血浆氨基末端脑钠肽前体、左心室质量指数与老年射血分数保留性心力衰竭患者预后的相关性研究  

Study on the relationship between Plasma Pro amino terminal brain natriuretic peptide, left ventricular mass index and the prognosis in elderly heart failure patients with preserved ejection fraction

作　　者：周磊 张晓红 Zhou lei;Zhang Xiaohong(Department of Cardiology,the Third Affiliated Hospital of Anhui Medical University&the First People′s Hospital of HeFei,Hefei 230061,China)

机构地区：[1]安徽医科大学第三附属医院合肥市第一人民医院心内科,230061

出　　处：《中国综合临床》2020年第2期144-149,共6页Clinical Medicine of China

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)及左心室质量指数(left ventricular mass index,LVMI)评估老年射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者预后的临床价值。方法选取2018年1月至2018年12月安徽医科大学第三附属医院心内科就诊的170例心力衰竭患者(年龄≥65岁)作为研究对象进行前瞻性研究。根据左心室射血分数(left ventricular ejection fraction,LVEF)分为HFpEF组(100例),射血分数减低心力衰竭(heat failure with reduced ejection fraction,HFrEF)组(70例);另外选择健康体检者58例作为对照组。比较3组左心房内径(left atrial diameter,LAD)、室间隔厚度(interventricular septum thickness,IVST)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、LVEF、LVMI及血浆NT-proBNP浓度的差异。研究组经规范化治疗后随访6个月,观察主要心血管不良事件(major cardiovascular adverse events,MACE)的发生情况。应用多元Logistic回归分析上述指标与MACE发生的相关性。应用ROC曲线分析NT-proBNP及LVMI的预测价值。结果HFpEF组、HFrEF组及对照组LAD、IVST、LVPWT、LVEDD、LVEF、LVMI存在差异(F值分别为110.878、75.838、74.044、137.985、495.267、122.810,P均<0.001),且HFpEF组与对照组比较LAD、IVST、LVPWT、LVEDD、LVMI[(40.81±4.46)mm,(9.39±1.15)mm,(9.68±1.11)mm,(55.54±3.67)mm,(125.45±19.17)g/m2]均高于对照组[(32.90±3.20)mm,(7.62±0.64)mm,(7.81±0.58)mm,(47.05±3.13)mm,(77.72±11.79)g/m2],LVEF低于对照组[(59.63±5.23)%与(67.70±4.35)%],差异有统计意义(P<0.05);与HFpEF组比较,IVST、LVPWT、LVEF[(9.39±1.15)mm,(9.68±1.11)mm,(59.63±5.23)%]高于HFrEF组[(7.59±1.28)mm,(8.01±1.39)mm,(36.90±7.63)%],LAD、LVEDD[(40.81±4.46)mm,(55.54±3.67)mm]均低于HFrEF组[(45.51±6.11)mm,(64.77±9.55)mm],差异均有统计学意义(P均<0.05)。对�Objective To investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)and Left ventricular mass index(LVMI)in evaluating the prognosis of elderly heart failure patients with preserved ejection fraction(HFpEF).Methods From January 2018 to December 2018,170 patients with heart failure(age≥65years old)in the Third Affiliated Hospital of Anhui Medical University were selected as the subjects of prospective study.According to the left ventricular ejection fraction(LVEF),the patients were divided into two groups:the heart failure with preserved ejection fraction(HFpEF)group(100 cases),the heart failure with reduced ejection fraction(HFrEF)group(70 cases),and the healthy subjects(58 cases)as the control group.Left atrial diameter(LAD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end diastolic diameter(LVEDD),LVEF,left ventricular mass index(LVMI)and plasma NT-proBNP concentrations were compared among the three groups.The study group was followed up for 6 months after standardized treatment to observe the occurrence of major cardiovascular adverse events(MACE).Multiple logistic regression was used to analyze the correlation between the above indexes and the occurrence of mace.ROC curve was used to analyze the predictive value of NT proBNP and LVMI.Results There were significant differences in LAD,IVSTt,LVPWT,LVEDD,LVEF and LVMI among each group(F value was 110.878,75.838,74.044,137.985,495.267 and 122.810,respectively,all P<0.001).The LAD,IVST,LVPWT,LVEDD,and LVMI in the HFpEF group((40.81±4.46)mm,(9.39±1.15)mm,(9.68±1.11)mm,(55.54±3.67)mm,(125.45±19.17)g/m2)were higher than those in the control group((32.9±3.20)mm,(7.62±0.64)mm,(7.81±0.58)mm,(47.05±3.13)mm,(77.72±11.79)g/m^2),and the LVEF was lower than that of the control group((59.63±5.23)%vs.(67.7±4.35)%)with statistical significance(all P<0.05).IVST,LVPWT,LVEF in HFpEF group((9.39±1.15)mm,(9.68±1.11)mm,(9.63±5.23)%)were higher than those in HFrEF group((7

关 键 词：心力衰竭 射血分数保留性心力衰竭 氨基末端脑钠肽前体 左心室质量指数 预后 

分 类 号：R541[医药卫生—心血管疾病]