血N末端B型利钠肽原升高对肥厚型心肌病患者远期预后的影响分析

李爱红

[摘要]目的 探讨血N末端B型利钠肽原（NT-proBNP）水平对肥厚型心肌病远期预后的影响。方法 选择我院2013年10月～2015年10月入院的临床确诊为肥厚型心肌病的108例患者作为研究对象，根据NT-proBNP水平将入选者分为NT-proBNP<860 pmol/L组（n=35）、860 pmol/L≤NT-proBNP≤1905 pmol/L组（n=37）、NT-proBNP>1905 pmol/L组（n=36），分析NT-proBNP对肥厚型心肌病患者远期预后的影响。结果 梗阻型肥厚型心肌病患者的NT-proBNP水平明显高于非梗阻型肥厚型心肌病患者和心尖肥厚型心肌病患者，差异均有统计学意义（t=36.288、62.085，P<0.01）;非梗阻型肥厚型心肌病患者的NT-proBNP水平明显高于心尖肥厚型心肌病患者，差异有统计学意义（t=28.022，P<0.01）。随访（42.3±11.4）个月，期间共9例患者死亡，1例患者进行了心脏移植术，总事件率为8.33%（9/108）。NT-proBNP>1905 pmol/L组的事件率高于NT-proBNP<860 pmol/L组和860 pmol/L≤NT-proBNP≤1905 pmol/L组，差异有统计学意义（P<0.01）。结论 NT-proBNP对肥厚型心肌病患者的遠期预后有良好的预测价值。

[关键词]N末端B型利钠肽原;肥厚型心肌病;预后;死亡率

[中图分类号] R542.2          [文献标识码] A          [文章编号] 1674-4721（2019）7（a）-0044-04

[Abstract] Objective To investigate the influence of blood N-terminal B-type natriuretic peptide progenitor （NT-proBMP） level on the long-term prognosis of hypertrophic cardiomyopathy （HCM）. Methods A total of 108 patients with clinically confirmed HCM admitted to our hospital from October 2013 to October 2015 were selected as the study subjects. According to the NT-proBMP level， they were divided into the NT-proBMP<860 pmol/L group （n=35）， the 860 pmol/L≤NT-proBMP≤l905 pmol/L group （n=37）， the NT-proBMP>1905 pmol/L group （n=36）. The influence of NT-proBNP on long-term prognosis of HCM patients was analyzed. Results The level of NT-proBNP in patients with obstructive hypertrophic cardiomyopathy were significantly higher than those in patients with non-obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy， the differences were statistically significant （t=36.288， 62.085， P<0.01）. The level of NT-proBNP in patients with non-obstructive hypertrophic cardiomyopathy was significantly higher than that in patients with apical HCM， and the difference was statistically significant （t=28.022， P<0.01）. During follow-up （42.3±11.4） months， a total of 9 patients died and 1 patient underwent heart transplantation， the total incidence was 8.33% （9/108）. The event rate of the NT-proBMP>1905 pmol/L group was higher than that of the NT-proBMP<860 pmol/L group and the 860 pmol/L≤NT-proBMP≤1905 pmol/L group， and the difference was statistically significant （P<0.01）. Conclusion NT-proBMP has a good prediction value for the long-term prognosis of HCM patients.

[Key words] N-terminal B-type natriuretic peptide; Hypertrophic cardiomyopathy; Prognosis; Mortality

肥厚型心肌病是临床上常见的特发性心肌病，目前的研究证实其为一种常染色体显性遗传心脏病，主要病理特征为室间隔心肌呈非对称性肥厚、心室变小，可伴（或不伴）左室流出道梗阻。普遍认为心肌纤维化是影响肥厚型心肌病病程的重要机制，而NT-proBNP水平与心肌纤维化程度密切相关。心肌纤维化程度已经成为肥厚型心肌病患者危险分层的重要指标，心肌纤维化可导致心室壁重塑，心肌电生理活动异常，从而增加心血管不良事件和死亡[1]。有横断面临床研究显示，B型利钠肽（B-typenatriuretic peptide，BNP）和N末端B型利钠肽原（N-terminal B-type natriuretic peptide，NT-proBNP）与肥厚型心肌病的严重程度及运动耐量相关[2]。本研究进一步探讨NT-proBNP水平对肥厚型心肌病远期预后的影响，现报道如下。