申彬如，张煜，崔妍 ，刘蕾



合并或不合并肺动脉高压的左心衰竭患者血浆N末端B型利钠肽原水平的差异

申彬如，张煜，崔妍 ，刘蕾

摘要

关键词心力衰竭；高血压，肺性；N末端B型利钠肽原

作者单位：130021 吉林省长春市，吉林大学第一医院 心内科

Differences of Plasma NT-proBNP Level in Patients With Left Heart Failure Combining or not Combining Pulmonary Hypertension

SHEN Bin-ru,ZHANG Yu,CUI Yan,LIU Lei.
Department of Cardiology,First Affiliated Hospital of Jilin University,Changchun(130021),Jilin,China
Corresponding Author:ZHANG Yu,Email:zyu99@jlu.edu.cn

Abstract

Objective:To observe the relationship between plasma levels of NT-proBNP and pulmonary hypertension in patients with left heart failure(LHF).

Methods:A total of 391 LHF patients were enrolled in our study,according to pulmonary arterial pressure,the patients were divided into 3 groups:Control group,the patients without pulmonary hypertension,n=102,Mild pulmonary hypertension group,n=94 and Moderate to severe pulmonary hypertension group,n=195.Plasma levels of NT-proBNP,left ventricular diameter(LVD),right ventricular diameter(RVD)and left ventricular ejection fraction(LVEF)were examined and compared among 3 groups.

Results:Plasma levels of NT-proBNP and RVD in Mild pulmonary hypertension group and Moderate to severe pulmonary hypertension group were higher than Control group,those indexes in Moderate to severe pulmonary hypertension group were higher than Mild pulmonary hypertension group,P<0.05-0.001.While LVD and LVEF were similar among 3 groups,P>0.05.

Conclusion:Plasma levels of NT-proBNP were increased in LHF patients combining pulmonary hypertension,the changing trend elevated with the increased pulmonary hypertension accordingly.

Key words Heart failure;Hypertension,pulmonary;NT-proBNP(Chinese Circulation Journal,2016,31:226.)

随着人们生活水平的提高以及工作压力的增大，心血管系统疾病已成为严重威胁人类健康的疾病，左心衰竭是多种心脏疾病如冠心病、心脏瓣膜病、先天性心脏病等疾病终末阶段的表现，左心衰竭是肺动脉高压的最常见原因，而肺动脉高压又预示着左心衰竭预后不佳。血浆N末端B型利钠肽原（NT-proBNP）主要在心室肌张力增加时合成和分泌，具有排钠、排尿、舒张血管的作用，是诊断左心衰竭、判断预后的一项敏感实验室指标[1,2]。目前关于左心衰竭患者血浆NT-proBNP水平的研究较多，而关于左心衰竭合并肺动脉高压患者血浆NT-proBNP水平的报道尚少，本研究将探讨不同肺动脉压力水平的左心衰竭患者血浆NT-proBNP水平是否存在差异。

1　资料与方法

一般资料：选择2014-02至2014-11我院心血管内科收治的左心衰竭患者391例，其中男性247例，女性144例。所有患者入院后均行心电图、超声心动图、X线胸片以及血浆NT-proBNP、血尿常规、肝肾功能化验。入选标准为超声心电图检查提示左心室射血分数（LVEF）≤40%，排除肾、肝、肺部疾病患者。所有患者肺动脉压力（PASP）根据超声心动图按伯努利方程及右心房室压力阶差估算得到（PASP=4×Vmax2+RAP,Vmax：三尖瓣反流的最大速度，RAP：右心房压）[3]，按肺动脉压力值分为肺动脉压力正常组[n=102，PASP<35 mmHg （1 mmHg=0.133 kPa）]，轻度肺动脉高压组（n=94，45 mmHg≥PASP≥35 mmHg），中重度肺动脉高压组（n=195，PASP>45 mmHg）[4]。……