【作者】 张茜；

【导师】 欧细平；

【作者基本信息】 中南大学 ， 内科学， 2009， 硕士

【摘要】 目的:观察慢性心功能不全患者血浆NT-proBNP和ET的水平以及超声心动图反映心室功能的有关参数,研究NT-porBNP和ET对心脏功能的评价作用及在心衰诊断中的应用价值,并对左、右心室功能不全心力衰竭患者血浆NT-proBNP和ET的水平进行比较,并探讨二者的相关性。方法:选取中南大学湘雅医院心血管内科的门诊和住院患者共96例,分为左心室功能不全组62例(其中左室收缩功能不全组31例,左室舒张功能不全组31例),右心室功能不全组14例,对照组心功能正常者20例。采集入选病例所有临床资料,并对左心室功能不全患者心功能进行NYHA分级。入院或就诊24小时内行超声心动图检查,对所有患者抽静脉血测定血浆中NT-proBNP和ET水平。结果:(1)左室收缩功能不全组、左室舒张功能不全组、右心室功能不全组和对照组四组间比较,以左室收缩功能不全组中NT-proBNP水平(2743.47±2276.52pg/ml)最高,其次为左室舒张功能不全组(446.94±415.76pg/ml),而右心室功能不全组NT-proBNP水平(387.24±333.46pg/ml)较低,但均高于对照组(97.60±84.43pg/ml),各组间差异有统计学意义(p=0.000)。(2)四组间比较,ET水平在左室舒张功能不全组(39.17±24.49ng/L)较左室收缩功能不全组(55.31±33.62ng/L)和右心室功能不全组(54.04±38.15ng/L)低,但高于对照组(15.98±12.37ng/L),各组间差异有统计学意义(P=0.000)。(3)NT-proBNP水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:189.46±161.47pg/ml,NYHAⅢ级:770.43±727.69pg/ml,NYHAⅣ级:2782.69±2470.11pg/ml),各级间差异有统计学意义(P=0.001)。(4)ET水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:31.42±20.57ng/L,NYHAⅢ级:45.18±21.41ng/L,NYHAⅣ级:60.38±38.64ng/L),各级间差异有统计学意义(P=0.013)。(5)在左心室功能不全组中,NT-proBNP与ET呈正相关,(r=0.407,P=0.001),与左室射血分数呈负相关(r=-0.430,P=0.000),与左室舒张末期内径呈正相关,(r=0.451,p=0.000);ET与左室射血分数呈弱负相关(r=-0.272,P=0.033),与左室舒张末期内径呈弱正相关(r=0.256,P=0.045)。结论:(1)NT-proBNP与ET是诊断心力衰竭的重要指标。(2)左心室功能不全患者NT-proBNP水平明显较右心室功能不全患者高,左室收缩功能不全患者NT-proBNP和ET水平明显较左室舒张功能不全患者高。(3)NT-proBNP与ET水平均随着NYHA心功能分级的逐级增加而升高,可以预测心力衰竭的严重程度。(4)左心室功能不全患者NT-proBNP与ET呈正相关性,提示二者在心力衰竭的发生、发展中起重要作用。(5)NT-proBNP与超声心动图评价左心室功能的方法具有良好的相关性。更多还原

【Abstract】 Objective:To investigate the concentrations of N-terminal pro-brain natriuretic peptide(NT-proBNP)、endothelin(ET) and the indexes of ventricular function examed by ultrasonic cardiogram(UCG) in patients with heart failure.To study the roles of NT-proBNP and ET on cardiac function evaluation and diagnosis of heart failure.To compare NT-proBNP and ET levels in patients between left and right ventricular dysfunction.The relationship between NT-proBNP and ET was also studied.Methods:Ninety-six patients were included in the study.The patients were divided into 4 groups:the left ventricular systolic dysfunction group,the left ventricular diastolic dysfunction group,the right ventricular dysfunction group,and the control group.The left ventricular dysfunction group were divided into 3 groups:NYHAⅡ,NYHAⅢ,NYHAⅣ.NT-proBNP and ET were measured in all subjects.Results:1.In the left ventricular systolic dysfunction group,the left ventricular diastolic dysfuncton group and the right ventricular dysfunction group,the concentrations of NT-proBNP and ET were much higher than that of control group(97.60±84.43pg/ml),(P=0.000).Among the four groups,the concentration of NT-proBNP was highest in the left ventricular systolic dysfunction group(2743.47±2276.52pg/ml),second in the left ventricular diastolic dysfunction group(446.94±415.76pg/ml),third in the right ventricular dysfunction group(387.24±333.46pg/ml).2.Among the four groups,the concentration of ET in the left ventricular diastolic dysfunction group(39.17±24.49ng/L) was much lower than that of left ventricular systolic dysfunction group(55.31±33.62ng/L) or right ventricular dysfunction group(54.04±38.15ng/L),but showed higher concentration than that in the control group(15.98±12.37ng/L),(P=0.000).3.There were significant differences of NT-proBNP levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:189.46±161.47pg/ml,NYHAⅢ:770.43±727.69pg/ml,NYHAⅣ:2782.69±2470.11pg/ml),(P=0.001).4.There were significant differences of ET levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:31.42±20.57ng/L,NYHAⅢ:45.18±21.41ng/L,NYHAⅣ:60.38±38.64ng/L),(P=0.013).5.In the left ventricular dysfunction group,the concentration of NT-proBNP was positively correlated with ET(r=0.407,P=0.001),and negatively correlated with LVEF(r=-0.430,P=0.000),and positively correlated with LVEDD(r=0.451,P=0.000).The concentration of ET negatively correlated with LVEF(r=-0.272,P=0.033),and positively correlated with LVEDD(r=0.256,P=0.045) Conclusion:1.NT-proBNP and ET could diagnose heart failure.2.The concentration of NT-proBNP in patients with left ventricular dysfunction was much higher than that with right ventricular dysfunction,the concentrations of NT-proBNP and ET in patients with left ventricular systolic dysfunction were much higher than that in left ventricular diastolic dysfunction.3.NT-proBNP and ET were positively correlated with NYHA classification,they could predict severity of heart failure.4.NT-proBNP in patients with left ventricular dysfunction was positively correlated with ET,NT-proBNP and ET might possess important significance in development of CHF.5.NT-proBNP had good correlation with UCG.更多还原