脑钠肽及Tei指数联合评价高血压性心脏病患者心功能的临床研究

目的探讨脑钠肽（BNP）及Tel指数评价高血压性心脏病患者心功能的临床意义。方法89例高血压性心脏病患者，按照其入院时NYHA心功能分级分为心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组。21例选自本院体检中心的心功能正常者作为对照组。行超声心动图检查测出rrei指数、左室射血分数（LVEF）、左室重量指数（LVMI），并检测血BNP。结果随着心功能分级程度的加重rrei指数与血BNP水平逐渐增加，Tei指数均值在心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为0．40±0．12、0．49±0．09、0．58±0．18和0．69±0．07；BNP均值在心功能I级、Ⅱ级、Ⅲ级、Ⅳ级分别为42．19±17．51、297．45±21．92、703．12±15．76和912．75±37．16（pg／m1），组间比较P〈0．05，差异有统计学意义。除BNP指标在心功能Ⅰ级组与对照组比较差异无统计学意义（P〉0．05）外，余指标均明显高于对照组[Tei指数对照组0．31±0．08，BNP对照组（33．12±3．15）pg／ml]（P〈0．05），差异有统计学意义。随心功能障碍程度的加重，血BNP水平升高，并且和Tei指数、LVMI呈正相关（r分别为0．563，0．368，P〈0．05）；与左室射血分数（LVEF）呈负相关（r=-0．372，P〈0．05）。结论在高血压性心脏病患者中，血BNP水平与Tei指数、心功能以及左室构型之间有较好的相关性，血BNP水平与Tei指数能综合反映心脏的功能。     

先天性心脏病介入治疗前后脑利钠肽前体水平的比较

目的了解小儿心脏病患者血浆氨基末端脑利钠肽(brainnatriureticpeptide,BNP)前体(N-pro-BNP)水平与心功能的关系及其在介入治疗前后的变化。方法收集自2004年7月至2005年1月间左向右分流先天性心脏病患儿共58例,所有患儿在介入治疗前后均进行心功能分级的临床评价,通过二维超声心动图测定射血分数(EF)、缩短分数(FS)、左心室舒张末期内径(LVDd)及N-pro-BNP水平,比较介入前后的改变。结果58例均成功接受介入治疗。介入治疗前后LVDd,EF,FS和血浆N-pro-BNP水平分别为36·7±5·2mm比35·4±4·2mm,78·1%±5·3%比75·3%±6·5%(P<0·05),41·1%±5·4%比38·3%±4·9%(P<0·05),194·7±154·7ng/L比561·0±594·2ng/L(P<0·05)。室间隔缺损(VSD)组术前N-pro-BNP水平(68·7±60·8ng/L)明显低于动脉导管未闭(PDA) 房间隔缺损(ASD)组(277·5±279·5ng/L),VSD组术后N-pro-BNP水平(436·8±793·6ng/L)较术前(68·7±60·8ng/L)明显升高(P<0·05),PDA ASD组手术前后差异无统计学意义。结论介入治疗后48h内EF和FS有所下降,血浆N-pro-BNP水平则明显升高。VSD组内术后N-pro-BNP水平较术前明显升高,推测可能是操作过程中对左心室反复的机械刺激所致。     

Tei指数联合B-型脑钠肽评价高血压患者左室重构和心功能

目的探讨Tei指数联合B-型脑钠肽(BNP)在高血压患者左心室重构及心功能不全诊断中的价值。方法 122例高血压伴左室肥厚(LVH)患者,按纽约心脏病(NYHA)心功能分级标准分为心功能Ⅰ级、Ⅱ级、Ⅲ级及Ⅳ级组。另选体检正常者30人作为对照组。分别检测BNP、超声心动图Tei指数、左室射血分数(LVEF)、计算左室重量指数(LVMI)。结果 Tei指数:正常对照组为0.33±0.06,LVH、NYHA心功能Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级组的Tei指数平均值分别为0.39±0.05、0.50±0.08、0.59±0.16和0.68±0.09,与正常对照组比较差异显著(P<0.05);BNP水平:正常对照组(BNP 46.69±6.06),LVH、NYHA心功能Ⅰ级组(BNP=88.09±6.89),组间比较有统计学意义(P<0.05),其余各组均明显高于对照组(P<0.01)。随着NYHA心功能分级程度加重,BNP水平逐级升高,NYHA心功能Ⅱ级、Ⅲ级、Ⅳ级组的BNP均值分别为288.55±22.02、668.08±16.18和1 068±38.01(pg/ml);各组间比较差异有统计学意义(P<0.05);结论 BNP水平与高血压、LVH、心功能障碍程度有较好的相关性,左室构型及心功能障碍越重,BNP水平越高;BNP水平与Tei指数、LVMI、LVEF有较好的相关性,BNP水平越高,Tei指数越大,LVMI越高,而LVEF越低,BNP水平能较好地反映高血压患者左室重构及心脏功能。     

脑钠肽在先天性心脏病临床评估中的应用潜力

脑钠肽是心室肌细胞在室壁牵张力刺激下分泌的一类肽类激素,因其反映心室前后负荷及收缩、舒张功能的敏感性与无创性,广泛用于各种心血管疾病研究中。现主要针对血浆脑钠肽水平在先天性心脏病的早期诊断、危险性分层和预后评估等方面的应用潜力作一概述。     

脑钠肽与左室射血分数评估左心功能的常见误差分析

目的观察血浆脑钠肽(BNP)水平与左室射血分数(LVEF)对左心功能的评估效果,分析常见误差的原因。方法收集不同心功能水平患者320例,分别按BNP及LVEF分组,采用Biosite公司脑钠素试剂盒和Tri-age BNP测试仪进行BNP检测。结果以BNP(ng/L)分组,各组BNP水平比较,差异均有统计学意义(P<0.05);BNP≥100ng/L组与其他组LVEF值比较,差异有统计学意义(P<0.05)。以LVEF(%)分组,各组间BNP水平、LVEF、左室内径(LVEDd)比较,差异均有统计学意义(P<0.05);其中LVEF≥50%者270例,其中BNP<400ng/L者247例(91.5%)。结论随血浆BNP水平逐渐增高,LVEF均值逐渐降低,总体呈反比趋势;亦有心肌收缩力明显降低,而BNP升高不明显的情况。临床医生对各种检测指标应综合分析,不能过度依赖某一项检测。     

高原心脏病心功能指数与B型利钠肽相关研究

目的 通过观察高原心脏病心力衰竭患者心功能综合指数(Tei)和外周血N末端B型利钠肽前体(NT-proBNP)水平,探讨右室Tei指数、NT-proBNP在高原心脏病中的诊断价值.方法 对2008-2010年在解放军第二十二医院心内科住院的34例高原心脏病患者进行超声指标Tei指数和NT-proBNP水平测定,并进行相关性比较.结果 根据超声心动图征象将高原心脏病患者分为A、B两组,A组与健康对照组(C组)相比,肺动脉收缩压[86.6 mm Hg比9.7 mm Hg(1 mum Hg =0.133kPa)]、右室Tei指数(0.90比0.33)均显著增高(P＜0.05);B组C组相比,肺动脉收缩压(57.1比9.72) mm Hg、右室Tei指数(0.78比0.33)显著增高(P＜0.05);A、B两组患者外周血NT-proBNP水平分别为(1246.8±512.6)ng/L、( 637.3±351.3) ng/L,均显著高于C组(98.6±21.7) ng/L水平,P＜0.05.结论 右心室Tei指数和NT-proBNP浓度是反映右心整体功能的较敏感指标,两者对于诊断高原心脏病具有一定的临床意义.     

慢性心力衰竭患者脑钠肽水平与左心室质量指数相关性研究

目的:本文旨在研究脑钠肽(BNP)对慢性心力衰竭(CHF)的诊断价值和CHF患者血浆BNP水平与左心室质量指数的相关性.方法:选择65例CHF患者(CHF组,心功能Ⅲ～Ⅳ级)及48例健康体检者(正常对照组).采用酶联免疫吸附法测定两组血浆BNP水平;超声心动图测定左心室质量指数.并将CHF患者的血浆BNP水平与左心室质量指数作相关性分析.结果:CHF组的血浆BNP水平与左心室质量指数显著高于正常对照组(P均＜0.001);血浆BNP水平与左心室质量指数呈显著正相关(r=0.387,P＜0.01),取正常对照组BNP浓度的x 1.96s为正常上限值,BNP诊断CHF的敏感性为92%,特异性为93%.在CHF组,血浆BNP浓度在不同心功能分级之间也有显著差异(P＜0.01).结论:血浆BNP水平对于诊断CHF具有较高的敏感性和特异性,并且与左心室重量指数密切相关.     

心肌机能指数和血浆脑钠肽评估心力衰竭的临床研究

目的探讨超声指标——心肌机能指数(Tei)与血浆脑钠肽(BNP)水平鉴别收缩性心力衰竭(SHF)及舒张性心力衰竭(DHF)的临床应用价值。方法入选心力衰竭患者67例,按照左室射血分数(LVEF)分为SHF(LVEF<50%)及DHF组(LVEF≥50%)。32名健康者为对照组,测常规超声指标及Tei指数,并采用ELISA法测得血浆BNP水平。结果与对照组相比,DHF及SHF组Tei指数、BNP显著增高(P<0.01);心力衰竭两组相比,Tei指数、BNP在SHF组显著升高(0.63±0.11)比(0.82±0.20)ng/L,P<0.01;713.38ng/L比1345.86ng/L,P<0.05,且二者呈显著正相关(r=0.71,P<0.01)。结论Tei指数、BNP在心力衰竭患者显著升高,二者可鉴别SHF及DHF。     

脑利钠肽与急性心肌梗死患者心功能关系的研究

目的探讨脑利钠肽(BNP)与急性心肌梗死患者入院时心功能的关系及其对心功能的评价价值。方法入选新疆喀什地区第二人民医院内二科2008年12月—2010年8月确诊的急性心肌梗死患者196例。按心功能Kil-lip’s分级分为Ⅰ、Ⅱ、Ⅲ和Ⅳ组。超声心动测量左心室功能参数,酶免法测定血浆BNP。结果随着患者心功能级别的增加,BNP随之增加,BNP水平与超声心动左心室功能参数有较好的相关性。结论急性心肌梗死给患者的心功能带来严重的打击,BNP对于评价急性心肌梗死患者的心功能具有重要的临床意义。     

室间隔缺损患儿封堵术前后血浆N末端B型利钠肽原和左心室Tei指数变化的意义

目的 探讨室间隔缺损(VSD)患儿封堵术前后血浆N末端B型利钠肽原(NT-proBNP)水平和左心室Tei指数变化的临床意义.方法选择膜固型VSD患儿60例作为VSD组,年龄相当的健康儿童30名作为正常对照组.采用电化学发光免疫学方法测定正常对照组与VSD组术前和术后5 min、24 h、1个月、3个月、6个月的血浆NT-proBNP水平.应用超声心动图测定正常对照组与VSD组术前和术后24 h、1个月、3个月、6个月左心室Tei指数.将VSD封堵术前后患儿的左心室Tei指数的变化与血浆NT-proBNP水平作相关性分析.结果 (1)VSD组术前血浆NT-proBNP水平显著高于正常对照组[(229.45±57.75)ng/L比(99.21±46.86)ng/L,P＜0.01];VSD组术后5 min、术后24 h血浆NT-proBNP水平均显著高于术前[(356.27±96.78)ng/L和(356.38±91.95)ng/L比(229.45±57.75)ng/L,均P＜0.01];VSD组术后1、3和6个月血浆NT-proBNP水平均显著低于术前[(131.33±34.79)ng/L、(96.56±31.55)ng/L和(93.39±29.46)ng/L比(229.45±57.75)ng/L,P＜0.05或P＜0.01];VSD组术后3和6个月与正常对照组比较差异无统计学意义(P＞0.05).(2)VSD组术前左心室Tei指数显著高于正常对照组(0.45±0.05比0.33±0.08,P＜0.01);VSD组术后24 h(0.52±0.05)与1个月(0.51±0.03)左心室Tei指数均显著高于术前和正常对照组(均P＜0.01);VSD组术后3和6个月左心室Tei指数均显著低于术前(0.34±0.07和0.34±0.06比0.45±0.05,均P＜0.01),与正常对照组比较差异无统计学意义(P＞0.05).(3)VSD患儿封堵前后左心室Tei指数的变化与血浆NT-proBNP水平呈正相关(r=0.653,P＜0.05).结论血浆NT-proBNP水平与左心室Tei指数可作为评价VSD患儿封堵前后心功能的参考指标.

Abstract：

Objective To explore the implication of the dynamic changes of plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level and Tei index of left ventricle (LV) in children with ventricular septal defect(VSD) treated by transcatheter closure. Methods Sixty children with VSD treated by transcatheter closure with VSD occluder (Group VSD) and 30 healthy children (Group C) were included in this study. The plasma concentration of NT-proBNP, Tei index of LV and left ventricle ejection fraction (LVEF) were measured in Group C and at before, 5th minute, 4th hour, 1st month, 3rd month and 6th month after VSD closure in Group VSD. Results ( 1 ) The concentration of plasma NT-proBNP was significantly increased in children with VSD before transcatheter closure compared with Group C [(229.45 ±57.75 ) ng/L vs. (99. 21 ± 46. 86) ng/L,P ＜ 0. 01], significantly increased at 5th minute and 24th hour after transcatheter closure[( 356.27 ± 96. 78 ) ng/L and ( 356. 38 ± 91.95 ) ng/L vs. ( 229. 45 ± 57.75 ) ng/L, all P ＜0. 01], and significantly decreased at 1st month, 3rd months and 6th months after transcatheter closure [( 131.33 ± 34. 79 ) ng/L, (96. 56 ± 31.55 ) ng/L and ( 93. 39 ± 29. 46 ) ng/L vs. ( 229. 45 ± 57.75 ) ng/L,P＜0.05 or P＜0. 01]. (2) The Tei indexes of LV in Group VSD before transcatheter closure were significantly higher than in Group C (0. 45 ± 0. 05 vs. 0. 33 ± 0. 08, P ＜ 0. 01 ) and Tei index was significantly increased at 24th hour, 1 st month after transcatheter closure (P ＜ 0. 01 ) while significantly decreased at 3rd and 6th month compared with those before transcatheter closure (0. 34 ±0. 07 and 0. 34 ±±0. 06 vs. 0. 45 ±0. 05 ,all P ＜0. 01 ). (3) There is a positive correlation between the changes of the plasma concentration of NT-proBNP and the change of Tei index of LV before and after transcatheter closure (r = 0. 653, P ＜ 0. 05).Conclusion Tei index of LV and NT-proBNP can monitor cardiac function changes in children with VSD before and after transcatheter closure.     

脑钠尿肽作为起搏器植入心力衰竭患者筛选指标的临床意义

目的:评价血浆脑钠尿肽（BNP）作为永久性心脏起搏器植入术后心力衰竭的衡量指标的临床意义。方法: 入选行常规植入永久心脏起搏器的患者52例,年齡18～92（70±11）岁。记录患者的诊疗史和检查,心脏超声及收集血液样本,检测BNP。结果: 52例患者中（DDD 12例,VVI 38例,其他 2例）有19例测量左室射血分数（LVEF≤40%）和有心力衰竭症状（纽约心力衰竭分级Ⅱ、Ⅲ或Ⅳ级）。在取诊断界点为BNP≥425 pmol/L时,所有心力衰竭的患者中BNP作为筛选工具有着95%的灵敏度和57%的特异度。这在应用DDD型起搏器时为灵敏度71%,特度87%,而在应用VVI型起搏器为灵敏度90%,特异度69%。结论: BNP作为一种监测指标对于心脏起搏器植入患者心力衰竭的评定是适合而且有帮助的。     

充血性心力衰竭患者血浆脑钠素浓度与心功能的关系

目的 :探讨充血性心力衰竭 （CHF）患者血浆脑钠素 （BNP）浓度变化与心功能和 30 d再住院率的关系。方法 :随机选择 CHF患者 78例进行心功能分级 （NYHA分级 ） ,并测定其入院及出院当天血浆 BNP浓度 ,选择 2 0例健康中老年健康体检者作为对照组。结果 :CHF组较对照组血浆 BNP浓度明显升高 ,4 77± 2 4 4 pmol/ L 对 184± 5 4pmol/ L（P<0 .0 1） ;不同心功能分级之间均有显著差异 ,NYHA ～ 级血浆 BNP浓度分别为 2 6 3± 5 6、4 12±16 4、770± 14 2 pm ol/ L（各组间 P<0 .0 1）。 CHF患者 33例出院时血浆 BNP浓度小于 30 0 pmol/ L,30 d再住院率6 % ;4 5例出院时血浆 BNP浓度大于 30 0 pmol/ L,30 d再住院率 2 7% （P<0 .0 5 ）。结论 :血浆 BNP浓度可作为诊断CHF的参考指标 ,随着心衰的加重 ,血浆 BNP浓度逐渐升高 ,当血浆 BNP浓度降至 30 0 pmol/ L 以下时 ,患者 30 d再住院率显著下降。     

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。     

N-端心房利钠肽与N-端脑利钠肽对预测左室收缩功能障碍的价值

目的比较N-端心房利钠肽(心钠素NT-proANP)和N-端脑钠肽(NT-proBNP)对左室收缩功能障碍(LVSD)预测效率,依据二者特性确定适用范围并界定最佳下限(cut-off)值。方法入选心血管病患者380例(病例组),依据左室射血分数(LVEF)将患者划分为LVSD组(LVEF≤40%,n=90)及非LVSD组(LVEF40%,n=290)。另选136名健康体检者作为对照组。超声心动图测定LVEF;ELISA法测定血浆NT-proANP和NT-proB-NP浓度。描记NT-proANP和NT-proBNP预测左室收缩功能障碍受试者工作特征(ROC)曲线。依据年龄(以65岁为分界)、性别及原发心血管疾病种类划分亚组,分别描记各组患者NT-proANP和NT-proBNP预测左室收缩功能障碍ROC曲线;确定最佳cut-off值。结果病例组血浆NT-proANP和NT-proBNP浓度均显著高于对照组log(NT-proANP):(3.30±0.41)vs(2.98±0.16),P0.01;log(NT-proBNP):(2.71±0.30)vs(2.49±0.13),P0.01。NT-proANP和NT-proBNP对不同程度LVSD(LVEF≤40%或LVEF≤30%)患者诊断ROC曲线下面积(AUC)均大于0.73(P0.01);对LVEF≤40%的患者,NT-proANPAUC大于NT-proBNP(0.820vs0.738);对LVEF≤30%的患者,NT-proANPAUC明显小于NT-proBNP(0.853vs0.877)。根据各亚组ROC曲线确定cut-off值,NT-proANP为1676.92pmol/L时对各组LVSD预测敏感度88.9%～100%;特异度14.0%～58.7%;阳性预测值9.04%～30.04%;阴性预测值96.96%～98.77%。NT-proBNP为417.37pmol/L时,敏感度77.8%～94.4%;特异度10.0%～55.8%;阳性预测值7.07%～48.88%;阴性预测值94.46%～98.87%。结论 NT-proBNP与NT-proANP均能够反映心力衰竭高危人群心脏功能状态,可作为LVSD的诊断指标,对于LVEF≤40%的预测,NT-proANP效果优于NT-proBNP,有助于早期发现LVSD患者。     

Interventional catheterization decreases plasma levels of atrial natriuretic peptide (ANP) in children with congenital heart defects

Atrial natriuretic peptide (ANP) is one of the cardiac peptides implicated in volume and sodium homeostasis. We investigated the effect of interventional catheterization on plasma levels of ANP, aldosterone, and cortisol in 28 children with various congenital heart defects (CHD). Patients were divided by age into two groups: group A - infants and children over 3 months of age (n = 22), and group B - newborns (n = 6). These were compared to age-matched control groups. In group A, interventions included pulmonic valvotomy (n = 8), aortic valvotomy (n = 4), balloon angioplasty of native coarctation of the aorta (n = 3), balloon dilatation of the mitral valve (n = 1), and Rashkind double umbrella closure of patent ductus arteriosus (n = 6). Group B interventions included pulmonic valvotomy (n = 3), aortic valvotomy (n = 1), and balloon atrial septosomy (n = 2). In group A, mean ANP levels were markedly higher than in age-matched controls (125.2 ± 15.8 vs. 24.6 ± 4.6 pg/ml) (P <0.0001), and decreased immediately after intervention (75.6 ± 11.4 pg/ml, P <0.02), and more markedly on follow-up (42.9 ± 5.0 pg/ml, P <0.0001). In group B (newborns), mean basal plasma levels were high before and after intervention and were not different from age-matched controls (243 ± 42.1 vs. 220.8 ± 16.2 pg/ml). There was a significant decrease on follow-up measurement (62.1 ± 12.7 pg/ml, P <0.005). In both groups, plasma cortisol levels increased significantly immediately following catheterization (P <0.02), and normalized on follow-up. Basal aldosterone levels were normal in group A and high in Group B (9.9 ± 3.8 vs. 167.6 ± 16.9 ng/dl) (P <0.001). It is suggested that plasma ANP levels are increased in children with CHD, without overt heart failure, and decrease significantly following successful intervention. In newborns with CHD, the physiological high ANP levels obscure the effect of the CHD. Cathet. Cardiovasc. Diagn. 45:27–32, 1998. © 1998 Wiley-Liss, Inc.     

Plasma brain natriuretic peptide and atria natriuretic peptide as predictors for diastolic heart failure in patients with type 2 diabetes mellitus

Objective To study the change of diastolic cardiac function in diabetic patients and to determine the diagnostic value of plasma brain natriuretic peptide （BNP） and atria natriuretic peptide （ANP） for diastolic heart failure in patients with type 2 diabetes mellitus. Methods Twelve healthy subjects and seventy-one diabetic patients were included in the study. Plasma BNP and ANP were measured with immtmoradiometic assay. Results Plasma levels of BNP and ANP increased significantly with increased severity of diastolic heart dysfunction. The ratio of E/A had significant negative correlation with the plasma levels ofBNP （r=0.669,P〈0.001） and ANP （r=0.579, P〈0.01）. AUC of ANP and BNP in ROC model was 91.9% and 65.3%, respectively. Conclusions The plasma level of BNP might be a valuable predictor for differential diagnosis of diastolic cardiac function in diabetic patients.