NT-proBNP对高血压合并糖尿病患者左心功能早期评估的意义

目的探讨血清N端脑钠肽前体（NT-proBNP）水平对高血压合并糖尿病患者左心功能早期评估的意义。方法 123例临床无心力衰竭症状的高血压患者按是否合并糖尿病分为高血压合并糖尿病组（n=63）和单纯高血压组（n=60）。所有患者经肘前静脉穿刺采血测定血清NT-proBNP,同时接受心脏超声检查。采用多元回归分析血清NT-proBNP与心脏超声指标的关系。结果高血压合并糖尿病组血清NT-proBNP为（376±50）ng/L,明显高于单纯高血压组的（98±16）ng/L（P〈0.01）;心脏超声检查显示,单纯高血压组患者心脏结构和心功能指标均在正常范围,但高血压合并糖尿病组患者的左心房内径（LAD）、左心室舒张末期内径（LVED）、室间隔厚度（IVST）和左心室后壁厚度（LVPWT）均显著增大,心率（HR）明显加快,左心室射血分数（LVEF）显著降低（P〈0.05或P〈0.01）。多元回归分析显示,高血压合并糖尿病患者的NT-proBNP与LVEF呈负相关（R2=-0.30,P〈0.05）;与LAD、LVED、HR、IVST、LVPWT均呈正相关（R2=0.18、0.11、0.09、0.20、0.13,P〈0.05或P〈0.01）。结论血清NT-proBNP可作为高血压合并糖尿病患者左心功能的早期评估指标。

Clinical significance of NT-proBNP in early evaluation of left heart function for patients with hypertension combined with diabetes mellitus

Objective To investigate the clinical significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in early evaluation of left heart function for patients with hypertension combined with diabetes mellitus. Methods One hundred and twenty-three patients with hypertension and without clinical evidence of heart failure were divided into hypertension combined with diabetes mellitus group (n=63) and simple hypertension group (n=60). Plasma NT proBNP concentrations were measured, and echocardiography was performed in all patients. The correlation between plasma NT-proBNP concentration and parameters of echocardiography was explored by multiple regression analysis. Results The plasma NT-proBNP concentration in hypertension combined with diabetes mellitus group was (376±50) ng/L, and was significantly higher than that in simple hypertension group (98±16) ng/L (P<0.01). Echocardiography revealed that the cardiac structure and cardiac function were normal in simple hypertension group, while the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVED), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST) and heart rate (HR) significantly increased, and the left ventricle ejection fraction (LVEF) significantly decreased in hypertension combined with diabetes mellitus group (P<0.05 or P<0.01). Multiple regression analysis indicated that NT-proBNP was negatively related to LVEF （R2=-0.30, P<0.05）, but positively related to LAD, LVED, HR, IVST and LVPWT （R2=0.18, 0.11, 0.09, 0.20 and 0.13, P<0.05 or P<0.01）in hypertension combined with diabetes mellitus group. Conclusion Plasma NT-proBNP may serve as a parameter of early evaluation for left heart function in patients with hypertension combined with diabetes mellitus.