无症状心衰陈旧性心肌梗死患者血浆N端B型脑钠肽的变化及其临床意义.docVIP

无症状心衰陈旧性心肌梗死患者血浆N端B型脑钠肽的变化及其临床意义 ?28? 血浆 实用临床医学2006年第7卷第8期PracticalClinicalMedicine,2006,Vol7.No8 无症状心衰陈旧性心肌梗死患者 N端B型脑钠肽的变化及其临床意义 孟宪浩,沃金善,徐庆科 (青岛大学医学院附属医院心内科,山东青岛266OO3) 摘要:目的:探讨既往有心肌梗死病史的无症状心衰患者血浆N端B型脑钠肽(NT—proBNI)的浓度变化及其临床 意义.方法:人选83例既往有心肌梗死病史,无任何临床心衰症状至少1年以上的门诊体检者,采用酶联免疫吸 附法测定血浆NT—proBNl浓度,以心脏彩色多普勒超声诊断仪测定心室结构功能,分为射血分数(EF)≥0.5组 (41例)和EFlt;0.5组(42例).结果:EFlt;0.5组血浆NT—proBNP浓度[(1123.8±234.3)fmol/mL]显着高于 EF≥O.5组[(505.0±86.9)fmol/mL],Plt;O.001.在EFlt;0.5组,射血分数(EF),左心室短轴缩短率(FS)与血 浆NT—ProBNP浓度呈显着负相关(r=一0.96,Plt;O.O0l;r一一0.93,Plt;O.001);而在EF≥0.5组,EF,FS与血 浆NT—ProBNP浓度无相关关系.受试者工作特征曲线(ROC)显示,界值为675fmol/ml时,血浆NT—proBNP浓 度诊断无症状心衰的敏感性95.24%,特异性92.68,阳性预测值93.02,阴性预测值95.00,阳性似然比 13.O2.曲线下面积为0.940.结论:血浆NT—proBNP水平可以作为诊断既往有心肌梗死病史的患者发生无症状心 衰的一个良好指标,且NT—proBNP的水平随着心功能受损程度的加重而升高,能较好地反映左心室的功能. 关键词:N端B型脑钠肽;无症状心衰;心肌梗死;射血分数 中图分类号:R541.4文献标识码:A文章编号:1009--8194(2006)08—0028--04 ChangesandClinicalSignificanceofPlasma NT—proBNPLevelsinPatientswithPreviousMyocardial InfarctionAssociatedwithAsymptomaticHeartFailure MENGXian—hao,WOJin—shan,XUQing—ke (Depa7一tmenlofCardiology,AffiliatedHospitalofQingdaoUnivelsityMedicalCollege, Qingdao266003,China) Abstract:Ohjective:ToinvestigatethechangesandclinicalsignificanceofplasmaN—terminalpro— brainnatriureticpeptide(NT—proBNP)lex,e1sinpatientswithpreviousmyocardialinfarctionasso— ciatedwitt1asvmptomaticheartfailure.Methods:EighD—threeoutpatientswithaprevioushistory ofmyocardialinfarctionnotassociatedwithsymptomsofheartfailureforatleastoneyearwere c11osen.TheconcentrationsofPlasmaN—i—proBNPweremeasuredbyenzyme—linkedimmunosor— bentassay(EIISA).ColoredDopplerechocardiographywasperformedlOevaluatetheleft,en— tricu1arfunction.Theoutpatientsweredividedintotwogroups:ejectionfraction(EF)≥≥0.5group (7t一41)andEFlt;0.5group(n一42)group.Results:TheplasmaNTproBNPlevelwassignifi— cantlvbigherintheEFlt;0.5groupthanthatintheEF≥0.5group[(1l23.8±234.3)fmol/mL vs(505.0±86.9)fmol/mL,Plt;0.O01].Fhereweresignificantlynegativecorrelationsbetween DlasmaNT-proBNPconcentrationandEF,