肥厚型心肌病血浆BNP测定的临床意义

目的:探讨血浆B型利钠肽(BNP)水平测定在肥厚型心肌病(HCM)患者中的应用价值。方法:连续入选2005年1月至2006年12月在我科就诊的HCM患者53例,患者均行超声心动图检查和血浆BNP的测定。观察BNP水平与临床指标及超声心动图参数的关系。结果:53例中男性36例(67.9%),年龄(47.8±14.6)岁,有左心室流出道梗阻者26例(49.1%)。HCM患者的血浆BNP水平明显升高,梗阻型患者明显高于非梗阻型患者[(1 404.2±1 087.2)fmol/mL比(837.2±792.6)fmol/mL,P<0.05]。多元相关分析显示,在非梗阻型患者中与血浆BNP相关的因素为NYHA分级(r=0.696,P<0.01)、左心房内径(LAD)(r=0.617,P<0.01)、二尖瓣血流E峰与A峰比值(E/A)(r=0.988,P<0.01)、左心室舒张末内径(LVEDD)(r=0.731,P<0.05)与左心室射血分数(LVEF)(r=-0.733,P<0.05);而与梗阻型患者血浆BNP水平相关的因素为胸痛和呼吸困难的症状(r=0.418,P<0.05)与LAD(r=0.421,P<0.05)。结论:HCM患者的血浆BNP水平升高,梗阻型患者高于非梗阻型患者。对于梗阻型与非梗阻型患者,血浆BNP测定可能有不同的应用价值。

The value of B-type natriuretic peptide levels in hypertrophic cardiomyopathy

Objective： To observe the value of B-type natriuretic peptide （BNP） in hypertrophic cardiomyopathy（HCM）. Method： 53 HCM patients were analyzed prospectively from Jan 2005 to Dec 2006. Ultracardiography and plasma BNP were detected for all the patients. The relationship among BNP levels and sympatoms and the parameters of uhracardiography were analyzed. Result： The patients＇ mean age was （47.8± 14.6） 36 patients （67.9%） were male. 26 patients（49.1% ） had left ventricular outflow tract obstruction. The levels of plasma BNP elevated significantly, especially in obstructive type [ （ 1 404.2± 1 087.2） fmol/mL vs （837.2± 792.6）fmol/mL, P 〈 0.05]. In nonobstructive type patients, BNP levels were correlated with NYHA degree （r = 0.696, P 〈 0.01 ）, left atrial size（ r = 0.617, P 〈 0.01 ）, E/A ratio （ r = 0.988, P 〈 0.01 ）, LVEDD（ r = 0.731, P 〈0.05） and LVEF（ r = - 0.733, P 〈 0.05）. In obstructive type patients, BNP levels were correlated with the main symptoms of the patients as dyspnea or chest pain（ r = 0.418, P 〈 0.05） and left atrial size（ r = 0.421, P 〈 0.05）. Conclusion：The levels of plasma BNP elevated significantly in HCM patients, especially in obstructive type. The value of BNP levels in nonobstructive type and obstructive type maybe different.