N末端脑钠肽检测在心力衰竭诊断中的临床应用

目的 探讨血浆N末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度与心力衰竭严重程度的相关性.方法 选择2010年1月至2010年12月在深圳市宝安区观澜人民医院住院的心功能不全患者163例为研究对象.其中6例住院期间死亡(死因为顽固性心力衰竭),10...     

射血分数正常的心力衰竭患者全血N-末端脑钠肽前体浓度变化

目的评估射血分数正常的心力衰竭（心衰）患者全血N-末端脑钠肽前体（N—terminalpro—brainnatriureticpeptide,NT—pro—BNP）浓度的变化。方法入选78例心脏病患者分为3组：心功能正常组22例,射血分数正常心衰（heartfailurewithpreservedejectionfrction,HFPEF）组33例,射血分数减低心衰（heartfailurewithreducedejectionfraction．HFREF）组23例。测定患者的全血NT—pro．BNP浓度并进行超声心动图检查。结果HFPEF组患者全血NT．proBNP浓度高于心功能正常组[（1424±996）pg／mL vS．（167±117）pg／mL,P〈0．01],低于HFREF组[（1424±996）mg／Lvs（5910±2828）mg／L,P〈0．01],差异有统计学意义。心衰患者全血NT—proBNP浓度与射血分数呈负相关（r=-0．72,P〈0．01）,与左心房内径（r=0．34,P〈0．05）、左心室舒张末内径（r=O．61,P〈0．05）及左心室收缩末内径（r=0．62,P〈0．05）、E／A比值（r=0．40,P〈0．05）呈正相关。结论HFPEF患者全血NT—pro—BNP浓度升高．但升高幅度不如HFREF患者明显。     

血清胱抑素C与N端脑钠肽前体在老年心力衰竭患者中的表达及意义

目的探讨血清胱抑素C(Cys C)与N端脑钠肽前体(NT-pro BNP)在射血分数保留的心力衰竭(HFpEF)与射血分数下降的心力衰竭(HFrEF)中的表达及其之间的关系,并分析其临床意义。方法收集2015年1月至2016年6月在合肥市第一人民集团医院滨湖医院干部病房及心血管内科住院的≥60岁老年心力衰竭患者75例,其中HFpEF患者55例,HFrEF患者20例。依据NYHA心功能分级标准评价其心功能,分为Ⅱ、Ⅲ、Ⅳ级,另外选择年龄≥60岁无心血管疾病史患者50例为对照组,对比分析各组患者的临床资料,并对血清Cys C、NT-Pro BNP、左室射血分数(LVEF)等指标进行相关性分析。采用受试者工作特征(ROC)曲线评价Cys C和NT-Pro BNP在两种类型老年心力衰竭患者中的诊断价值。结果 HFpEF组年龄明显大于HFrEF组和对照组,差异有统计学意义(P0.05),3组间NT-pro BNP和Cys C浓度差异显著(P0.05)。HFpEF组血清Cys C均与NT-pro BNP、肌酐、尿素氮、尿酸水平呈正相关(P0.05),校正了干扰因素后,血清Cys C与NT-pro BNP依然相关(r=0.460,P=0.001)。HFpEF组和HFrEF组NT-pro BNP水平均与LVEF呈负相关,且具有统计学意义(r值分别为-0.277、-0.512,P值分别为0.041、0.021)。ROC曲线分析结果表明,HFpEF组和HFrEF组当NT-pro BNP的诊断界值分别为355和1835 ng/L时,Youden指数最大,敏感度分别为98.2%和95.0%,特异度分别为60.0%和78.1%;HFrEF组当血清Cys C的诊断界值为1.765 mg/L时,ROC曲线下面积达到最大,敏感度和特异度分别为85.0%和75.2%。结论两种类型心力衰竭患者Cys C与NT-pro BNP表达水平不同,NT-pro BNP是心力衰竭诊断的敏感指标,而Cys C对HFrEF患者诊断的参考意义比HFpEF患者大。     

N端脑钠素前体与脑钠素对无症状性心力衰竭的诊断价值

目的探讨N端脑钠素前体（NT-proBNP）与脑钠素（BNP）对无症状性心力衰竭（SHF）的诊断价值。方法通过放射性核素门控心血池显像筛选SHF患者34例。无心力衰竭（HF）症状和体征;HF患者34例,心功能NYHA分级Ⅱ～Ⅲ级;正常健康人30例作为对照组。采用电化学发光双抗体夹心法测定三组血浆NT-proBNP、BNP。结果HF组及SHF组血浆BNP、NT-proBNP显著高于对照组（P〈0．05）,HF组显著高于SHF（P〈0．05）。结论SHF患者血浆BNP和NT-proBNP水平明显高于对照组可判断SHF存在,NT-proBNP升高可能是诊断SHF更好的指标。随HF加重．BNP和NT-proBNP明显增高．此可判断HF的严重程度。     

双水平气道正压通气对慢性充血性心力衰竭患者氨基末端脑钠肽前体的影响

目的 探讨双水平气道正压通气对老年慢性充血性心力衰竭病人血浆氨基末端脑钠肽前体(NT-proBNP)水平的影响. 方法 将120例患者随机分为2组,对照组给予常规抗心衰治疗,治疗组加用双水平气道正压通气(BiPAP)治疗,2组病例均在治疗前、治疗后12 h、24 h、72 h、7 d、14 d测定血浆NT-proBNP水平,以及评价心衰治疗的效果. 结果 BiPAP组在治疗后24 h起NT-proBNP水平与常规治疗组即有明显差异,治疗组各项指标改善程度优于对照组,2组差异有统计学意义(P＜0.01). 结论 使用BiPAP可以显著降低老年慢性充血性心衰患者血浆NT-proBNP水平,是治疗心衰的一种安全、可靠的手段.     

合并心力衰竭对慢性阻塞性肺疾病患者血浆氨基酸末端脑钠素前体水平的影响

目的:观察慢性阻塞性肺疾病急性发作(AECOPD)期患者,是否合并心脏疾患引起心力衰竭(心衰),及与单纯心脏疾患引起心衰的血浆N-末端脑钠素前体(NT-proBNP)水平变化的规律及临床意义。方法:利用酶联免疫定量分析(ELISA)法测定血浆中NT-proBNP的浓度,其中AECOPD患者39例(合并心脏疾患引起心衰患者12例);单纯心脏疾患引起心衰15例,同时进行动脉血气分析及超声心动图检查。结果:12例合并心衰的AECOPD患者血浆NT-proBNP值明显高于27例未合并者(P<0.001);血浆NT-proBNP值与左心室舒张末期、收缩末期内径及射血分数存在显著相关性(r=0.471,0.502,-0.522;P=0.003,0.002,0.001);血浆NT-proBNP水平诊断左心收缩功能不全的受试者工作特征(ROC)曲线下面积为0.828。结论:测定血浆NT-proBNP水平可能成为临床诊断AECOPD合并心功能不全有意的参考指标。     

血钠尿肽前体N末端在心力衰竭时的变化

目的:观察慢性心力衰竭患者血B型钠尿肽前体N末端(NT-proBNP)的变化。方法:应用电化学发光法检测89例收缩性心力衰竭(收缩性心力衰竭组)和17例单纯舒张功能不全性心力衰竭患者(DHF组)以及22例心功能正常的对照组的血NT-proBNP水平。结果:收缩性心力衰竭组不同心功能级别患者的NT-proB-NP均显著高于对照组,且自Ⅰ~Ⅳ级心功能的NT-proBNP逐级升高,分别为(388·9±304·7)、(772·7±648·4)、(1946·4±1914·4)和(3743·4±2592·5)ng/L,DHF组为(578·1±848·3)ng/L,对照组为(69·5±51·2)ng/L。结论:血NT-proBNP的检测有助于对慢性心力衰竭的诊断。     

体重管理干预对慢性心力衰竭患者血清氨基末端脑钠肽前体水平、焦虑情绪和生活质量的影响

目的 探究体重管理干预模式对慢性心力衰竭(CHF)患者血清氨基末端脑钠肽前体(NT-proBNP)水平、焦虑情绪和生活质量的影响. 方法 选取2017年3月至2018年3月成都市第五人民医院收治的CHF患者92例,随机分成观察组和对照组,每组46例,两组患者均接受常规治疗,观察组在常规治疗基础上采用体重管理干预模式.比...     

The effect of beta-blocker (carvedilol) therapy on N-terminal pro-brain natriuretic peptide levels and echocardiographic findings in patients with congestive heart failure

BACKGROUND: The favorable effects of beta-blockers on decreasing mortality in contemporary heart failure management have been demonstrated in recent years. N-terminal pro-brain natriuretic (NT-proBNP) peptide levels increase in patients with heart failure. The purpose of this study was to investigate the correlation between the NT-proBNP levels and echocardiographic findings for the patients who received carvedilol therapy in addition to standard therapy for congestive heart failure. METHODS AND RESULTS: A total of 25 patients with symptomatic congestive heart failure and 25 healthy individuals were enrolled in the study. Before introducing beta-blocker into their therapy regimens, baseline transthoracic echocardiography recordings were made and venous blood samples were drawn for establishing NT-proBNP levels. The patients were administered with a minimum dose of carvedilol. Three months after reaching the maximum tolerable dose, blood samples were drawn from the patients once again for NT-proBNP measurements, and transthoracic echocardiography was performed. There was a significant drop in plasma NT-proBNP levels at the end of the study in comparison to the baseline values (baseline: 381.20+/-35.06 pg/mL, at the end of the third month: 254.44+/-28.64 pg/mL; P < 0.001). While left ventricular end-diastolic and end-systolic diameters were observed to have significantly decreased as a result of the therapy (P < 0.001), left ventricular ejection fraction (P<0.001) was established to have increased significantly. CONCLUSIONS: Carvedilol therapy resulted in a marked decrease in plasma NT-proBNP levels and increase left ventricular ejection fraction in patients with congestive heart failure.     

慢性心力衰竭患者N端脑钠肽前体、内皮素与心功能的关系

目的探讨慢性心力衰竭(心衰,CHF)患者N端脑钠肽前体(NT-proBNP)、内皮素(ET)水平与心功能的关系。方法入选56例CHF患者作为研究对象,29例心功能正常者作为对照组。心衰患者按照NYHA分级分为心功能Ⅱ级、Ⅲ级、Ⅳ级3个亚组,分别测定患者NT-proBNP、ET水平,同时用心脏彩色多普勒超声心动仪测定左室射血分数(LVEF)和左室舒张末期内径(LVDD)并进行组间比较及相关性分析。结果对照组及CHF心功能Ⅱ级、Ⅲ级、Ⅳ级亚组的患者NT-proBNP水平分别为(336.24±41.25)ng/ml、(1761.35±21.43)ng/ml、(2693.45±41.54)ng/ml、(3161.26±67.56)ng/ml,ET水平分别为(19.89±11.35)ng/L、(48.60±21.25)ng/L、(61.56±31.68)ng/L、(161.67±46.56)ng/L。对照组患者及CHF心功能Ⅱ级组、Ⅲ级组、Ⅳ级组患者血浆NT-proBNP、ET水平呈逐渐增高趋势,差异具有显著统计学意义(P0.01)。除心功能Ⅱ级组与心功能Ⅲ级组间ET与LVEF水平比较无统计学差异(P0.051),其余各组间NT-proBNP、ET水平及LVEF、LVDD水平比较,均有显著统计学差异(P均0.01)。NT-proBNP与心功能分级呈正相关(r=0.769,P0.05),与LVDD呈正相关(r=0.606,P0.05),与LVEF呈负相关(r=-0.656,P0.05)。ET水平与心功能分级呈正相关(r=0.357,P0.05),与LVDD呈正相关(r=0.265,P0.05),与LVEF呈负相关(r=-0.274,P0.05)。结论 CHF患者NT-proBNP与ET水平随心力衰竭程度的加重而相应升高,与心功能分级有良好的相关性,对心力衰竭患者心力衰竭严重程度及预后的评价有意义。     

Relation between N-terminal pro-brain natriuretic peptide values and invasively measured left ventricular hemodynamic indices

BACKGROUND:

Pro-brain natriuretic peptide (proBNP) is synthesized in the left ventricle. In response to transmural pressure, it is secreted into the circulation and consequently cleaved to yield the active hormone BNP and its N-terminal fragment (NT-proBNP). Determination of NT-proBNP is used as an aid in the diagnosis of left ventricular dysfunction.

METHODS:

We analyzed NT-proBNP-levels before left-heart catheterization in 115 patients. At the end of the study, we compared the NT-proBNP values to the invasively measured hemodynamic indices (left ventricular ejection fraction, maximum change in pressure over time [dP/dt_max] and left ventricular end-diastolic pressure) and the clinically observed New York Heart Association (NYHA) classifications.

RESULTS:

A significant (P=0.008) increase of the NT-proBNP values was observed in cases of low ejection fraction (less than 41%). Furthermore, a significant (P=0.03) increase of the NT-proBNP values was measured in cases of heavily reduced dP/dt_max (less than 1500 mmHg/s). The increase of NT-proBNP values in cases of high end-diastolic pressures was distinct but not significant. In the clinical observation (NYHA classification), a significant increase of NT-proBNP levels corresponded to increasing severity of heart failure. However, a large standard deviation was seen in all groups.

CONCLUSION:

Concerning low ejection fractions, a high end-diastolic pressure and strong reduced dP/dt_max in all cases an increase of pro-BNP-values was seen. However, the partly reported strong correlation of the BNP value to the left ventricular ejection fraction, dP/dt_max and left ventricular end-diastolic pressure results was not found in the cases of middle and moderate heart failure, in contrast to the clinical observation. Regarding the large standard deviation, it may be possible to discriminate an unfavourable course of heart failure in an early stage.     

机械通气辅助治疗的呼吸衰竭患者N末端脑钠肽前体的变化及临床意义

目的 探讨机械通气辅助治疗的呼吸衰竭患者N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide, NT-proBNP）浓度变化特点,评估血清NT-proBNP浓度检测的临床意义.方法 回顾性分析201 1年至2012年因呼吸衰竭而于韶关粤北人民医院重症监护病房（intensive care unit,ICU）住院治疗的患者共43例,采用电化学发光免疫分析法监测患者血清NT-proBNP浓度,同时检测并记录体温峰值、红细胞沉降率、白细胞计数、中性粒细胞比值、C反应蛋白、降钙素原、心功酶、心肌肌钙蛋白T、左心室射血分数、中心静脉压、住院时间等指标.入选患者根据NT-proBNP分为明显升高组（NT-proBNP＞9 000 pg/mL）21例,普通升高组（1 000 pg/mL ＜NT-proBNP＜9 000 pg/mL）22例.探讨血清NT-proBNP浓度对于评估患者炎症状态,心脏功能及住院时间的临床价值.结果 血清NT-proBNP浓度明显升高组（A组）与NT-proBNP普通升高组（B组）相比较,体温峰值、红细胞沉降率、白细胞计数、中性粒细胞比值、C反应蛋白、降钙素原、ICU住院时间和中心静脉压均显著升高,差异有统计学意义（P＜0.05）.血清NT-proBNP浓度与体温峰值（r=0.663,P＜0.001）、红细胞沉降率（r=0.583,P＜0.001）、C反应蛋白（r=0.637,P＜0.001）、白细胞计数（r=0.659,P＜0.001）、中性粒细胞比值（r=0.748,P＜0.001）、降钙素原（r=0.638,P＜0.001）、住院时间（r=0.658,P＜0.001）、中心静脉压（r=0.595,P＜0.001）、心肌肌钙蛋白T（r=0.350,P=0.019）呈正相关.两组间血气分析结果比较,差异无统计学意义（P＞0.05）.结论 血清NT-proBNP浓度与机械通气辅助治疗的呼吸衰竭患者的感染严重程度以及心脏功能相关,可作为病情监测的有效标志物.     

NT-proBNP、Hcy诊断急性冠脉综合征的临床研究

目的探讨NT—proBNP、Hcy诊断急性冠脉综合征（ACS）的临床意义。方法对70例AMI患者、50例UAP患者、50例SAP患者和50例健康体检者的血浆NT—proBNP、Hey水平进行比较分析。ACS患者均行冠状动脉造影术,并对其病变程度进行评估。结果AMI组和UAP组患者血浆NT—proBNP水平显著高于SAP组及对照组（P〈0．05）,而SAP组与对照组比较差异无统计学意义（P〉0．05）;ACS组、SAP组血浆Hcy水平均高于对照组,各组间比较差异有统计学意义（P〈O．05）。随着冠脉病变支数增加,ACS患者血浆NT—proBNP、Hcy水平逐渐升高（P〈0．05）。ACS患者中,心血管事件组血浆NT—proBNP、Hcy水平明显高于无心血管事件组（p〈0．05）。结论急性冠脉综合征患者的血浆NT—proBNP、Hcy水平均与冠状动脉粥样化病变程度密切相关,是ACS心血管不良事件的预测因子。     

血浆N末端B型利钠肽原水平评估肝硬化患者心功能改变及其与肝功能的关系

目的 心脏彩色多普勒超声监测肝硬化患者心脏结构和功能改变,检测肝硬化患者血浆N末端B型利钠肽原(NT-proBNP)水平,探讨NT-proBNP水平在评估心脏结构和功能改变及其与肝功能的关系. 方法 检测40例肝硬化患者及25例健康对照者的血浆NT-proBNP水平.肝硬化患者肝功能Child-Pugh分级,A级10例(A组),B级15例(B组),C级15例(C组),患者用心脏超声评估其心脏结构和功能改变.肝硬化组与对照组间比较用t检验,组间比较用单因素方差分析,相关性分析用Spearman相关检验.结果 肝硬化组NT-proBNP水平为(240.15±80.87)pg/ml,较对照组的(55.86±20.13)pg/ml明显增高,P＜0.05,差异有统计学意义;肝硬化患者不同肝功能分级组间NT-proBNP水平比较:A组和B组分别为(189.20±20.25) pg/ml、(202.34±31.20) pg/ml,与C组的(300.13±34.96) pg/ml比较明显降低,P＜0.05,差异有统计学意义;A组与B组比较差异无统计学意义(P＞ 0.05).肝硬化患者不同肝功能分级A、B、C组间,左室直径、右室直径、室间隔厚度、左室后壁厚度、主动脉瓣环直径、左室射血分数、E峰、A峰、E/A比较,差异无统计学意义(P＞0.05);不同肝功能分级各组间LAs比较:A组和B组分别为(29.83±3.76) mm、(31.78±4.05) mm,均低于C组的(35.08±3.68) mm,P＜0.05,差异有统计学意义;A组与B组比较差异无统计学意义(P＞ 0.05).相关性分析发现NT-proBNP与LAs呈正相关(r=0.535,P＜0.05),与LVPW亦呈正相关(r=0.312,P＜0.05),而与LVd、IVS、EF和E/A无相关性. 结论 肝硬化患者血浆NT-proBNP水平增高,可反映肝硬化患者潜在的心功能不全,且可反映患者的肝功能状况.     

Plasma N-terminal pro-brain natriuretic peptide levels in elderly patients with isolated diastolic dysfunction

Objective To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16 elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p>0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NT-BNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460.1±92.7pg/mL, p<0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities. The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.     

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte (N/L) ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide (NT-proBNP) in elderly patients with chronic heart failure (CHF). We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation (AF). Cox regression analysis was used to assess the multivariable relationship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events (MCE). Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio (OR): 1.079, 95% confidence interval (CI): 1.027–1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio (HR): 1.407, 95% CI: 1.098–1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE (HR: 1.461, 95% CI: 1.104–1.934, P = 0.008). Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.     

不稳定型心绞痛患者冠脉介入术前后N末端脑钠肽前体水平的变化

目的 观察冠脉介入前、后不稳定型心绞痛（UAP）患者N末端脑钠肽前体（NT-proBNP）水平变化,探讨心肌缺血与NT-proBNP的关系.方法 选择心功能正常的UAP患者75例,胸痛症状无发作3 d以上时行冠状动脉造影检查,病变适宜者接受经皮冠状动脉介入治疗.术前及术后16～24 h进行超声心动图检查和血浆NT-proBNP浓度测定,术后72 h复查血浆NT-proBNP水平.结果 单纯冠脉造影（CAG组）37例,经皮冠状动脉介入治疗（PCI组）38例,其中单支病变28例,包括左冠状动脉前降支置入支架（LAD组）18例、右冠状动脉或回旋支置入支架（非LAD组）10例.CAG组术前和术后16～24 h的NT-proBNP水平及左室射血分数（LVEF）无明显变化（P＞0.05）;PCI组术后16～24 h的血浆NT-proBNP浓度高于术前（P＜0.05）,LVEF较术前降低,但差异无统计学意义（P＞0.05）;LAD组的NT-proBNP升高幅度大于非LAD组（P＜0.05）,两组术后72 h的NT-proBNP水平均低于术前（P＜0.05）.结论 在心功能正常且无明显改变的情况下,UAP患者介入治疗后血浆NT-proBNP浓度暂时升高,可能与术中球囊扩张所致的一过性心肌缺血有关.心肌缺血是刺激NT-proBNP分泌增多的重要因素.     

房室同步性对血浆氨基末端脑钠素前体水平的影响

目的探讨缓慢心律失常和房室同步性对血浆氨基末端脑钠素前体(NT-proBNP)水平的影响。方法将120例无明确结构性心脏疾病患者按缓慢心律失常情况分为三组:A组为病窦综合征组(n=52),B组为Ⅱ度房室传导阻滞(AVB)组(n=29),C组为Ⅲ度AVB组(n=39)。另选42例无明确结构性心脏疾病、无心律失常者为D组。测定各组术前及术后第2天血浆NT-proBNP水平,分析血浆NT-proBNP水平及其与房室同步性、年龄、性别、体重指数、QRS波时限、左房内径(LAD)、左室射血分数(LVEF)、高血压和糖尿病的关系。结果在校正年龄后,A、B、C和D组血浆lg(NT-proBNP)水平分别为2.175±0.391,2.574±0.476,2.903±0.635和1.869±0.333 ng/L。血浆NT-proBNP水平:A、D组0.10)。在置入心脏起搏器后,房室同步性改善患者的NT-proBNP水平术后较术前降低(2.37±0.43 ng/L vs 2.73±0.53 ng/L,P<0.01),房室同步性不变的患者术后与术前无差异(P>0.05),而房室同步性恶化的患者较术前升高(2.61±0.57 ng/L vs 2.38±0.61 ng/L,P<0.05)。多元回归显示,房室同步性的改变情况是血浆NT-proBNP水平变化值的独立影响因素(P<0.001)。结论缓慢心律失常患者随房室失同步加重,血浆NT-proBNP水平依次升高,房室失同步可导致NT-proBNP升高。     

急性心力衰竭患者血清半乳凝素-3的变化及临床意义

目的 :通过检测急性心力衰竭(心衰)患者血清半乳凝素-3(galectin-3,Gal-3)的变化,探讨Gal-3在心衰发病中的作用。方法:选择急性心衰患者120例,其中纽约心脏病协会(NYHA)心功能Ⅱ级30例,Ⅲ级50例,Ⅳ级40例。于治疗前、后检测Gal-3和氨基末端脑钠肽前体(NT-proBNP),超声心动图测左心房内径(LAD)、左心室舒张末期内径(LVEDD)和左心室射血分数(LVEF)。并以健康体检者40名为对照组。结果:NYHAⅡ~Ⅳ级组血Gal-3、NTproBNP水平高于对照组(P<0.05);各亚组之间Gal-3、NT-proBNP水平均有差异(均P40%组(P70 mm组Gal-3水平高于LVEDD<0.05);NT-proBNP在治疗前、后均无差异。治疗前Gal-3、NT-proBNP水平分别与NYHA分级、LAD、LVEDD呈正相关、与LVEF呈负相关(r分别为0.64、0.48、0.67、-0.67,P<0.05或P<0.05)。发生心脏不良事件者Gal-3、NT-proBNP水平更高。结论:急性心衰患者血Gal-3水平与心衰严重程度相关,与左心室的结构和功能相关,提示Gal-3可能参与急性心衰的发病过程。Gal-3和NT-proBNP水平同时异常升高者近期预后差。     

原发性高血压患者N端脑钠肽前体测定及其意义

目的研究原发性高血压患者N端脑钠肽前体(N-terminalpro-brainnatriureticpeptide,NT-proBNP)水平及其与左心室扩大和心功能的关系。方法测定原发性高血压患者64例血清NT-proBNP浓度,用心脏彩色多普勒检查测定其左心室舒张末径、左心室射血分数及二尖瓣血流E峰速度与A峰速度的比值(E/A)。结果血浆NT-proBNP浓度在左心室扩大组为(0.33±0.23)μg/L,显著高于左心室正常组(0.12±0.07)μg/L,差异有统计学意义(P<0.01);在重度高血压组为(0.25±0.19)μg/L,较轻中度高血压组(0.14±0.14)μg/L增高,差异有统计学意义(P<0.05);伴有舒张功能不全的高血压患者其血清NT-proBNP浓度和舒张功能正常者相比也有升高的趋势,但差异无统计学意义。血清NT-proBNP浓度与年龄(r=0.40,P<0.01)和左心室舒张末径(r=0.55,P<0.01)呈正相关,与射血分数呈负相关(r=-0.37,P<0.01)。结论NT-proBNP可以作为高血压患者左心室扩大及收缩功能下降的指标,其与舒张功能的关系值得进一步的研究。