氨基末端 B 型脑利钠肽前体与急性脑梗死患者左心室舒张功能的相关性分析

摘要

Objective To analyze the correlation between NT-proBNP and left ventricular diastolic function of patients with acute cerebral infarction. Methods A total of 273 patients with acute cerebral infarction were selected as control group in the Central Hospital of Baoji from March 2013 to March 2016,and they were divided into subgroups A1( with diameter of infarction focus over 5 cm,n = 54),A2(with diameter of infarction focus within 3 to 5 cm,n = 118)and A3(with diameter of infarction focus less than 3 cm,n = 101)according to the diameter of infarction focus,into subgroups B1(with large - artery atherosclerosis,n = 91),B2(with cardiac embolism,n = 57),B3(with small artery occlusion,n = 80),B4(with other specific etiology,n = 17)and B5(with unknown etiology,n = 28)according to the TOAST type for ischemic stroke;a total of 232 healthy people admitted to this hospital for physical examination were selected as control group at the same time. NT-proBNP, isovolumic relaxation time(IVRT),peak value of left atrioventricular valve ring movement speed at early filling stage and peak value of left atrioventricular valve ring movement speed at late filling stage( Ea/ Aa ratio),and tissue motion velocity of left atrioventricular valve ring at left atrial systolic stage(A' value)were detected,Pearson correlation analysis was used to analyze the correlations between NT-proBNP and IVRT,Ea/ Aa. Results NT-proBNP of observation group was statistically significantly higher than that of control group,IVRT of observation group was statistically significantly longer than that of control group,while Ea/ Aa ratio of observation group was statistically significantly lower than that of control group( P ﹤ 0. 05);no statistically significant differences of A' value was found between observation group and control group( P ﹥ 0. 05). Pearson correlation analysis showed that,NT-proBNP was positively correlated with IVRT of observation group( r = 0. 33,P = 0. 02 ),was negatively correlated with Ea/ Aa ratio( r = - 0. 37,P = 0. 01);of A1 group and A2 group,NT-proBNP was positively correlated with IVRT,respectively(r = 0. 39,0. 28,P ﹤ 0. 05),was negatively correlated with Ea/ Aa ratio,respectively(r= - 0. 41, - 0. 30,P ﹤ 0. 05);of A3 group,NT-proBNP was not linearly correlated with IVRT( r = 0. 20,P ﹥ 0. 05) or Ea/ Aa ratio( r = - 0. 25,P ﹥ 0. 05 );of B1 group and B2 group,NT-proBNP was positively correlated with IVRT, respectively(r = 0. 29,0. 42,P ﹤ 0. 05),was negatively correlated with Ea/ Aa ratio,respectively(r = - 0. 31, - 0. 39,P﹤ 0. 05);of B3,B4 and B5 group,NT-proBNP was not linearly correlated with IVRT(r = 0. 22,0. 24,0. 20,P ﹥ 0. 05)or Ea/ Aa ratio(r = - 0. 23, - 0. 21, - 0. 25,P ﹥ 0. 05). Conclusion NT-proBNP is correlated with IVRT and Ea/ Aa ratio of patients with acute cerebral infarction,detection of NT-proBNP is helpful to judge the damage status of left ventricular diastolic function,especially in patients with diameter of infarction focus over 5 cm,with large - artery atherosclerosis or cardiac embolism.%目的：分析氨基末端 B 型脑利钠肽前体（NT-proBNP）与急性脑梗死患者左心室舒张功能的相关性。方法选取2013年3月—2016年3月宝鸡市中心医院收治的急性脑梗死患者273例作为观察组，按梗死灶直径大小分为大面积梗死组（直径﹥5 cm）54例、中面积梗死组（直径3~5 cm）118例、小面积梗死组（直径﹤3 cm）101例；按缺血性脑卒中 TOAST 分型分为大动脉粥样硬化型（LAA）组91例、心源性栓塞型（CE）组57例、小动脉闭塞型（SAO）组80例、其他明确病因型（SOE）组17例、不明病因型（SUE）组28例。另选取同期在宝鸡市中心医院体检健康者232例作为对照组。检测所有受试者NT-proBNP、左心室等容舒张时间（IVRT）、充盈早期左房室瓣环运动速度峰值/充盈晚期左房室瓣环运动速度峰值（ Ea/ Aa）及左房室瓣环左心房收缩期组织运动速度（ A＇值）等， NT-proBNP与 IVRT、Ea/ Aa 的相关性分析采用 Pearson 相关性分析。结果观察组患者NT-proBNP高于对照组，IVRT 长于对照组，Ea/ Aa 低于对照组（P ﹤0.05）；两组受试者 A＇值比较，差异无统计学意义（P ﹥0.05）。Pearson 相关性分析结果显示，观察组患者NT-proBNP与 IVRT 呈正相关（ r =0.33，P =0.02），与 Ea/ Aa 呈负相关（ r =-0.37，P=0.01）。大面积梗死组、中面积梗死组患者NT-proBNP与 IVRT 呈正相关（r 值分别为0.39、0.28，P ﹤0.05），与 Ea/Aa 呈负相关（r 值分别为-0.41、-0.30，P ﹤0.05）；小面积梗死组患者NT-proBNP与 IVRT（ r =0.20）、Ea/ Aa（ r=-0.25）无直线相关关系（P ﹥0.05）。LAA 组、CE 组患者NT-proBNP与 IVRT 呈正相关（r 值分别为0.29、0.42，P﹤0.05），与 Ea/ Aa 呈负相关（r 值分别为-0.31、-0.39，P ﹤0.05）；SAO 组、SOE 组和 SUE 组患者NT-proBNP与IVRT（r 值分别为0.22、0.24、0.20）、Ea/ Aa（r 值分别为-0.23、-0.21、-0.25）无直线相关关系（ P ﹥0.05）。结论 NT-proBNP与急性脑梗死患者 IVRT、Ea/ Aa 存在相关关系，临床可通过检测NT-proBNP水平以评估急性脑梗死患者左心室舒张功能损伤情况，且其对大面积梗死及 TOAST 分型为 LAA、CE 型患者的评估价值较高。