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目的:探讨扩张型心肌病(DCM)患者血浆氨基端脑钠素原(NT-proBNP)的变化及其影响因素。方法:用酶联免疫吸附方法,测定203例DCM组患者的血浆NT-proBNP浓度,并与203例对照组相比较。DCM组内再按下列不同的观察指标对NT-proBNP进行分析比较:按NYHA心功能分级进行Ⅱ级,Ⅲ级,Ⅳ级间比较;按体重指数进行超重者和不超重者间比较;按血清肌酐浓度进行肾功能异常者和肾功能正常者间比较;按是否合并心房颤动进行心房颤动者和无心房颤动者间比较。并用多元逐步回归分析,分析DCM患者中血浆NT-proBNP的影响因素。结果:与对照组比较,DCM组血浆NT-proBNP浓度显著升高(P<0.01)。DCM组血浆NT-proBNP浓度在各级NYHA心功能的DCM患者均显著高于对照组(P均<0.01),且在不同NYHA心功能分级间亦逐级显著升高(P均<0.01);在肾功能异常者血浆NT-proBNP浓度显著高于肾功能正常者(P<0.01);超重者血浆NT-proBNP浓度显著低于不超重者(P<0.01)。多元逐步回归分析结果显示:只有NYHA心功能分级、体重指数、血清肌酐浓度、左心室射血分数、心率和左心房内径依次入选为血浆NT-proBNP浓度的独立预测因素(P<0.05或0.01),其中NYHA心功能分级最强(P<0.01)。结论:DCM患者血浆NT-proBNP浓度显著升高,除取决于患者心功能外,还受体重指数、血清肌酐浓度等因素影响。
Objective: To investigate the changes of plasma NT-proBNP and its influencing factors in patients with dilated cardiomyopathy (DCM). Methods: Plasma concentrations of NT-proBNP in 203 patients with DCM were measured by enzyme-linked immunosorbent assay and compared with 203 controls. DCM group according to the following different indicators of NT-proBNP were analyzed and compared: According to NYHA cardiac function grade Ⅱ, Ⅲ, Ⅳ grade comparison; body mass index overweight and not overweight; according to serum Creatinine concentrations were compared between patients with normal renal function and renal dysfunction; according to whether atrial fibrillation with or without atrial fibrillation were compared between persons. Multiple regression analysis was used to analyze the influencing factors of plasma NT-proBNP in patients with DCM. Results: Compared with the control group, plasma NT-proBNP concentration was significantly increased in DCM group (P <0.01). The plasma concentration of NT-proBNP in DCM group was significantly higher than that in control group (all P <0.01), and significantly increased in different grades of NYHA heart function (P <0.01). The NT-proBNP concentration in patients with abnormal renal function was significantly higher than that in patients with normal renal function (P <0.01). The plasma concentrations of NT-proBNP in overweight patients were significantly lower than those in non-overweight patients (P <0.01). Multivariate stepwise regression analysis showed that only NYHA functional class, body mass index, serum creatinine, left ventricular ejection fraction, heart rate and left atrial diameter were selected as independent predictors of plasma NT-proBNP concentration (P <0.05 or 0.01) , Of which NYHA had the strongest cardiac function classification (P <0.01). Conclusion: The plasma concentration of NT-proBNP in patients with DCM is significantly higher than that in patients with DCM, except for the cardiac function. The body mass index and serum creatinine concentration are also affected.