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。

Effects of atrioventricular asynchrony on the plasma level of N-terminal pro-brain natriuretic peptide

Objective To investigate the effects of bradyarrhythmia and atrioventricular asynchrony on plasma level of N-terminal pro-brain natriuretic peptide(NT-proBNP). Methods 120 patients without defined structural heart disease were enrolled in this study: group A,52 patients with sick sinus syndrome;group B,29 patients with Ⅱ° atrioventricular block(AVB);group C,39 patients with Ⅲ° AVB;group D,42 patients without arrhythmia.The plasma level of NT-proBNP was determined and compared and stepwise multi-valuables regression performed to define the independent determinants of them. Results The logarithm of NT-proBNP levels in group A,B,C and group D were 2.175±0.391,2.574±0.476,2.903±0.635 and 1.869±0.333 ng/L,respectively.The plasma levels of NT-proBNP in theses groups in order was D,A