血浆N一末端脑钠肽前体对射血分数正常心力衰竭患者诊断价值

目的探讨射血分数正常的心力衰竭患者血浆N-末端脑钠肽前体的水平。方法30例射血分数正常的心力衰竭患者（观察组）与30例体检健康者（对照组）均行超声心动图检查，检测并比较2组血浆N-末端脑钠肽前体水平。结果观察组血浆N-末端脑钠肽前体水平明显高于对照组（P〈O．01）；血浆N-末端脑钠肽前体水平与心脏彩超指标舒张早期二尖瓣环运动速度（r=-0．395，P〈0．01）、舒张早期二尖瓣环运动速度／舒张晚期二尖瓣环运动速度（r=-0．292，P〈0．05）、舒张早期二尖瓣血流速度／舒张早期二尖瓣环运动速度（r=-0．529，P〈O．01）呈负相关，与左心房内径（r=0．300，P〈0．05）及左心室后壁厚度（r=0．262，P〈0．05）呈正相关；血浆N-末端脑钠肽前体水平与舒张功能分级、NYHA分级明显相关（P〈O．01）；N-末端脑钠肽前体诊断射血分数正常心力衰竭的AUC为0．702，最佳诊断界值127．58pg／mL，此时灵敏度为63．3％，特异度为83．3％。结论血浆N-末端脑钠肽前体对诊断左室射血分数正常的心力衰竭及评价心力衰竭严重程度有重要价值。

Diagnostic value of N-terminal-probrain natriuretic peptide to heart failure with normal ejection fraction

Objective To explore the level of plasma N-terminal probrain natriuretic peptide（NT-proBNP） in patients with heart failure and normal ejection fraction. Methods Thirty heart failure patients with normal ejection fraction（observation group） and 30 healthy subjects （control group） received echocardiography and were detected plasma NT-proBNP with electrochemiluminescence immunoassay. Results Plasma NT-proBNP level was significantly higher in observation group than that in control group（P〈0.01）. Plasma NT-proBNP level was negatively correlated with early diastolic mitral annular motion velocity（r=-0. 395, P〈0.01）, ratio of early diastolic mitral annular motion velocity to late diastolic velocity of the mitral annulus （r=-0. 292, P〈O. 05） and ratio of early diastolic peak mitral flow velocity to early diastolic mitral annular motion velocity （r--0. 529, P〈0.01）, and positively correlated with left atrial dimension （r=0. 300, P〈0.05） and left ventricular posterior wall（r=0. 262, P〈0.05）. Plasma NT-proBNP was correlated with the diastolic dysfunction degree and NYHA degree（P〈0.01）. AUC was 0. 702. The best cut-off value was 127. 58 pg/mL in diagnosing of heart failure with normal ejection fraction, with the sensitivity and specificity of 63. 3 % and 83.3 %, respectively. Conclusion Plasma NT-proBNP level can serve as a marker for the detection and evaluation of heart failure with normal ejection fraction.