病]