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

李愛(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。