脑钠素在判断2型糖尿病患者心肌舒缩功能的作用研究  

Judgment about myocardial function with plasma BNP in patients with noninsulin-dependent diabetes mellitus

作　　者：陈一天[1] 江时森[1] 许瑞吉[2] 黄承[3] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院心血管内科,江苏南京210002 [2]南京大学医学院临床学院南京军区南京总医院核医学科,江苏南京210002 [3]南京大学医学院临床学院南京军区南京总医院超声诊断科,江苏南京210002

出　　处：《医学研究生学报》2004年第5期420-422,共3页Journal of Medical Postgraduates

基　　金：南京军区南京总医院重点课题基金资助项目 (批准号 :2 0 0 3 0 2 0 )

摘　　要：目的 :观察 2型糖尿病 (diabetesmellitus ,DM)患者心功能变化以及与血浆脑钠素 (brainnatriureticpeptide ,BNP)的关系。　方法 :选择 2型DM患者 83例 ,应用心脏超声测定其左心室射血分数 (LVEF)、二尖瓣舒张早期血流速度 (E)和舒张晚期血流速度 (A) ,采用固相免疫放射分析 (Immnoradiometicassay ,IRMA)方法测定血浆BNP浓度 ,并与正常对照组 (1 2例 )进行对比分析。　结果 :83例 2型DM患者 ,心脏超声结果显示心功能正常者 2 4例 (2 8.9% ) ;舒张功能不全者 4 7例 (5 6 .7% ) ;收缩功能不全者 6例 (7.2 % ) ;收缩及舒张功能均有障碍者 6例 (7.2 % )。相关分析可见LVEF值与血浆BNP水平呈良好负相关 (r=- 0 .6 1 4 ,P <0 .0 1 )。在单纯舒张功能不全组 ,血浆BNP水平随着舒张功能不全程度加重而逐渐提高 ,且与E/A比值呈明显负相关 (r =- 0 .5 35 ,P <0 .0 1 ) ;当血浆BNP水平>4 8ng/L(LVEF >5 0 %者的x +1 .96s)时 ,诊断DM患者心脏收缩功能不全的敏感性和特异性分别是 91 .7%和 83.3%。当血浆BNP水平 >1 1ng/L(心功能正常组的x +1 .96s)时 ,诊断DM患者单纯舒张功能不全的敏感性和特异性分别是 93.6 %和 85 .2 %。　结论 :血浆BNP浓度随着心脏舒缩功能障碍程度的加重而升高 ,是能较好反映DM患者心功能状态?Objective:To study the alteration of cardiac function in diabetic patients and evaluate the relationship between cardiac function and BNP. Methods:83 diabetic patients and 12 healthy subjects were selected into the study. Left ventricular ejection fraction(LVEF) and mitral annular early diastole (E) and late diastole (A) inflow velocities were measured with echocardiography. Plasma BNP were measured with Immnoradiometic assay(IRMA)? Results:According to the result of the echocardiography, the diabetics who have no primary cardiac diseases were subdivided into normal cardiac function group( n =24,28.9%),diastolic dysfunction group( n =47,56.7%), systolic dysfunction group( n =6,7.2%), both diastolic and systolic dysfunction group( n =6,7.2%). More than half of diabetic patients have diastolic dysfunction. The plasma level of BNP had significant negative correlation with LVEF( r = -0.614, P <0.01).In the diastolic cardiac dysfunction group, the plasma BNP increased with diastolic heart failure severity, and the BNP had significant negative correlation with E/A( r =-0.535, P < 0.01). A plasma BNP concentration exceeding 48 ng/L had a sensitivity of 91.7% and a specificity of 83.3% for detection of systolic cardiac dysfunction with diabetics. A plasma BNP concentration exceeding 11 ng/L had a sensitivity of 93.6% and a specificity of 85.2% for detection of diastolic cardiac dysfunction with diabetics. Conclusion:The plasma levels of BNP increase significantly according to the severity of diastolic and systolic cardiac dysfunction. The plasma BNP concentration may be a good biochemical parameter for evaluating the cardiac function of diabetic patients.

关 键 词：2型糖尿病 脑钠素 心功能 

分 类 号：R331.31[医药卫生—人体生理学]