血清NT-proBNP与心脏超声参数对肥厚型心肌病患者合并肺动脉高压的预测价值  

Prognostic value of serum NT-proBNP and cardiac ultrasound parameters in patients with hypertrophic cardiomyopathy complicated with pulmonary hypertension

作　　者：房洁 李娜 Fang Jie;Li Na(Department of Cardiovascular,the 960th Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army,Jinan 250031,China;Department of Respiratory,the 960th Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院心血管内科,济南250031 [2]中国人民解放军联勤保障部队第九六〇医院呼吸科,济南250031

出　　处：《中国医师杂志》2025年第1期62-66,70,共6页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(20203100721)。

摘　　要：目的探讨血清N末端B型利钠肽前体(NT-proBNP)与心脏超声参数对肥厚型心肌病(HCM)患者合并肺动脉高压(PAH)的预测价值。方法选取2020年9月—2023年9月中国人民解放军联勤保障部队第九六〇医院接收的280例HCM患者为研究对象,合并PAH的患者设为观察组(n=116),不合并PAH的患者设为对照组(n=164)。收集两组患者一般资料,并测定其血清指标[心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、NT-proBNP、心型脂肪酸结合蛋白(H-FABP)]以及心脏超声指标[左、右心房内径,左心室后壁厚度,左室射血分数(LVEF),肺动脉内径(PAD),二尖瓣E/e′值等]。使用多元logistic回归分析法研究HCM患者发生PAH的影响因素,并基于这些因素开发一个用于预测PAH的模型,通过受试者工作特征(ROC)曲线评价诊断模型的有效性。结果观察组患者血清NT-proBNP、左心房内径、右心房内径、左心室后壁厚度、PAD和肺动脉收缩压(PASP)高于对照组,而LVEF低于对照组,差异有统计学意义(均P<0.05);多因素logistic分析结果显示,NT-proBNP、左心房内径、右心房内径、左心室后壁厚度、LVEF、PAD以及PASP均是HCM伴PAH的影响因素(均P<0.05)。以此因素构建的模型预测HCM患者合并PAH的ROC曲线下面积为0.991。结论NT-proBNP、心房内径、左心室后壁厚度、LVEF、PAD以及PASP均是HCM患者合并PAH的影响因素,对合并PAH的诊断具有较高的预测价值。Objective To investigate the predictive value of serum N-terminal B-type natriuretic peptide precursor(NT-proBNP)and cardiac ultrasound parameters in patients with hypertrophic cardiomyopathy(HCM)complicated with pulmonary hypertension(PAH).MethodsA total of 280 patients with HCM admitted to the 960th Hospital of the Joint Logistics Support Force of Chinese People′s Liberation Army from September 2020 to September 2023 were selected as the study objects.Patients with PAH were set as the observation group(n=116),and patients without PAH were set as the control group(n=164).General data of the two groups of patients were collected,and the serum indexes[cardiac troponin I(cTnI),cardiac troponin T(cTnT),NT-proBNP,cardiac fatty acid binding protein(H-FABP)]and cardiac ultrasound indexes[left and right atrial diameter,left ventricular posterior wall thickness,left ventricular ejection fraction(LVEF)were measured.Pulmonary artery diameter(PAD),mitral valve E/e′value,etc.].Multivariate logistic regression analysis was used to study the factors affecting the occurrence of PAH in HCM patients,and a model for predicting PAH was developed based on these factors.The validity of the diagnostic model was evaluated by receiver operating characteristic(ROC)curve.ResultsSerum NT-proBNP,left atrial diameter,right atrial diameter,left ventricular posterior wall thickness,PAD and pulmonary artery systolic pressure(PASP)in the observation group were higher than those in the control group,while LVEF was lower than that in the control group,with statistical significance(all P<0.05).Multivariate logistic analysis showed that NT-proBNP,left atrial diameter,right atrial diameter,left ventricular posterior wall thickness,LVEF,PAD and PASP were all influencing factors of HCM with PAH(all P<0.05).The model constructed with this factor predicted that the area under ROC curve of HCM patients with PAH was 0.991.ConclusionsNT-proBNP,atrial inner diameter,left ventricular posterior wall thickness,LVEF,PAD and PASP are all influential factors o

关 键 词：超声心动描记术 N末端B型利钠肽前体 肥厚型心肌病 肺动脉高压 

分 类 号：R542.2[医药卫生—心血管疾病] R544.1[医药卫生—内科学]