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目的:利用超声心动图,探讨N-末端脑钠尿肽原(NT-proBNP)对急性心肌梗死(AMI)患者左室舒张功能的评价及其意义。方法:入选左室收缩功能正常的AMI患者66例,测定血浆NT-proBNP水平。根据组织多普勒超声(TDI)及二尖瓣血流频谱指标评价的左室舒张功能,将患者分为4组:A组:左室舒张功能正常组(n=16);B组:轻度左室舒张功能减低(LVDD)组(n=21);C组:中度LVDD组(n=24);D组:重度LVDD组(n=5)。对患者随访12个月,临床终点是因心衰加重或再梗所致再住院和心源性死亡。结果:NT-proBNP水平随着LVDD的加重而显著增高(P<0.01)。NT-proBNP能够独立于其它影响因素判断LVDD,当其水平为962.1μg/L时,判断LVDD的敏感性是76%,特异性是75%。12个月后发生终点事件患者的血浆NT-proBNP水平与未发生者相比差异有统计学意义(P<0.05)。结论:AMI后NT-proBNP水平能够独立评价LVDD并判断预后。它可用于对AMI患者危险分层并指导临床治疗。
Objective: To evaluate the significance and significance of NT-proBNP on left ventricular diastolic function in patients with acute myocardial infarction (AMI) by echocardiography. Methods: Sixty-six AMI patients with normal left ventricular systolic function were enrolled in this study. Plasma NT-proBNP levels were measured. The patients were divided into 4 groups according to the assessment of left ventricular diastolic function by tissue Doppler ultrasonography (TDI) and mitral flow spectrum index: group A: normal left ventricular diastolic function group (n = 16); group B: light LVDD group (n = 21); group C: moderate LVDD group (n = 24); group D: severe LVDD group (n = 5). The patients were followed up for 12 months. The clinical end point was rehospitalization and cardiac death due to aggravated heart failure or recurrent infarction. Results: The level of NT-proBNP increased significantly with the increase of LVDD (P <0.01). NT-proBNP was able to determine LVDD independently of other influencing factors. When its level was 962.1 μg / L, the sensitivity and the specificity of LVDD were 76% and 75% respectively. The plasma levels of NT-proBNP in patients who had an end point after 12 months were significantly different from those who did not (P <0.05). Conclusion: NT-proBNP level after AMI can independently evaluate LVDD and determine the prognosis. It can be used to stratify the risk of AMI patients and guide clinical treatment.