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血N末端B型利钠肽原升高对肥厚型心肌病患者远期预后的影响分析

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  [摘要]目的 探讨血N末端B型利钠肽原(NT-proBNP)水平对肥厚型心肌病远期预后的影响。方法 选择我院2013年10月~2015年10月入院的临床确诊为肥厚型心肌病的108例患者作为研究对象,根据NT-proBNP水平将入选者分为NT-proBNP<860 pmol/L组(n=35)、860 pmol/L≤NT-proBNP≤1905 pmol/L组(n=37)、NT-proBNP>1905 pmol/L组(n=36),分析NT-proBNP对肥厚型心肌病患者远期预后的影响。结果 梗阻型肥厚型心肌病患者的NT-proBNP水平明显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,差异均有统计学意义(t=36.288、62.085,P<0.01);非梗阻型肥厚型心肌病患者的NT-proBNP水平明显高于心尖肥厚型心肌病患者,差异有统计学意义(t=28.022,P<0.01)。随访(42.3±11.4)个月,期间共9例患者死亡,1例患者进行了心脏移植术,总事件率为8.33%(9/108)。NT-proBNP>1905 pmol/L组的事件率高于NT-proBNP<860 pmol/L组和860 pmol/L≤NT-proBNP≤1905 pmol/L组,差异有统计学意义(P<0.01)。结论 NT-proBNP对肥厚型心肌病患者的遠期预后有良好的预测价值。
  [关键词]N末端B型利钠肽原;肥厚型心肌病;预后;死亡率
  [中图分类号] R542.2          [文献标识码] A          [文章编号] 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
  肥厚型心肌病是临床上常见的特发性心肌病,目前的研究证实其为一种常染色体显性遗传心脏病,主要病理特征为室间隔心肌呈非对称性肥厚、心室变小,可伴(或不伴)左室流出道梗阻。普遍认为心肌纤维化是影响肥厚型心肌病病程的重要机制,而NT-proBNP水平与心肌纤维化程度密切相关。心肌纤维化程度已经成为肥厚型心肌病患者危险分层的重要指标,心肌纤维化可导致心室壁重塑,心肌电生理活动异常,从而增加心血管不良事件和死亡[1]。有横断面临床研究显示,B型利钠肽(B-typenatriuretic peptide,BNP)和N末端B型利钠肽原(N-terminal B-type natriuretic peptide,NT-proBNP)与肥厚型心肌病的严重程度及运动耐量相关[2]。本研究进一步探讨NT-proBNP水平对肥厚型心肌病远期预后的影响,现报道如下。
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