老年高血压性肥厚型心肌病和高血压左心室肥厚患者的比较研究

摘要

Objective: To compare the clinical characteristics and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) between the patients with hypertensive hypertrophic cardiomyopathy in elder age (HHCME) and the patients with hypertensive left ventricular hypertrophy (HTN-LVH). Methods: Our work included 2 groups, HHCME group,n=47 and HTN-LVH group,n=44. Duplex Doppler echocardiography was performed to determine left atrial diameter (LAd), left ventricular end-diastolic dimension (LVEDd), interventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), velocity of early diastolic period (VE) and velocity of end-diastolic period (VA) in mitral valve oriifce. Plasma level of NT-proBNP was measured by ELISA. The above indexes were compared between 2 groups. Results:①Compared with HTN-LVH group, HHCME group presented decreased LVEDd and increased IVST, LVEF, allP<0.001. There were no signiifcant differences in VE/VA ratio and LAd between 2 groups, allP>0.05.②Plasma level of NT-proBNP was higher in HHCME group,P<0.01. With the adjusted age, gender, history of hypertension, LAd, IVST, left ventricular systolic and diastolic function, the level of NT-proBNP in HHCME group (1317.19 fmol/ml) was still signiifcantly higher than that in HTN-LVH group (526.19fmol/ml),P<0.01. Conclusion: The plasma NT-proBNP level was higher in HHCME patients than that in HTN-LVH patients which indicated that HHCME patients may have worse prognosis. NT-proBNP might be helpful for differencing HHCME.%目的：比较研究老年高血压性肥厚型心肌病（HHCME）和高血压性左心室肥厚（HTN-LVH）患者的临床特点和血浆N末端B型利钠肽原（NT-proBNP）水平。　　方法：入选HHCME患者47例为HHCME组， HTN-LVH患者44例为HTN-LVH组。以二维及多普勒超声心动图分别测定两组患者左心房内径（LAd）、左心室舒张末期内径（LVEDd）、室间隔厚度（IVST），左心室射血分数（LVEF），舒张期二尖瓣口E波流速（VE）及A波流速（VA）等。用酶联免疫吸附法测定患者血浆NT-proBNP浓度。　　结果：①HHCME组患者与HTN-LVH组患者比较，左心室舒张末期内径明显缩小（P<0.001），室间隔厚度、左心室射血分数显著升高（P<0.001），两组VE/VA差异无统计学意义（P>0.05）。两组患者左心房内径差异无统计学意义（P>0.05）；②NT-proBNP水平在HHCME组显著升高（P<0.01）。校正年龄、性别、高血压病史以及左心腔内经、室壁厚度及左心室收缩、舒张功能的影响后，HHCME组血浆NT-proBNP水平（1317.19 fmol/ml）仍显著高于HTN-LVH组（526.19 fmol/ml），P<0.01。　　结论： HHCME患者血浆NT-proBNP水平明显高于HTN-LVH患者，预示HHCME患者预后较HTN-LVH患者差。血浆NT-proBNP水平可能有助于HHCME的鉴别诊断。