血浆N末端脑钠肽前体与左心室质量指数对老年左心室射血分数正常心力衰竭的意义  

Significance of plasma NT-proBNP and left ventricular mass index in elderly patients with normal left ventricular ejection fraction

作　　者：陈海荣[1] 潘碧云 李名兰 温达 CHEN Hai-rong;PAN Bi-yun;LI Ming-lan;WEN Da(Haikou People′s Hospital of Hainan,Haikou 570208,China)

机构地区：[1]海南省海口市人民医院,海口570208

出　　处：《岭南心血管病杂志》2018年第1期66-71,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨血浆氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)与左心室质量指数(left ventricular mass index,LVMI)对于老年左心室射血分数(left ventricular ejection fraction,LVEF)正常心力衰竭的诊断意义。方法选取海南省海口市人民医院心血管内科2015年9月至2016年9月收治的心力衰竭患者160例,按照超声心动图中LVEF的结果分为LVEF正常心力衰竭(heart failure with normal left ventric-ular ejectionfraction,HFNEF)组(84例)和LVEF减低心力衰竭(heart failure with reduced left ventricular ejectionfraction,HFREF)组(76例)。另外,选取同期心功能正常的患者80例为对照组。比较3组超声心动图的相关指标及血浆NT-proBNP浓度。绘制血浆NT-proBNP诊断HFNEF的受试者工作特征(receiver operator character-istic,ROC)曲线,计算其诊断HFNEF的灵敏度和特异度;绘制LVMI诊断HFNEF的ROC曲线,计算其诊断HFNEF的灵敏度和特异度;以血浆NT-proBNP浓度作为反映左心室充盈压的间接指标,比较HFNEF组LVMI与血浆NT-proBNP浓度的相关性。结果对照组的LVMI明显小于HFNEF组及HFREF组,差异有统计学意义(P<0.05);但HFNEF组与HFREF组的LVMI相比,差异无统计学意义(P>0.05)。对照组血浆NT-proBNP浓度最低,HFNEF组次之,HFREF组最高,3组间比较差异有统计学意义(P<0.05)。以血浆NT-proBNP浓度131 pg/m L为临界值,诊断HFNEF的灵敏度为0.94,特异度为0.83,阳性预测值为0.95,阴性预测值为0.21;以LVMI>125 g/m2为标准,诊断HFNEF的灵敏度为0.62,特异度为0.99。HFNEF组中,血浆NT-proBNP浓度与LVMI呈现相关性(r=0.513,P<0.01)。结论老年HFNEF患者血浆NT-proBNP浓度和LVMI都明显升高,对于诊断HFNEF都具有一定意义;单独运用NT-proBNP或LVMI进行诊断,存在一定的缺陷;如果能够联合应用,可能会取长补短,提高诊断的正确率。Objectives To investigate the significance of plasma concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)and left ventricular mass index(LVMI)in the diagnosis of heart failure with normal left ventricular ejection fraction(LVEF)in elderly patients.Methods Totally160patients with congestive heart failure were enrolled from September2015to September2016in Haikou People′s Hospital of Hainan.According to the results of LVEF in echocardiography,the patients were divided into heart failure with normal left ventricular ejectionfraction(HFNEF)group(84cases)and heart failure with reduced left ventricular ejection fraction(HFREF)group(76cases).Another80patients with normal heart function were selected as control group.Relative indexes of echocardiography and plasma concentrations of NT-proBNP were compared among the three groups.Receiver operator characteristic(ROC)curve of plasma concentration of NT-pro BNP was used to diagnose HFNEF,and the sensitivity and specificity of HFNEF were calculated.ROC curve of LVMI was drawn and its sensitivity and specificity were calculated.Taking plasma con?centration of NT-proBNP as an indirect indicator of left ventricular filling pressure,relationship of LVMI and plasma concentration of NT-proBNP in HFNEF group was analyzed.Results LVMI in control group was significantly lower than those in HFNEF group and HFREF group(P<0.05),but there was no significant difference between HFNEF group and HFREF group(P>0.05).Plasma concentration of NT-proBNP was the lowest in control group,followed by HFNEF group and HFREF group,differences among the three groups were significant(P<0.05).Sensitivity and specificity of HFNEF were0.94and0.83,when NT-pro BNP131pg/mL was used as the cut-off value,and positive and negative predictive value were0.95,0.21.Taking LVMI>125g/m2as the standar,sensitivity and specificity of HFNEF diagnosis were0.62and0.99,respectively.Plasma concentration of NT-proBNP correlated with LVMI in HFNEF group(r=0.513,P<0.01).Conclusions Plasma concentration of NT-proBNP

关 键 词：心力衰竭 N末端脑钠肽前体 左心室质量指数 

分 类 号：R541.6[医药卫生—心血管疾病]