血浆N末端B型利钠肽原联合E／E’评价原发性高血压患者左心室舒张功能不全的价值  

Value of NT-proBNP combined with Doppler E/E＇ in the evaluation of left ventricular diastolic dysfunction in patients with hypertension

作　　者：刘丹[1] 刘晓阳[2] 

机构地区：[1]大连医科大学附属大连市第三人民医院心内科,116031 [2]大连医科大学附属大连市第三人民医院神经内科,116031

出　　处：《中国综合临床》2013年第9期932-936,共5页Clinical Medicine of China

摘　　要：目的探讨左心室射血分数正常的原发性高血压患者血浆N末端B型利钠肽原（NT-proBNP）水平与舒张功能不全的关系。方法选择临床情况稳定、左心室射血分数／〉50％的原发性高血压患者44例，舒张功能正常组14例，舒张功能不全组30例，其中延迟松弛组18例，假性正常化充盈组12例，测定其血浆NT·proBNP浓度，同时应用脉冲多普勒成像测定跨二尖瓣舒张早期血流速度峰值（E），应用组织多普勒成像测定二尖瓣环舒张早期运动速度峰值（E’），依据E／E’比值将受试者分为3组，并对相关数据进行统计分析。结果舒张功能不全组血浆NT—proBNP为（115．2±78．9）ng／L，正常充盈组为（34．7±17．5）ng／L，假性正常化充盈组为（206．6±75．8）ng／L，随着左心室舒张功能不全加重，血浆NT—proBNP水平升高（F=85．263，P=0．000），3组间两两比较差异均有统计学意义（P均〈0．01）。依据E／E’比值将受试者分为3组：E／E’〈10组16例，10—15组18例，E／E’〉15组10例，3组受试者的血浆NT-proBNP分别为（39．5±20．1）、（71．2±26．4）、（203．7±75．2）ng／L，血浆NT—proBNP随着E／E’比值的增加逐渐增加（r=0．80，P〈0．01）。以NT．proBNP119ng／L为界值，诊断左心室充盈压升高（E／E’〉15）的敏感性为87％，特异性100％。结论血浆NT．proBNP联合多普勒超声E／E’对识别原发性高血压患者早期的心脏改变，特别是左心室舒张功能不全有潜在的应用价值。Objective To investigate the relationship between plasma N-terminal pro brain natriureticpeptide（NT-proBNP） level and left ventricular （LV） diastolic dysfunction in hypertensive patients without systolic dysfunction. Methods Forty-four cases of primary hypertensive patients with left ventricular ejection fraction more than 50% were enrolled, 14 cases in normal diastolic function group, 30 cases in diastolic dysfunction group（ 18 cases in delayed relaxation group and 12 cases in pseudo normalization filling group）. LV diastolic function was assessed with conventional Doppler by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E＇ wave velocities （E/E＇） was used to detect LV filling pressures. Patients were divided into three groups according to E/E＇ ratios. Plasma concentrations of NT-proBNP were also measured. All related data were statistically analyzed. Results The levels of NT-proBNP were （ 115.2 ± 78.9） ng/L in LV diastolic dysfunction group, （34. 7 ±17.5） ng/L in normal filling group and （206. 6 ±75.8） ng/L in pseudonormal filling group. The level of NT-proBNP significantly elevated （ F = 85. 263, P = 0. 000） along with the severity of left ventrieular diastolic dysfunction. There was significant difference between each of the two groups among the three groups （all P 〈 0. 01 ）. According to E/E＇ ratios, the patients were divided into three groups： E/E＇〈10（n=16）, 10 〈E/E〈15（n=18）,E/E＇ 〉15（n=10）.The level of NT-proBNP were （39. 5 ~ 20. 1 ） ng/L, （71.2 ± 26.4） ng/L and （203.7 ±75.2） ng/L respectively in the three groups. The NT-proBNP blood level was positively correlated significantly with E/E＇ ratio （ r = 0. 80, P 〈 0. 01 ） . The sensitivity was 87% and the specificity was 100% for diagnosis of left ventricular filling pressure （ E/E＇ 〉 15 ） according to a NT

关 键 词：原发性高血压 N末端B型利钠肽原 左心室舒张功能不全 组织多普勒成像 

分 类 号：R544.1[医药卫生—心血管疾病]