缬沙坦对冠心病伴舒张功能不全病人血浆NT-proBNP及组织多普勒指标的影响  

THE EFFECT OF VALSARTAN ON PLASMA AMINO-TERMINAL B-TYPE BRAIN NATRIURETIC PEPTIDE(NT-proBNP) AND TISSUE DOPPLER INDEXES IN PATIENTS WITH CORONARY HEART DISEASE COMPLICATING DIASTOLIC DYSFUNCTION

作　　者：成娅[1] 沃金善[1] 郭洁[1] 赵青[1] 孙品[2] 

机构地区：[1]青岛大学医学院附属医院心内科,山东青岛266003 [2]青岛大学医学院附属医院心脏超声室,山东青岛266003

出　　处：《青岛大学医学院学报》2013年第2期113-116,共4页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨缬沙坦对冠心病伴舒张功能不全病人血浆氨基末端脑钠肽前体(NT-proBNP)及组织多普勒指标的影响。方法通过冠状动脉造影及左心导管术选取诊断为冠心病伴舒张功能不全的病人74例,分为缬沙坦组38例和对照组36例,两组病人均给予冠心病常规治疗,缬沙坦组病人同时口服缬沙坦80～160mg/d治疗,疗程6个月。所有病人用药前通过左心导管术检测左心室舒张末期压(LVEDP)和左心室舒张期压力下降最大速率(dp/dtmin)。用药前后分别测量血浆NT-proBNP的浓度、左心室排血分数(LVEF)、舒张早期二尖瓣口血流速度(E)、舒张晚期二尖瓣口血流速度(A)、舒张早期二尖瓣环运动速度(Em),并计算E/A、E/Em比值。结果病人治疗前LVEDP与血浆NT-proBNP水平呈正相关(r=0.85,P<0.05),LVEDP水平与E/Em比值呈正相关(r=0.83,P<0.05),NT-proBNP水平与E/Em比值呈正相关(r=0.87,P<0.05),dp/dtmin与E/Em比值呈正相关(r=0.43,P<0.05)。与治疗前比较,缬沙坦组病人治疗后血浆NT-proBNP水平明显下降(t=12.89,P<0.01),对照组病人血浆NT-proBNP水平也明显下降(t=8.55,P<0.05);与对照组比较,缬沙坦组病人治疗6个月后血浆NT-proBNP水平明显下降(t=3.38,P<0.01)。与治疗前比较,缬沙坦组病人E/Em比值及A明显降低(t=4.39、96.00,P<0.05),Em、E、E/A比值较前明显升高(t=-4.79～-4.11,P<0.05)。与对照组比较,缬沙坦组病人治疗6个月后Em、E、A、及E/A、E/Em比值变化显著(t=5.12～46.57,P<0.01)。结论缬沙坦对冠心病病人左心室舒张功能有明显改善作用。Objective To study the effect of valsartan on plasma amino-terminal B-type brain natriuretic peptide （NT- proBNP） and tissue Doppler indexes in patients with coronary heart disease （CHD） complicating diastolic dysfunction （DDF）. Methods Seventy-four patients with CHD complicating DDF-confirmed by coronary angiography and left heart catheterization- were enrolled in this study. The patients were divided into two groups as valsartan group （38 cases） and control group （36 cases）, a conventional therapy of CHD was offered to patients in the two groups, and for those in valsartan group, valsartan 80--160 mg/ day was given for six months. The left ventricular end-diastolic pressure （LVEDP） and minimum value of the first derivative of left ventricular pressure （dp/dtmin） were measured through the left heart catheterization before treatment. The levels of NT-proBNP, left ventricular ejection fraction （LVEF）, early diastolic mitral valve flow velocity （E）, late diastolic mitral valve flow velocity （A）, and early diastolic velocity mitral annulus velocity （Era） before and after medication were measured, the ratio of E/A and E/ Em calculated. Results Before treatment, LVEDP was positively correlated with NT-proBNP （r = 0.85, P 〈0.05） and E/Era （r=0.83,P〈0.05）; NT-proBNP was positively correlated with E/Era （r=0.87,P〈0.05）, dp/dtmin was positively correlated with E/Em （r=0.43, P 〈0.05）. Compared with before treatment, plasma NT-proBNP of the patients in valsartan group after treatment declined （t = 12.29, P 〈0.01）, the same was also noted in t he controls （t = 8.55, P〈 0.05）. Compared with the control group, the NT-proBNP level of the patients in valsartan group, after six months of treatment, markedly declined （t = 3.38, P 〈 0.01）. Compared with before treatment, the values of E/Era and A of patients in valsartan group after treatment declined （t =4.39,96.00;P〈0.05）, and Era, E, and E/A obviously elevated （t=-4.79--4.11,P〈0.05）

关 键 词：缬沙坦 舒张功能不全 利钠肽 脑 多普勒 治疗结果 

分 类 号：R541.6[医药卫生—心血管疾病]