氯沙坦对高血压左室肥厚血清脑钠肽的影响

目的探讨氯沙坦对高血压左室肥厚(LVH)患者血清脑钠肽(BNP)水平的影响及其意义。方法选取高血压LVH患者44例,随机分为治疗组和对照组各22例,治疗组服用氯沙坦20周,对照组不给氯沙坦,治疗前后血清BNP浓度以电化学发光法测定,左室重量指数(LVM I)用超声心动图测定。结果高血压LVH患者氯沙坦治疗后LVM I和血清BNP水平分别从(151.54±33.01)g/m3与(174.30±146.95)ng/L降为(134.36±22.71)g/m3与(110.31±83.06)ng/L(P均<0.05),两者治疗前后均呈显著正相关,r分别为0.8和0.75(P均<0.001),血清BNP水平下降的患者LVM I从(147.16±32.97)g/m3降为(131.15±23.48)g/m3(P<0.01)。结论氯沙坦能逆转高血压LVH及降低血清BNP水平,BNP可能可作为高血压治疗后LVH是否逆转的参考指标之一。     

比索洛尔、赖诺普利对原发性高血压患者左室肥厚及血浆脑钠肽的影响

目的探讨比索洛尔、赖诺普利对原发性高血压（EH）患者左室肥厚（LVH）、血浆脑钠肽（BNP）的影响。方法选择124例EH患者,根据有无LVH分为LVH组76例、无LVH组48例,LVH组口服比索洛尔、赖诺普利12个月;检测两组血浆BNP及LVH组治疗前后A/E比值、左室质量指数（LVMI）变化。结果 LVH组血浆BNP明显高于无LVH组（P〈0.05）;LVH组治疗12个月后,A/E比值、LVMI和血浆BNP均明显降低（P〈0.05或〈0.01）,且其血浆BNP水平与LVMI呈正相关（r=0.60,P〈0.01）。结论比索洛尔、赖诺普利可逆转EH患者的LVH,降低其血浆BNP水平。     

氯沙坦对高血压左室肥厚患者血浆脑钠肽的影响

目的：研究氯沙坦干预对高血压伴左室肥厚患者脑钠肽（BNP）的影响及意义。方法：选择100例左室射血分数正常范围的高血压患者,其中58例伴左室肥厚,42例不伴左室肥厚,另选50例健康者作为健康对照组,比较三组间血浆BNP水平。左室肥厚组给予氯沙坦治疗6个月,比较治疗前后BNP、左室质量指数（LVMI）的变化。结果：①高血压伴左室肥厚患者BNP浓度显著高于不伴左室肥厚组及健康对照组[（62．21±9．70）pg／ml比（39．35±10．57）pg／ml比（13．89±5．34）pg／ml,P〈0．01];②BNP的浓度与LVMI呈正相关（r=0．44,P〈0．05）;③与治疗前比较,氯沙坦治疗高血压伴左室肥厚6个月后,血浆BNP[（62．21±9．70）pg／ml比（38．78±7．94）pg／m1]、LVMI[（128．71±12．64）g／m。比（107．36±11．32）g／m。]均显著降低（P〈o．01）。结论：氯沙坦可明显降低高血压伴左室肥厚患者脑钠肽水平,逆转左室肥厚。     

Prevalence of left ventricular hypertrophy in a hypertensive population

AIMS: This investigation was set up to study the prevalence of leftventricular hypertrophy in a hypertensive population with referenceto a normotensive control group. From the general population3498 men and women aged 35, 45, 55 and 65 years old were invitedto a health examination. Participants with blood pressure above160 mmHg systolic or 95 mmHg diastolic or those taking antihypertensivemedication or having done so during the previous 6 months wereasked to undergo an echocardiographic examination. Normotensivecontrols were randomly selected from the same population. Of552 participants in the final study population, 194 were normotensivecontrols and 358 were in the hypertensive group. Echocardiographicmeasurements were made according to the Penn conventions andindexed for body surface. Cut-off values for left ventricularhypertrophy were 134 g. m^{– 2} for males and 102 g. m^–2 for women. RESULTS: Overall, the prevalence of left ventricular hypertrophy wasl4%/20% (men/women) in normotensives and 25%/26% in hypertensives(P<0·01). After subdivision by age and sex, therewas a significant difference in the prevalence of left ventricularhypertrophy between normotensives and hypertensives only inthe 65-year-old group (P<0·02 for males and P<0·05for females). CONCLUSION: The association between blood pressure and left ventricularhypertrophy in the general population is weak. Left ventricularhypertrophy is only significantly more frequent among hypertensivesas compared to normotensives in older people.     

伊贝沙坦对高血压左室肥厚患者的左室结构的影响

目的 研究伊贝沙坦对高血压左室肥厚（LVH）患者的左室结构的影响。方法 60例原发性高血压左室肥厚患者随机分为2组：治疗组每天口服伊贝沙坦150mg，对照组每天口服氨氯地平5mg。平均12个月，观察用药后血压、左室结构的变化。结果 用药后2组收缩压（SBP）和舒张压（DBP）均显著降低（P〈0．01）；室间隔厚度（IVST）及左室后壁厚度（LYPWT）均变薄（P〈0．01），左室重量指数（LYMI）明显减少（P〈0．01），对照组各项指标无明显变化（P〈0．05）。结论 对原发性高血压左室肥厚的患者，长期应用伊贝沙坦具有良好降压效果，同时还可逆转LVH，改善患者预后。     

Reversal of left ventricular hypertrophy with captopril: Heterogeneity of response among hypertensive patients

Reversal of left ventricular hypertrophy (LVH) has been reported not to occur with all antihypertensive agents. Moreover, a dissociation between blood pressure response to medical therapy and reversal of ventricular hypertrophy has been previously observed. To evaluate the effects of captopril we studied the electrocardiographic (ECG) changes in 26 severe hypertensive patients who received the drug for more than one year. In 14 patients with normal pretreatment ECG, captopril controlled blood pressure effectively [132±2.9 (SE) to 104±3.9 mmHg, p<0.001], but had no effect on ECG voltage. In 12 patients with pretreatment LVH, two different response patterns were observed despite similar blood pressure control (144±4.9 to 102±3.1 mmHg and 148±7.3 to 109±7.3 mmHg, p<0.001 for both): seven had complete normalization of ECG while five had residual LVH pattern. No significant difference was found between the latter two groups in regard to age, sex, weight, etiology of hypertension, pretreatment ECG voltage, blood pressure, plasma renin activity, duration of treatment and duration of maintained blood pressure control. The reversal of LVH pattern occurred early (between 12 to 16 months) with no overall correlation between lowering of blood pressure and ECG voltage changes. The heterogeneity of response observed in this study suggests that factors other than blood pressure control modify the reversal of cardiac hypertrophy by antihypertensive therapy.     

Development of a nomogram for screening the risk of left ventricular hypertrophy in Chinese hypertensive patients

Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality in hypertensives. Therefore, early identification of at‐risk patients is necessary. The objective of this study was to estimate the risk of LVH among Chinese hypertensives by designing a nomogram. 832 hypertensives were divided into two groups based on the presence of LVH. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were successively applied for optimal variable selection and nomogram construction. Discrimination power, calibration, and clinical usefulness were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Internal validation was performed using the bootstrap method. The nomogram included five predictors, namely gender, duration of hypertension, age, body mass index (BMI), and systolic blood pressure. The area under the ROC curve (AUC) was 0.724 (95% CI: 0.687‐0.761), indicating moderate discrimination. The calibration curve showed an excellent agreement between the predicted LVH and the actual LVH probability. The risk threshold between 5% and 72% according to the decision curve analysis, and the nomogram is clinically beneficial. Internal validation by bootstrapping with 1000 samples showed a good C‐index of 0.715, which suggested that the predictive abilities for the training set and testing set were in consistency. Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensives. This tool could be useful in identifying patients at high risk for LVH. Further studies are required to ascertain the stability and applicability of this nomogram.     

高血压病患者脑钠肽水平与心脏测量指标的相关性

目的探讨高血压病患者脑钠肽（brain natriuretic peptide,BNP）水平与心脏测量指标的相关性。方法选择57例明确诊断为高血压病的患者和30例年龄相仿的健康对照者。测定其室间隔厚度（left ventricular septum thickness,LVST）、左心室后壁厚度（posterior wall thickness,PWT）、左室质量指数（left ventricular mass index,LVMI）、左室舒张末内径（left ventricular end diastolic diameter,LVEDD）和BNP浓度,并进行对照比较。结果高血压病患者血浆中BNP浓度明显较健康对照组升高（P<0.01）,并随血压分级增加而升高;BNP与LVST、PWT、LVMI、LVEDD呈显著正相关（r=0.52,P<0.05;r=0.46,P<0.05;r=0.42,P<0.05;r=0.40,P<0.01）。伴左室肥厚的高血压病患者组的血浆BNP水平较不伴左室肥厚的高血压病患者组显著升高（P<0.05）。结论高血压病患者的血浆BNP浓度显著升高,BNP浓度与血压分级密切相关,并与左室肥厚相关。     

脑利钠肽和C反应蛋白及左心室舒张功能与老年血液透析患者心脑血管事件的相关性研究

目的 观察脑利钠肽(BNP)和C反应蛋白(CRP)水平及应用组织多普勒超声心动图测定患者静息状态心室舒张早期二尖瓣血流速度(E)与二尖瓣环运动速度(Em)的比值(E/Em)与老年血液透析患者的心脑血管事件(CVD)风险的相关性. 方法 2006年1月至2011年6月,对96例老年血液透析患者进行前瞻性队列研究,每月随访1次,随访时间24～30个月,根据是否发生CVD事件分为CVD组(35例)和对照组(61例).记录观察开始时患者临床和实验室资料及超声心动图结果,记录患者因CVD事件住院和死亡的原因和时间. 结果 CVD组CRP、BNP水平[分别为(3.1±6.7)mg/L、(1345.2±1427.8)pmol/L]较对照组[分别为(1.8±1.2)mg/L、(719.8±1073.8)pmol/L]升高,差异有统计学意义(t值分别为2.14、-2.82,P＜0.05和P＜0.01);E/Em升高(t=5.229,P＜0.01).Kaplan-Meier生存曲线结果显示,BNP≥500 pmol/L、CRP≥1.5 mg/L、E/Em≥17时,老年血液透析患者的CVD发生率升高(P＜0.05或P＜0.01).Cox回归模型提示,CRP≥1.5 mg/L,BNP≥500 pmol/L和E/Em≥17为老年血液透析患者CVD独立危险因素.Bivariate 相关分析结果显示,LogBNP水平与E/Em值呈线性相关(r=0.23,P＜0.05). 结论 BNP、CRP 、及E/Em升高与老年血液透析患者CVD发生率相关.     

Effects of ketanserin of left ventricular hypertrophy in hypertensive patients

Summary Ketanserin, a serotonergic S₂-receptor antagonist, was used in a prospective study in nine hypertensive patients with ECG criteria of left ventricular hypertrophy (LVH). Echocardiographic measurement with M mode was made after 1 month of placebo, and after 3, 6, and 12 months of ketanserin treatment as monotherapy at a mean dose of 31 mg bid. Ketanserin treatment decreased mean left ventricular mass by 9.3% at 3 months (not significant), by 15.3% at 6 months (p < 0.008), and by 26.2% at 12 months (p < 0.02), with a tendency towards improvement in left ventricular ejection fraction, which was not statistically significant. The study showed a sustained effect upon regression of LVH in hypertensives, with preservation of left ventricular function.     

Value of B-type natriuretic peptide in diagnosing left ventricular dysfunction in dialysis-dependent patients

Background: B‐type natriuretic peptide (BNP) is elevated in patients with end‐stage renal failure. The reported accuracy of BNP in diagnosing left ventricular dysfunction in these patients has been inconsistent. Aim: To investigate the diagnostic values of BNP for left ventricular dysfunction in patients undergoing haemodialysis for chronic renal failure. Methods: We measured plasma BNP before and at 10 min and 3, 6 and 24 h after haemodialysis in 56 patients. Results: The average plasma BNP before haemodialysis was 284 ± 369 pg/mL, which was higher than that of healthy subjects (37 ± 37 pg/mL; n = 32, P < 0.01). The average plasma BNP in patients with left ventricular dysfunction (n = 21) was substantially higher than that in those with normal ventricular function before and at 10 min and 3, 6 and 24 h after haemodialysis (P < 0.001). The area under the receiver operating characteristic curves was greater than 0.895 before and at the four time points after haemodialysis (P < 0.01). Using 152 pg/mL as a cut‐off value, predialysis BNP has 81% sensitivity and 83% specificity in diagnosing left ventricular dysfunction in these patients. Conclusion: We concluded that plasma BNP offers a good sensitivity and specificity in diagnosing left ventricular dysfunction in patients with dialysis‐dependent renal failure.     

高血压病左室肥厚及舒张功能不全患者血浆NT-proBNP的变化

目的：观察高血压病左室肥厚及舒张性心功能不全患者血浆N末端脑利钠肽前体（NT-proBNP）含量变化。方法：利用酶联免疫法,对经多普勒超声心动图检查证实的68例高血压病伴左室肥厚及舒张功能不全患者及66例高血压病无左室肥厚患者的血浆NT—proBNP浓度进行测定。结果：高血压病伴左室肥厚及舒张功能不全患者组的血浆NT—proBNP浓度明显高于高血压非左室肥厚组[（308．35±74．04）pg／ml：（211．50±73．58）pg／ml,P〈0．01]。NT—proBNP与左室质量指数（LVMI）呈正相关（r=0．863,P〈0．001）,与E／A呈负相关（r=-0．758,P〈0．001）。结论：高血压病伴左室肥厚及舒张功能不全患者的血浆NT—proBNP浓度明显升高,且与应用超声心动图技术评价的高血压伴左室肥厚及舒张功能不全有较好的相关性。     

B-type natriuretic peptide and left ventricular hypertrophy in hypertensive patients.

AIM: To assess the accuracy of B-type natriuretic peptide (BNP) plasma levels for the diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients. PARTICIPANTS AND METHODS: We studied a sample of 409 adults aged 45 years or older, recruited from residents of Porto by random digit dialing. Data were collected by clinical interview and physical examination, ECG, echocardiogram and venous blood sampling for the measurement of plasma concentrations of BNP. Hypertension (HT) was defined as blood pressure > or = 140/90 mmHg on the day of interview and/or self-reported HT if treated with any antihypertensive medication; LVH was defined as left ventricular mass index (LVMI) > or = 125 g/m2 in men and 110 g/m2 in women. The participants were further classified in four strata according to left ventricular morphology--normal, concentric remodeling, eccentric LVH or concentric LVH. RESULTS: Two hundred and thirty-two (56.7%) individuals were hypertensive, and among these 73 (31.5%) had LVH. BNP levels were significantly higher in these individuals (median [P25-P75] = 55.8 pg/ml [22.6-88.4]) than in hypertensive patients without LVH (29.9 pg/ml [10.0-62.8]), p = 0.003. BNP levels also differed significantly across strata of left ventricular geometry, the main difference depending on the presence or absence of LVH. There was a positive correlation between plasma BNP levels and LVMI (Spearman's P 0.185, p = 0.005). The area under the ROC curve--a parameter for diagnostic accuracy quantification--was 0.62 (95% confidence interval 0.54-0.70), indicating low discriminatory power between normal and abnormal LVMI. CONCLUSION: In the assessed population, BNP levels were higher in hypertensive patients with LVH than in the absence of LVH. However, BNP did not perform well in discriminating between the presence or absence of LVH.     

高血压左室肥厚患者组织纤维化的血清指标观察

目的本研究旨在通过观察高血压病患者组织纤维化血清学指标的变化，以探讨其作为心肌肥厚指标的临床价值。方法测定高血压伴左室肥厚３６例，高血压不伴左室肥厚３１例及正常对照３０例血清中Ⅲ型前胶原（ＰＣⅢ）、层粘连蛋白（ＬＮ）、透明质酸（ＨＡ）的含量。并将左室心肌重量指数（ＬＶＭＩ）与上述各参数作相关分析。结果高血压伴左室肥厚组较高血压不伴左室肥厚组及正常对照组的血清ＰＣⅢ、ＬＮ、ＨＡ含量显著增高（Ｐ＜０．０１）；血清ＰＣⅢ、ＬＮ、ＨＡ均与ＬＶＭＩ呈显著正相关。结论血清ＰＣⅢ、ＬＮ、ＨＡ均可作为高血压左室肥厚患者组织纤维化的血清学指标，为临床诊断高血压心肌肥厚提供间接的依据。     

高血压左心室肥厚患者B型钠尿肽与早期舒张功能不全的关系

目的研究B型钠尿肽(BNP)与高血压左心室肥厚(LVH)以及LVH时无症状的左心室舒张性心功能不全(LVDD)的关系,探讨高血压LVH伴LVDD时的诊断方法。方法 113例高血压患者采用彩色多普勒超声心动图检测舒张末左心室室间隔厚度(IVSD)、左心室后壁厚度(PWT)、二尖瓣舒张早期最大峰值速度(E)、舒张晚期最大峰值速度(A)、E/A、左心室等容舒张时间(IVRT)等,计算左心室重量(LVM)、左心室重量指数(LVMI);采用酶联免疫法检测BNP,BNP与高血压LVH及LVDD的关系采用相关性分析。结果所有患者BNP与收缩压呈正相关(r=0.190,P<0.05),与IVSD、PWT、LVM、LVMI呈正相关(r=0.399、0.394、0.678、0.795、P<0.01);与E、E/A呈负相关(r=-0.885、-0.869,P<0.01);与A、IVRT呈正相关(r=0.735、0.817,P<0.01)。BNP在82.79ng/L时,诊断LVDD的敏感性为90%,特异性为100%,准确性为92%。结论高血压LVH时,BNP明显升高,而当高血压LVH伴LVDD时,BNP升高更明显,BNP是反映LVH及LVH伴早期LVDD的敏感指标。     

Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunction on plasma N terminal proBNP

OBJECTIVES: To examine the relation between plasma concentration of the N terminal of the precursor of brain natriuretic peptide (NT proBNP), left ventricular hypertrophy (LVH), and left ventricular systolic dysfunction (LVSD) in patients with a history of hypertension. DESIGN: Prospective study. SETTING: Teaching hospital based study. PATIENTS: NT proBNP concentrations were determined in five groups of individuals. Group 1: 15 echocardiographic normal controls; group 2: 22 patients with hypertension, normal left ventricular systolic function, and no LVH; group 3: 24 patients with hypertension, normal left ventricular systolic function, and LVH; group 4: 13 patients with history of hypertension, no history of ischaemic heart disease, and left ventricular wall motion index (WMI) between 1.9-1.3; and group 5:17 patients with a history of hypertension, no history of ischaemic heart disease, and WMI < 1.2. RESULTS: Median (range) NT proBNP concentrations (in fmol/ml) for groups 1-5, respectively, were: 129.4 (53.6-159.7), 147.4 (54.3-730. 5), 137.1 (35.8-403.9), 356.7 (124.4-934.4), and 493.5 (248.9-909). Mean log NT proBNP differed among all five groups (p < 0.0001), and between groups 4 and 5 versus groups 1-3 (p < 0.0001), and group 4 versus group 5 (p = 0.02) only. CONCLUSIONS: The results suggest that the presence of hypertension with or without LVH (and normal left ventricular systolic function) does not affect NT proBNP concentrations. Moreover, there is a significant rise in NT proBNP only when LVSD develops in hypertension. Thus, NT proBNP remains a useful diagnostic aid for LVSD, even in hypertensive patients.     

高血压与左心室肥厚

左心室肥厚 ( LVH)是心血管疾病的重要危险因素 ,高血压是 LVH最常见的原因。本文就高血压患者 LVH的诊断方法、致病因素、病理生理、不良后果及药物治疗等问题作介绍     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

高血压病左室肥大Q-T离散度异常与室性心律失常的关系

观察180例高血压病患者的Q-T离散度(Q-Td),左室肥大组及左室正常组Q-Td分别为67.31±13.57和38.8±8.55ms(P<0.001),左室肥大组室性心律失常检出率为92.5%,其中复杂性者为64.2%,室速为23.9%,该组中Q-Td>60ms 3项检出率均高于<60ms及左室正常组中Q-Td>60ms者,复杂性室性心律失常及室速有显著性差异(P<0.001).提示高血压左室肥大Q-Td增加与室性心律失常尤其是复杂性室性心律失常及室速有一定关系,结合左室重量指数(LVMI)和Q-Td可作为评估高血压病患者预后的参考指标.