摘要
目的探讨心房颤动（房颤）对不同心功能分级患者血浆氨基末端脑钠素前体（NT—proBNP）水平的影响。方法入选191例心力衰竭患者，按心功能情况分为两组：轻度心力衰竭组（NY—HA分级Ⅰ、Ⅱ级）及重度心力衰竭组（NYHA分级Ⅲ、Ⅳ级）。另选84例非心力衰竭患者为对照组。测定患者NT-proBNP的水平，并将之对数转化。分析房颤对三组患者NT-proBNP水平的影响情况，以及房颤、左心室射血分数（LVEF）、NT—proBNP水平之间的关系；同时，运用多元回归寻找三组患者NT—proBNP水平的独立影响因素。结果非心力衰竭组中，房颤亚组的NT-proBNP水平比窦性心律亚组高[（2．95±0．41）ng／L vs（2．21±0．44）ng／L，P〈0．01]，年龄、房颤和左心房内径（LAD）是NT—proBNP水平的独立影响因素（P〈0．001）。轻度心力衰竭组中，房颤亚组的NT—proBNP水平比窦性心律亚组高[（3．26±0．40）ng／LVS（2．98±0．54）ng／L，P〈0．05]，房颤、LAD、左心室收缩末内径（LVESD）和LVEF是NT—proBNP水平的独立影响因素（P〈0．05）。重度心力衰竭组中，房颤亚组的NT—proBNP水平与窦性心律亚组差异无统计学意义（（3．59±0．52）ng／L vs（3．56±0．55）ng／L，P=0．73]，年龄和LVEF是NT-proBNP水平的独立影响因素（P〈0．05）。当LVEF〈0．40时，房颤组与窦性心律组NT—proBNP水平差异无统计学意义[（3．70±0．60）ng／LVS（3．46±0．56）ng／L，P〉0．103；当LVEFt〉0．4，房颤组的NT-proBNP水平比窦性心律组高[（3．08±0．57）ng／LVS（2．67±0．73）ng／L，P〈0．001]。结论房颤对不同心功能分级的患者血浆NT-proBNP水平的影响是不同的：对于心功能良好的患者或轻度异常的患者（NYHA分级Ⅰ、Ⅱ级或LVEF〉0．40），房颤可使患者的NT-proBNP水平上升，而对于心功能重度异常患者（NYHA分级Ⅲ、Ⅳ级或LVEF≤0．40），房颤对NT—proBNP水平并无影响。
Objective To assess the effect of atrial fibrillation （AF） on plasma levels of NT-proBNP in patients with different cardiac functions. Methods One hundred and ninty-one patients with chronic heart failure （CHF） were divided into two groups： minor CHF group （NYHA Ⅰ/Ⅱ class） and sever CHF group （NYHA Ⅲ/Ⅳ class）. In addition,84 patients without HF （non-HF group） were enrolled as control. The plasma NT-proBNP were assayed and the effect of AF on the NT-proBNP levels was analyzed to determine independent of NT-proBNP levels in 3 groups. Results Patients with AF in non-HF had higher NT-proBNP levels than those with sinus rhythm （SR） [ （ 2. 95 ± 0. 41 ） vs （ 2. 21± 0. 44 ） ng/L, P 〈 0. 01 ], and multi-variables regression demonstrated that age, AF and left atrial diameter （ LAD ） were independent determinants of NT- proBNP levels （P 〈 0. 001 ）. NT-proBNP levels in minor CHF were also higher in patients with AF than that in patients with SR [ （ 3.26± 0. 40 ） ng/L vs （ 2.98 ±0.54 ） ng/L, P 〈 0. 05 ] ; AF, LAD, left ventricular end- systolic dimension （LVESD） and left ventric-ular eject fraction （LVEF） were the independent factors of NT-proBNP levels （ P 〈 0. 05 ）. However, there was no difference of NT-proBNP levels between patients with AF and patients with SR [ （ 3.59 ± 0.52 ） ng/L vs （ 3.56 ±0. 55 ） ng/L, P = 0. 73 ] ; while age and LVEF were independent factors （ P 〈 0.05 ）. In patients with LVEF 〈 0. 40, AF had not significant affect on NT-proBNP levels [AF vs SR： （3.70±0.60） ng/L vs （3.46 ±0. 56） ng/L,P 〉0. 103 ; however,AF patients with LVEF≥ 0. 40,NT-proBNP levels were increased [ AF vs SR ： （ 3.08 ± 0.57 ） ng/L vs （ 2.67 ± 0. 73 ） ng/L, P 〈 0. 001] Conclusion The effect of AF on plasma NT-proBNP was related with cardiac functions： in AF patients without or with minor cardiac dysfunction （ NYHA Ⅰ /Ⅱ class or LVEF 〉10. 40）, NT-proBNP increased; in AF patients with sever cardiac dysfunction （NYHA Ⅲ/Ⅳ class or LVEF 〈 0.40）, NT-proBNP had no significant changes.
出处
《中华心律失常学杂志》
2009年第3期213-216,共4页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金（30671999）,“十一五”国家科技支撑计划（2006BAI01A04）
作者简介
通信作者：葛均波，Email：gejunbo@zs-hospital．sh．cn
