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        血N末端B型利鈉肽原升高對(duì)肥厚型心肌病患者遠(yuǎn)期預(yù)后的影響分析

        2019-09-25 05:16:26李?lèi)?ài)紅
        中國(guó)當(dāng)代醫(yī)藥 2019年19期

        李?lèi)?ài)紅

        [摘要]目的 探討血N末端B型利鈉肽原(NT-proBNP)水平對(duì)肥厚型心肌病遠(yuǎn)期預(yù)后的影響。方法 選擇我院2013年10月~2015年10月入院的臨床確診為肥厚型心肌病的108例患者作為研究對(duì)象,根據(jù)NT-proBNP水平將入選者分為NT-proBNP<860 pmol/L組(n=35)、860 pmol/L≤NT-proBNP≤1905 pmol/L組(n=37)、NT-proBNP>1905 pmol/L組(n=36),分析NT-proBNP對(duì)肥厚型心肌病患者遠(yuǎn)期預(yù)后的影響。結(jié)果 梗阻型肥厚型心肌病患者的NT-proBNP水平明顯高于非梗阻型肥厚型心肌病患者和心尖肥厚型心肌病患者,差異均有統(tǒng)計(jì)學(xué)意義(t=36.288、62.085,P<0.01);非梗阻型肥厚型心肌病患者的NT-proBNP水平明顯高于心尖肥厚型心肌病患者,差異有統(tǒng)計(jì)學(xué)意義(t=28.022,P<0.01)。隨訪(42.3±11.4)個(gè)月,期間共9例患者死亡,1例患者進(jìn)行了心臟移植術(shù),總事件率為8.33%(9/108)。NT-proBNP>1905 pmol/L組的事件率高于NT-proBNP<860 pmol/L組和860 pmol/L≤NT-proBNP≤1905 pmol/L組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論 NT-proBNP對(duì)肥厚型心肌病患者的遠(yuǎn)期預(yù)后有良好的預(yù)測(cè)價(jià)值。

        [關(guān)鍵詞]N末端B型利鈉肽原;肥厚型心肌病;預(yù)后;死亡率

        [中圖分類(lèi)號(hào)] R542.2? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721(2019)7(a)-0044-04

        [Abstract] Objective To investigate the influence of blood N-terminal B-type natriuretic peptide progenitor (NT-proBMP) level on the long-term prognosis of hypertrophic cardiomyopathy (HCM). Methods A total of 108 patients with clinically confirmed HCM admitted to our hospital from October 2013 to October 2015 were selected as the study subjects. According to the NT-proBMP level, they were divided into the NT-proBMP<860 pmol/L group (n=35), the 860 pmol/L≤NT-proBMP≤l905 pmol/L group (n=37), the NT-proBMP>1905 pmol/L group (n=36). The influence of NT-proBNP on long-term prognosis of HCM patients was analyzed. Results The level of NT-proBNP in patients with obstructive hypertrophic cardiomyopathy were significantly higher than those in patients with non-obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy, the differences were statistically significant (t=36.288, 62.085, P<0.01). The level of NT-proBNP in patients with non-obstructive hypertrophic cardiomyopathy was significantly higher than that in patients with apical HCM, and the difference was statistically significant (t=28.022, P<0.01). During follow-up (42.3±11.4) months, a total of 9 patients died and 1 patient underwent heart transplantation, the total incidence was 8.33% (9/108). The event rate of the NT-proBMP>1905 pmol/L group was higher than that of the NT-proBMP<860 pmol/L group and the 860 pmol/L≤NT-proBMP≤1905 pmol/L group, and the difference was statistically significant (P<0.01). Conclusion NT-proBMP has a good prediction value for the long-term prognosis of HCM patients.

        [Key words] N-terminal B-type natriuretic peptide; Hypertrophic cardiomyopathy; Prognosis; Mortality

        肥厚型心肌病是臨床上常見(jiàn)的特發(fā)性心肌病,目前的研究證實(shí)其為一種常染色體顯性遺傳心臟病,主要病理特征為室間隔心肌呈非對(duì)稱(chēng)性肥厚、心室變小,可伴(或不伴)左室流出道梗阻。普遍認(rèn)為心肌纖維化是影響肥厚型心肌病病程的重要機(jī)制,而NT-proBNP水平與心肌纖維化程度密切相關(guān)。心肌纖維化程度已經(jīng)成為肥厚型心肌病患者危險(xiǎn)分層的重要指標(biāo),心肌纖維化可導(dǎo)致心室壁重塑,心肌電生理活動(dòng)異常,從而增加心血管不良事件和死亡[1]。有橫斷面臨床研究顯示,B型利鈉肽(B-typenatriuretic peptide,BNP)和N末端B型利鈉肽原(N-terminal B-type natriuretic peptide,NT-proBNP)與肥厚型心肌病的嚴(yán)重程度及運(yùn)動(dòng)耐量相關(guān)[2]。本研究進(jìn)一步探討NT-proBNP水平對(duì)肥厚型心肌病遠(yuǎn)期預(yù)后的影響,現(xiàn)報(bào)道如下。

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