不同类型心力衰竭患者心电图QRS波时限与血浆N末端B型利钠肽原水平的关系研究

目的探讨不同类型心力衰竭患者心电图QRS波时限与血浆N末端B型利钠肽原(NT-proBNP)水平的关系及其临床意义。方法入选慢性心力衰竭患者112例(试验组),并选取年龄和性别与试验组匹配的非慢性心力衰竭患者50例为对照组。入选者均测定心电图QRS波时限、血浆NT-proBNP水平及左室射血分数(LVEF),并进行美国纽约心脏病协会(NYHA)心功能分级。以LVEF≤45%为收缩功能不全诊断标准,将所有入选的心力衰竭病例分为收缩性心力衰竭组(SHF组,LVEF≤45%,n=52)和舒张性心力衰竭组(DHF组,LVEF>45%,n=60),比较各组QRS波时限、血浆NT-proBNP水平及NYHA分级,并对SHF组进行上述指标间的相关性分析。结果心电图QRS波时限在SHF组为(135.17±39.75)ms,显著长于DHF组的(100.93±27.13)ms及对照组的(80.56±7.76)ms,差异有统计学意义(P<0.05)。血浆NT-proBNP水平在SHF组及DHF组分别为(1 248.25±45.84)pg/ml、(664.07±35.75)pg/ml,均显著高于对照组(104.96±47.84)pg/ml,且SHF组和DHF组比较显示前者血浆NT-proBNP水平显著升高,差异均有统计学意义(P<0.01)。相关分析显示,SHF组患者QRS波时限与血浆NT-proBNP水平、NYHA分级呈正相关(P<0.05),与LVEF呈负相关(P<0.01)。结论心力衰竭患者心电图QRS波时限延长与血浆NT-proBNP水平升高及左室收缩功能减退密切相关,可用于辅助判断心力衰竭类型及指导治疗。

Correlation between Electrocardiogram QRS Complex Duration and Plasma Level of B-type Natriuretic Peptide in Patients with Different Clinical Types of Chronic Heart Failure

Objective To observe the correlation of electrocardiogram QRS complex duration and plasma N-terminal-pro-brain natriuretic peptide(NT-proBNP) in patients with different clinical types of chronic heart failure(CHF).Methods 112 patients with CHF were divided into two groups according to left ventricular ejection fraction(LVEF):systolic heart failure group(SHF group,LVEF≤45%,n=52) and diastolic heart failure group(DHF group,LVEF>45%,n=60).Fifty subjects without CHF were enrolled into the control group which matched the sex ratio and age range of the experimental groups.Data of QRS complex duration,plasma NT-proBNP,LVEF and NYHA functional classification were obtained and compared among the three groups.The correlations of QRS complex duration with plasma NT-proBNP,LVEF and NYHA functional classification were analyzed respectively in SHF group.Results The QRS complex duration was significantly longer in SHF group(135.17±39.75)ms than that in DHF group(100.93±27.13)ms(P<0.05) and control group(80.56±7.76)ms(P<0.05).Plasma level of NT-proBNP in SHF group(1 248.25±45.84)pg/ml was higher than that in DHF group(664.07±35.75)pg/ml(P<0.01),and that of both experiment groups were significantly higher than that in the control group(104.96±47.84)pg/ml(P<0.01).The QRS complex duration was positively correlated with plasma level of NT-proBNP and NYHA classification(P<0.05) and negatively correlated with LVEF(P<0.01) in SHF group.Conclusion Electrocardiogram QRS complex duration was closely correlated with plasma NT-proBNP and LVEF in patients with chronic heart failure,thus can be used as an effective biological parameter for assessing different types of CHF and suggesting corresponding treatment.