中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
32期
3914-3917
,共4页
方珊娟%王春梅%艾辉%聂绍平
方珊娟%王春梅%艾輝%聶紹平
방산연%왕춘매%애휘%섭소평
心力衰竭,收缩性%肌钙蛋白 T%超声心动描记术%利钠肽,脑%肾小球滤过率
心力衰竭,收縮性%肌鈣蛋白 T%超聲心動描記術%利鈉肽,腦%腎小毬濾過率
심력쇠갈,수축성%기개단백 T%초성심동묘기술%리납태,뇌%신소구려과솔
Heart failure,systolic%Troponin T%Echocardiography%Natriuretic peptide,brain%Glomerular filtration rate
目的：评估非缺血性慢性收缩性心力衰竭患者高敏肌钙蛋白 T（hs - cTnT）与 N 末端 B 型脑钠肽前体（NT - proBNP）及超声心动图指标的关系。方法前瞻性连续入选2013年6月—2014年6月就诊于北京安贞医院的非缺血性慢性收缩性心力衰竭患者73例，患者平均左心室射血分数（LVEF）为（27.3±7.9）％；其中纽约心脏病协会（NYHA）分级Ⅱ级者23例，Ⅲ级者31例，Ⅳ级者19例。检测超声心动图、hs - cTnT、NT - proBNP和血肌酐水平。hs - cTnT、NT - proBNP经对数转换后呈正态分布。lghs - cTnT与连续性变量之间采用直线相关分析与多元逐步回归分析。结果90.4％（66例）的患者检测到hs - cTnT。与 LVEF ﹥30％者hs - cTnT水平〔0.014（0.019）μg/ L〕相比， LVEF≤30％患者的hs - cTnT水平〔0.024（0.037）μg/ L〕明显增高，差异有统计学意义（ Z ＝-2.321，P ＝0.02）。lghs - cTnT与lgNT - proBNP水平呈正相关（r ＝0.539，P ﹤0.001），与左、右心室舒张末期内径呈正相关（r ＝0.291、0.036，P ﹤0.05），与年龄呈正相关（r ＝0.380，P ＝0.002），与 LVEF 呈负相关（r ＝-0.261，P ＝0.034），与估算肾小球滤过率（eGFR）呈负相关（r ＝-0.336，P ＝0.006）。多元逐步回归分析显示lgNT - proBNP、左心室舒张末期内径、年龄及 eGFR 是lghs - cTnT的独立影响因素（P ﹤0.05）。结论在非缺血性慢性收缩性心力衰竭患者中，hs - cTnT水平与超声心动图及NT - proBNP指标相关，hs - cTnT水平升高反映了进行性微量心肌损伤导致的心功能障碍。
目的：評估非缺血性慢性收縮性心力衰竭患者高敏肌鈣蛋白 T（hs - cTnT）與 N 末耑 B 型腦鈉肽前體（NT - proBNP）及超聲心動圖指標的關繫。方法前瞻性連續入選2013年6月—2014年6月就診于北京安貞醫院的非缺血性慢性收縮性心力衰竭患者73例，患者平均左心室射血分數（LVEF）為（27.3±7.9）％；其中紐約心髒病協會（NYHA）分級Ⅱ級者23例，Ⅲ級者31例，Ⅳ級者19例。檢測超聲心動圖、hs - cTnT、NT - proBNP和血肌酐水平。hs - cTnT、NT - proBNP經對數轉換後呈正態分佈。lghs - cTnT與連續性變量之間採用直線相關分析與多元逐步迴歸分析。結果90.4％（66例）的患者檢測到hs - cTnT。與 LVEF ﹥30％者hs - cTnT水平〔0.014（0.019）μg/ L〕相比， LVEF≤30％患者的hs - cTnT水平〔0.024（0.037）μg/ L〕明顯增高，差異有統計學意義（ Z ＝-2.321，P ＝0.02）。lghs - cTnT與lgNT - proBNP水平呈正相關（r ＝0.539，P ﹤0.001），與左、右心室舒張末期內徑呈正相關（r ＝0.291、0.036，P ﹤0.05），與年齡呈正相關（r ＝0.380，P ＝0.002），與 LVEF 呈負相關（r ＝-0.261，P ＝0.034），與估算腎小毬濾過率（eGFR）呈負相關（r ＝-0.336，P ＝0.006）。多元逐步迴歸分析顯示lgNT - proBNP、左心室舒張末期內徑、年齡及 eGFR 是lghs - cTnT的獨立影響因素（P ﹤0.05）。結論在非缺血性慢性收縮性心力衰竭患者中，hs - cTnT水平與超聲心動圖及NT - proBNP指標相關，hs - cTnT水平升高反映瞭進行性微量心肌損傷導緻的心功能障礙。
목적：평고비결혈성만성수축성심력쇠갈환자고민기개단백 T（hs - cTnT）여 N 말단 B 형뇌납태전체（NT - proBNP）급초성심동도지표적관계。방법전첨성련속입선2013년6월—2014년6월취진우북경안정의원적비결혈성만성수축성심력쇠갈환자73례，환자평균좌심실사혈분수（LVEF）위（27.3±7.9）％；기중뉴약심장병협회（NYHA）분급Ⅱ급자23례，Ⅲ급자31례，Ⅳ급자19례。검측초성심동도、hs - cTnT、NT - proBNP화혈기항수평。hs - cTnT、NT - proBNP경대수전환후정정태분포。lghs - cTnT여련속성변량지간채용직선상관분석여다원축보회귀분석。결과90.4％（66례）적환자검측도hs - cTnT。여 LVEF ﹥30％자hs - cTnT수평〔0.014（0.019）μg/ L〕상비， LVEF≤30％환자적hs - cTnT수평〔0.024（0.037）μg/ L〕명현증고，차이유통계학의의（ Z ＝-2.321，P ＝0.02）。lghs - cTnT여lgNT - proBNP수평정정상관（r ＝0.539，P ﹤0.001），여좌、우심실서장말기내경정정상관（r ＝0.291、0.036，P ﹤0.05），여년령정정상관（r ＝0.380，P ＝0.002），여 LVEF 정부상관（r ＝-0.261，P ＝0.034），여고산신소구려과솔（eGFR）정부상관（r ＝-0.336，P ＝0.006）。다원축보회귀분석현시lgNT - proBNP、좌심실서장말기내경、년령급 eGFR 시lghs - cTnT적독립영향인소（P ﹤0.05）。결론재비결혈성만성수축성심력쇠갈환자중，hs - cTnT수평여초성심동도급NT - proBNP지표상관，hs - cTnT수평승고반영료진행성미량심기손상도치적심공능장애。
Objective To evaluate the correlation between hs - cTnT of patients with nonischemic chronic systolic heart failure and NT - proBNP and ultrasonic echocardiography parameters. Methods We prospectively and consecutively enrolled 73 patients with nonischemic chronic systolic heart failure who received treatment in Beijing Anzhen Hospital from June 2013 to June 2014. The mean left ventricular ejection fraction( LVEF)was(27. 3 ± 7. 9)% ;for the NYHA grading,23 patients were at gradeⅡ,31 were at gradeⅢ,and 19 were at grade Ⅳ. Ultrasonic cardiogram,hs - cTnT,NT - proBNP and creatinine level were detected. hs - cTnT and NT - proBNP were in normal distribution after logarithmic transformation. Linear correlation analysis and multivariate stepwise regression analysis were conducted to explore the relation between lghs - cTnT and continuous variables. Results hs - cTnT was detected in 66(90. 4% )patients. Compared with the hs - cTnT level〔0. 014 (0. 019)μg/ L〕of patients with LVEF ﹥ 30% ,the hs - cTnT level〔0. 024(0. 037) μg/ L〕of patients with LVEF≤30%was significantly higher( Z = - 2. 321,P = 0. 02). The level of lghs - cTnT was positively correlated with the level of lgNT - proBNP(r = 0. 539,P ﹤ 0. 001),positively correlated with left ventricular end diastolic diameter( r = 0. 291,P =0. 018),positively correlated with right ventricular end diastolic dimension(r = 0. 036,P = 0. 004),positively correlated with age(r = 0. 380,P = 0. 002),negatively correlated with LVEF( r = - 0. 261,P = 0. 034),and negatively correlated with estimated glomerular filtration rate( r = - 0. 336,P = 0. 006). Multivariate regression analysis showed that lgNT - proBNP, LVEDD,age and eGFR were independent influencing factors for lghs - cTnT( P ﹤ 0. 05). Conclusion In patients with nonischemic systolic heart failure,hs - cTnT is correlated with ultrasonic cardiogram and NT - proBNP. The elevation of hs - cTnT level may indicate cardiac dysfunction induced by progressive slight myocardial injury.
