史力斌,丁文惠,杨颖,张宝娓,霍勇

• 1:北京大学第一医院心内科

摘要(Abstract)：

目的评估血浆NT-proBNP水平对于射血分数正常的冠心病患者出现无症状舒张功能减退的预测价值。方法筛选2009年6月至12月期间于北京大学第一医院心内科住院的确诊心肌梗死或经冠状动脉造影证实的冠心病患者,排除左室射血分数减低者(LVEF<50%)及有心力衰竭症状者,入选253例患者,结合常规超声心动图及组织多普勒结果将患者分为心室舒张功能正常组(115例)及心室舒张功能减退组(138例)。对比两组血浆NT-proBNP水平并分析其对心室功能减退的预测价值。结果心室舒张功能减退组NT-proBNP水平高于心室舒张功能正常组(中位数175.4ng/L,范围8.64～5970ng/L比中位数84.7ng/L,范围5.69～3250ng/L,P<0.01),经logistic回归分析,NT-proBNP水平是心室舒张功能减退的独立预测因子(对数转换后,OR=2.78,95%CI1.43～5.40,P<0.01),应用NT-proBNP水平诊断心室舒张功能减退的ROC曲线下面积为0.67(95%CI0.60～0.73,P<0.01),以NT-proBNP>119.15ng/L作为截点时敏感性为64%,特异性为62%。结论血浆NT-proBNP水平升高是射血分数正常的冠心病患者出现无症状心室舒张功能减退的独立预测指标。

关键词(KeyWords)： 氨基末端脑钠肽前体;冠心病;心室功能障碍;超声检查,多普勒

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 史力斌,丁文惠,杨颖,张宝娓,霍勇

参考文献(References)：

• [1]Garcia MJ,Thomas JD,Klein AL.New Doppler echocardiographic applications for the study of diastolic function.J Am Coll Cardiol,1998,32:865-875.
• [2]Redfield MM,Jacobsen SJ,Burnett JC Jr,et al.Burden of wywtolic and diastolic ventricular dysfunction in the community:appreciating the scope of the heart failure epidemic.JAMA,2003,289:194-202.
• [3]van Kimmenade RR,Pinto YM,Bayes-Genis A,et al.Usefulness of intermediate amino-terminal pro-brain natriuretic peptide concentrations for diagnosis and prognosis of acute heart failure.Am J Cardiol,2006,98:386-390.
• [4]Kiencke S,Handschin R,von Dahlen R,et al.Pre-clinical diabetic cardiomyopathy:prevalence,screening,and outcome.Eur J Heart Fail,2010,12:951-957.
• [5]Bibbins-Domingo K,Ansari M,Schiller NB,et al.Is B-Type natriuretic peptide a useful screening test for systolic or diastolic dysfunction in patients with coronary disease-Data fromthe Heart and Soul Study.Am J Med,2004,116:509-516.
• [6]Tschope C,Kasner M,Westermann D,et al.Elevated NT-ProBNP levels in patients with increased left ventricular filling pressure during exercise despite preserved systolic function.J Card Fail,2005,115Suppl:S28-S33.
• [7]Antonio Barragán,Juan Lacalzada,Alejandro de la Rosa,et al.Relationship between slightly elevated NT-proBNP and alterations in diastolic function detected by echocardiography in patients without structural heart disease.Int J Cardiol,2008,129:430-432
• [8]G rmüsU,Ozmen D,Ozmen B,et al.Serum N-terminal-pro-brain natriuretic peptide(NT-pro-BNP)and homocysteine levels in type2diabetic patients with asymptomatic left ventricular diastolic dysfunction.Diabetes Res Clin Pract,2010,87:51-56.
• [9]Liang F,Gardner DG.Mechanical strain activates BNP gene transcription through a p38/NF-kappaB-dependent mechanism.J Clin Invest,1999,104:1603-1612.
• [10]Pikkarainen S,Tokola H,Majalahti-Palviainen T,et al.GATA-4is a nuclear mediator of mechanical stretch-activated hypertrophic program.J Biol Chem,2003,278:23807-23816.
• [11]Chen AA,Wood MJ,Krauser DG,et al.NT-proBNP levels,echocardiographic findings,and outcomes in breathless patients:results from the ProBNP Investigation of Dyspnoea in the Emergency Department(PRIDE)echocardiographic substudy.Eur Heart J,2006,27:839-845.