脑钠肽结合超声多普勒评价舒张性心力衰竭患者的心功能

目的采用血浆脑钠肽（BNP）浓度测定结合超声多普勒心动图的参数来评价舒张性心力衰竭患者的心功能,为临床提供判断舒张性心力衰竭及其严重程度的敏感和特异的客观指标。方法选择舒张性心力衰竭患者85例（心力衰竭组）,按纽约心脏病学会（NYHA）心功能分级,Ⅱ级31例、Ⅲ级36例、Ⅳ级18例,以及健康对照组30例。测定血浆BNP浓度,超声多普勒结合组织多普勒显像（TDI）测定左室结构、左室舒张功能及左室舒张末压。结果舒张性心力衰竭患者血浆BNP浓度明显高于对照组（P〈0.001）,且随心力衰竭程度加重而逐渐升高（P〈0.001）。舒张性心力衰竭组左房内径（LA）、室间隔厚度（IVS）、左室后壁厚度（LVPW）、舒张早期流速峰值/舒张早期速度峰值（E/Em）较对照组升高,E/舒张晚期流速峰值（A）降低（P〈0.01）,血浆BNP浓度与E/A比值呈负相关（r=-0.634,P〈0.01）,与E/Em比值呈正相关（r=0.728,P〈0.01）。结论血浆BNP浓度测定结合超声多普勒心动图的参数判断舒张性心力衰竭患者的心功能简便准确。

Clinical Significance of Brain Natriuretic Peptide and Doppler Ultrasound in Diastolic Heart Failure

Objective To evaluate the cardiac function in patients （pts） with diastolic heart failure by plasma brain natriuretic peptide（BNP）with Doppler echocardiograpby parameters. Methods A total of 85 patients（pts） with diastolic heart failure （31 cases with NYHA class Ⅱ,36 cases with NYHA class Ⅲ and 18 cases with NYHA class Ⅳ） were enrolled. Thirty individuals were enrollcd as healthy control group. The plasma BNP was measured. Doppler ultrasound with tissue Doppler imaging（ TDI） was performed to deter mine left ventricular structure,left ventricular diastolic function and left ventricular end diastolic pressure. Results The level of plas ma BNP was increased in pts with diastolic heart failure as compared to healthy control group（P〈0. 001）. The level of plasma BNP was gradually increased with the severity of diastolic heart failure（P〈0. 001）. Compared with healthy control group, left atrium （LA）,interventricular septum（IVS）,left ventricle posterior wall（LVPW）and E/Era ratio increased and E/A ratio decreased in diastolic heart failure group（P〈0. 001 ）. The level of plasma BNP had negative correlation with E/A ratio （r= -0.634, P〈50.01 ） and positive correlation with E/Em （r=0. 728,P〈0.01）. Conclusion Plasma BNP and Doppler echocardiography parameter were the simple and accurate to evaluate the cardiac function in pts with diastolic heart failure.