保留收缩功能性心力衰竭与B型脑钠肽及尿酸的相关性研究

目的结合超声心动图参数探讨B型脑钠肽（brain natriuretic peptide,BNP）联合尿酸（uric acid,UA）对保留收缩功能性心力衰竭诊断的临床意义。方法顺序入选130例有器质性心脏病、纽约心脏协会（New York heart association,NYHA）心功能分级I～IV级的住院患者,其超声心动图提示有不同程度的舒张功能障碍且左心室射血分数（left ventricular ejection fraction,LVEF）≥45%,检测血浆B型脑钠肽、尿酸浓度,按照NYHA分级及BNP浓度进行分组,比较患者的临床指标及超声心动图参数;分别以NYHA分级及BNP为因变量进行多元线性回归分析;对100ng/L400ng/L组较BNP〈100ng/L组的年龄、血浆UA浓度、左心房内径、左心室舒张末期内径、E/E′及左心室质量明显升高,LVEF明显降低,房性心律失常发生率明显升高,差异均有统计学意义（P〈0.01）。经多元线性回归分析仅NYHA分级及E/E′是影响血浆BNP浓度的独立相关因素（r=0.33,P〈0.01;r=0.17,P〈0.05）。100ng/L

Correlation between B type natriuretic peptide,uric acid and heart failure with preserved systolic function

Objectives To investigate the clinical significance of combining plasma concentration of B type natriuretic peptide （BNP） and uric acid （UA） in diagnosis of heart failure with preserved systolic function,using echocardiography parameters.Methods Total 130 patients with organic heart disease of New York heart association（NYHA） gradeⅠto Ⅳ were sequentially enrolled,and all manifested with different grade of diastolic dysfunction and left ventricular ejection fraction（LVEF）≥45% by echocardiography.The plasma concentrations of BNP and UA were measured respectively.Clinical index and ultrasonic parameters were compared among different groups with different NYHA grade or plasma concentration of BNP respectively,Multivariate analysis was also performed against two dependent variable respectively.For ＇grey zone＇ patients with plasma concentrations of BNP from 100 ng/L to 400 ng/L,Univariate analysis was performed against NYHA grade.Results The plasma concentration of BNP in NYHA grade Ⅳ group was significantly higher than in the other groups （P0.01）.Comparing with NYHA gradeⅠ,Ⅱ group,E/E＇ （index of diastolic function） in NYHA grade Ⅳ group was significantly higher （P0.05）.Plasma BNP concentration and age showed independent correlation with NYHA grade（r=0.33,P0.01;r=0.19,P0.05）.The age,plasma concentration of UA,left atrial internal diameter,left ventricular end-diastolic dimension,left ventricular mass,E/E＇ and the incidence rate of atrial arrythmia were significantly higher in patients with plasma concentrations of BNP over 400 ng/L than those with BNP100 ng/L,while LVEF was significantly lower in the former group （all P0.01）.Plasma concentration of BNP was significantly correlated with NYHA grade and E/E＇ index according to multivariate analysis（r=0.33,P0.01;r=0.17,P0.05）,while plasma concentration of UA and age were significantly correlated with NYHA grade in grouped ＇grey zone＇ patients with BNP concentrations from 100 ng/L to 400 ng/L（r=0.47,P0.01;r=0.27,P0.05）.Conclusions It was valuable to objectively assess heart function in heart failure patients with preserved systolic function in early stage by combining plasma concentrations of BNP and UA together with E/E＇ index.