两种标志物在老年高血压合并射血分数中间值的心力衰竭患者心室重构中的表达  

Expression of two biomarkers in ventricular remodeling in elderly patients with hypertension combined with HFmrEF

作　　者：刘海英 战伟 王蒙 曲治权 Liu Haiying;Zhan Wei;Wang Meng;Qu Zhiquan(Department of Geriatrics,Hongqi Hospital Affiliated To Mudanjiang Medical University,Mudanjiang157011,Heilongjiang Province,China)

机构地区：[1]牡丹江医学院附属红旗医院老年科,157011

出　　处：《中华老年心脑血管病杂志》2024年第7期737-741,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：黑龙江省卫生健康委科研课题(20210303100259)。

摘　　要：目的 探究血清B型钠尿肽(brain natriuretic peptide, BNP)和N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)在老年高血压合并射血分数中间值的心力衰竭(heart failure with mildly reduced ejection fraction, HFmrEF)患者心室重构中的表达变化。方法 选取2022年1月至2024年1月牡丹江医学院附属红旗医院老年科收治的老年高血压患者288例,分为射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)组88例,HFmrEF组54例,射血分数减低的心力衰竭(heart failure with reduced ejection fraction, HFrEF)组62例,单纯高血压患者为对照组84例。比较各组BNP、NT-proBNP水平、心室重构指标。心室重构指标包括左心室后壁厚度(left ventricular posterior wall thickness, LVPWT)、室间隔厚度(Interventricular septum thickness, IVST)、左心室舒张末期内径(left ventricular end-diastolic diameter, LVEDD)、左心室舒张早期二尖瓣血流最大速度(E)/左心室舒张晚期二尖瓣血流最大速度(A)、左心室质量指数(left ventricle mass index, LVMI)、左心室射血分数(LVEF)。结果 各组LVPWT、IVST、LVEF、LVEDD、E/A、LVMI、BNP和NT-proBNP水平比较,差异有统计学意义(P<0.01)。HFpEF组、HFmrEF组和HFrEF组LVPWT、IVST、LVEDD、LVMI、BNP和NT-proBNP水平明显高于对照组,LVEF、E/A明显低于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,BNP、NT-proBNP是影响高血压合并HFmrEF患者心室重构的危险因素(P<0.01)。Spearman相关性分析显示,BNP、NT-proBNP水平与LVPWT、IVST、LVEDD、LVMI呈正相关(r=0.387,P=0.001,r=0.523,P=0.001,r=0.417,P=0.001,r=0.364,P=0.001;r=0.421,P=0.001,r=0.603,P=0.001,r=0.316,P=0.000,r=0.286,P=0.001),与LVEF、E/A呈负相关(r=-0.437,P=0.001,r=-0.624,P=0.001;r=-0.687,P=0.001,r=-0.592,P=0.001)。ROC曲线分析显示,BNP、NT-proBNP水平预测高血压合并HFmrEF患者心室重构的曲线下面积分别为0.906、0.881(P<0.01),最佳截�Objective To investigate the expression changes in serum brain natriuretic peptide(BNP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)in ventricular remodeling in elderly hypertensive patients with heart failure with mildly reduced ejection fraction(HFmrEF).Methods A total of 288elderly hypertensive patients admitted to our department from January 2022to January 2024were enrolled,and then divided into heart failure with preserved ejection fraction(HFpEF)group(88cases),HFmrEF group(54cases),heart failure with reduced ejection fraction(HFrEF)group(62cases),and control group(simple hypertension,84cases).The BNP and NT-proBNP levels and ventricular remodeling indicators were compared among all groups.Ventricular remodeling indicators included left ventricular posterior wall thickness(LVPWT),interventricular septum thickness(IVST),left ventricular end-diastolic diameter(LVEDD),maximum mitral flow velocity in early left ventricular diastolic period(E)/maximum mitral flow velocity in late left ventricular diastolic period(A),left ventricle mass index(LVMI)and left ventricular ejection fraction(LVEF).Results Significant differences were observed in the LVPWT,IVST,LVEF,LVEDD,E/A,LVMI,BNP and NT-proBNP levels among above four groups(P<0.01).The LVPWT,IVST,LVEDD,LVMI,BNP and NT-proBNP levels were obviously higher,and LVEF and E/A were notably lower in the HFpEF,HFmrEF and HFrEF groups than the control group(P<0.05).Multivariate logistic regression analysis showed that BNP and NT-proBNP were risk factors for ventricular remodeling in patients with hypertension combined with HFmrEF(P<0.01).Spearman correlation analysis indicated that BNP and NT-proBNP levels were positively correlated with LVPWT,IVST,LVEDD and LVMI(r=0.387,P=0.001,r=0.523,P=0.001,r=0.417,P=0.001,r=0.364,P=0.001;r=0.421,P=0.001,r=0.603,P=0.001,r=0.316,P=0.000,r=0.286,P=0.001),but negatively with LVEF and E/A(r=-0.437,P=0.001,r=-0.624,P=0.001;r=-0.687,P=0.001,r=-0.592,P=0.001).ROC curve analysis revealed that the AUC value of BNP and NT-proBNP levels i

关 键 词：利钠肽 脑 心力衰竭 高血压 每搏输出量 心室重构 

分 类 号：R541.6[医药卫生—心血管疾病] R544.1[医药卫生—内科学]