射血分数保留心力衰竭同型半胱氨酸及脑钠肽与左室功能相关性研究

目的探讨左室射血分数保留心力衰竭(HF-PEF)患者血清同型半胱氨酸(HCY)、脑钠肽(BNP)与左室功能相关性。方法采取整群抽样方法选取锡山人民医院射血分数保留心衰患者97例,NYHA心功能分为Ⅱ~Ⅳ级,作为HF-PEF组。HF-PEF组按纽约心脏病学会(NYHA)心功能分级分为3组,心功能Ⅱ级组(32例),心功能Ⅲ级组(37例),心功能Ⅳ级组(28例)。体检中心同期体检心功能正常者作为对照组,85例。两组均检测血清HCY及BNP,超声心动图检测左心室舒张末期室间隔厚度(IVST)、左心室舒张末期室壁厚度(LVPWT)、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、E/A、E/E’等指标,并计算左心室质量指数(LVMI)。结果与对照组比较,HFPEF组HCY[(10.86±3.45)μmol/L vs.(32.84±8.51)μmol/L]升高,BNP[(200.55±100.30)pg/ml vs.(2310.52±235.50)pg/ml]升高,差异有统计学意义(P均0.01)。与心功能Ⅱ级组比较,心功能Ⅲ级组和心功能Ⅳ级组HCY、BNP、LVMI升高,差异具有显著统计学意义(P均0.01)。HCY与BNP呈明显正相关(r=0.713,P0.01)。LVMI与血清BNP、HCY呈正相关,相关系数分比为0.675、0.634,有统计学意义(P均0.05)。结论 HF-PEF患者血清BNP、HCY与左室功能呈正相关,联合检测血清BNP对HF-PEF的诊断,严重程度、预后的预判具有指导意义。

Correlation between homocysterine or B-type brain natriuretic peptide and left ventricular function in ;heart failure with preserved ejection fraction

Objective To investigate the correlation between homocysterine （Hcy） or B-type brain natriuretic peptide （BNP） and left ventricular function in patients with heart failure with preserved ejection fraction （HF-PEF）. Methods The patients （n=97） with HF-PEF were chosen as HF-PEF group by using cluster sampling method, and then HF-PEF group was divided into 3 groups：grade II group （n=32）, grade III group （n=37） and grade IV group （n=28）. Meanwhile the persons having physical examination with normal heart function were chosen as control group （n=85）. The levels of serum HCY and BNP were detected, the indexes of IVST, LVPWT, LVEDd, LVEF, E/A and E/E’ were detected by using ultrasonic cardiogram, and LVMI was calculated in 2 groups. Results Compared with control group, the level of HCY increased [（10.86±3.45）μmol/L vs. （32.84±8.51）μmol/L] and BNP increased [（200.55±100.30） pg/ml vs. （2310.52±235.50） pg/ml] in HF-PEF group （all P〈0.01）. Compared with grade II group, HCY, BNP and LVMI increased in grade III group and grade IV group （all P〈0.01）. HCY and BNP were positively correlated to each other （r=0.713, P〈0.01）. LVMI was positively correlated to BNP and HCY （r=0.675, r=0.634, all P〈0.05）. Conclusion The levels of serum BNP and HCY are positively correlated to left ventricular function in patients with HF-PEF. The combined detection of serum BNP has guiding significance in the diagnosis and anticipation of severity and prognosis of HF-PEF.