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目的:探讨血浆大内皮素-1(Big ET-1)水平与肥厚型梗阻性心肌病(HOCM)患者心脏重构的相关性。方法:入选自2015-01至2016-05于我院住院治疗的HOCM患者167例,测定血浆Big ET-1、N末端B型利钠肽原(NT-pro BNP)水平等指标,完善心电图、动态心电图、超声心动图(UCG)及心脏磁共振成像(CMR)检查,进行相关统计学分析。结果:在167例HOCM患者中,相关性分析及多元线性回归发现Ln Big ET-1与Ln NT-pro BNP(r=0.35,P=0.000)、左心房前后径(r=0.169,P=0.019)及心率(r=0.141,P=0.037)呈正相关,与血红蛋白(r=-0.173,P=0.013)及室间隔厚度/左心室后壁厚度比值(r=-0.165,P=0.017)呈负相关。基于Big ET-1与左心房前后径呈正相关的发现,将研究对象分为左心房正常组74例及左心房增大组93例。与左心房正常组比,左心房增大组患者血浆Big ET-1水平显著增高(P=0.001);UCG测量的左心室舒张末期内径较大(P=0.024),室间隔较厚(P=0.003),左心室射血分数偏低(P=0.001);CMR测量的左心室舒张末期容积(P=0.002)及室间隔厚度(P=0.002)较大;伴发心房颤动的比率增加(P=0.004);存在二尖瓣中-大量反流(P=0.011)及纽约心脏协会(NYHA)心功能Ⅲ或Ⅳ级(P=0.022)的患者增多。结论:在HOCM患者中,Ln Big ET-1与Ln NT-pro BNP、左心房内径呈正相关。左心房增大的HOCM患者血浆Big ET-1水平显著升高,心脏结构重构更明显,伴发心房颤动的比率增加。Big ET-1可能在HOCM患者的心脏重构中发挥作用。
Objective: To investigate the correlation between plasma ET-1 level and cardiac remodeling in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: One hundred and sixty-seven HOCM patients admitted to our hospital from January 2015 to 2016-05 were enrolled in this study. The plasma ET-1 and NT-proBNP levels were measured. The electrocardiogram, Holter, echocardiography (UCG) and cardiac magnetic resonance imaging (CMR) examination, the relevant statistical analysis. Results: In 167 patients with HOCM, correlation analysis and multiple linear regression showed that Ln Big ET-1 and Ln NT-pro BNP (r = 0.35, P = 0.000) ) And heart rate (r = 0.141, P = 0.037), and negatively correlated with hemoglobin (r = -0.173, P = 0.013) and ventricular septal thickness / left ventricular posterior wall thickness Related. Based on the positive correlation between Big ET-1 and anteroposterior diameter of left atrium, the subjects were divided into 74 cases of normal left atrium and 93 cases of left atrial enlargement. Compared with the normal left atrium group, the plasma levels of Big ET-1 in patients with left atrial enlargement were significantly increased (P = 0.001). The diameter of left ventricular end-diastolic diameter measured by UCG was larger (P = 0.024) and the ventricular septum thicker (P = 0.003), left ventricular ejection fraction (P = 0.001), left ventricular end diastolic volume (P = 0.002) and interventricular septum thickness (P = 0.002) = 0.004). There was an increase in patients with moderate-mitral regurgitation (P = 0.011) and NYHA cardiac function grade III or IV (P = 0.022). CONCLUSION: Ln Big ET-1 and Ln NT-pro BNP and left atrial diameter are positively correlated in patients with HOCM. The plasma levels of Big ET-1 in patients with HOCM with increased left atrium were significantly increased, the structural remodeling of the heart was more pronounced, and the rate of atrial fibrillation was increased. Big ET-1 may play a role in cardiac remodeling in HOCM patients.