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目的探讨在老年原发高血压病合并不同类型CHD患者的血浆中NT-proBNP的水平的变化及临床意义。方法用酶联免疫吸附法(ELISA)测定各组患者血清BNP浓度,共125例,①单纯原发性高血压病组35例,其中伴左心室肥厚(LVH组)15例,不伴左心室肥厚(NLVH)20例,采用多普勒超声计算左心室重量指数(LVMI)②高血压病合并阵发性房颤(AF)患者24例,③高血压病合并不稳定性心绞痛(UAP)患者23例,④高血压病合并急性心肌梗死型(AMI)13例,⑤30例正常人对照组,UAP、AMI诊断标准参考中华医学会心血管病学分会等制定的标准。根据生化检查、NYHA心功能分级以及超声检测排除肺疾病,心脏瓣膜病及肾功能不全,比较BNP在各组中的水平及差异。结果正常对照组BNP为(49.77±8.62)pg/ml,单纯高血压患者,高血压病合并阵发性房颤患者,高血压病合并不稳定性心绞痛患者,高血压病合并急性心肌梗死患者的BNP指标分别为(227.48±38.39)pg/ml,(612.75±139.44)pg/ml,(618.78±189.24)pg/ml,(1409.85±417,06)pg/ml,在高血压合并AMI组中BNP水平高于其他组,高血压病合并房颤及高血压合并不稳定性心绞痛患者BNP水平高于单纯性高血压患者,单纯性高血压患者BNP水平高于正常对照组(P<0.05)。高血压病合并LVH患者BNP水平高于高血压病合并NLVH患者及对照组水平,BNP和左心室肥厚存在正相关性。结论 BNP是高血压病、左心室肥厚、阵发性房颤及心肌损伤和坏死的很强预测指标。
Objective To investigate the changes and clinical significance of NT-proBNP levels in elderly patients with essential hypertension complicated with different types of CHD. Methods Serum BNP levels were measured by enzyme-linked immunosorbent assay (ELISA) in 125 patients. ① In 35 patients with simple essential hypertension, 15 patients with left ventricular hypertrophy (LVH group) and 15 patients without left ventricular 20 cases of hypertrophy (NLVH), left ventricular mass index (LVMI) by Doppler ultrasound, 24 cases of hypertension complicated by paroxysmal atrial fibrillation (AF), 3 patients with hypertension complicated by unstable angina pectoris (UAP) 23 cases, ④ hypertensive disease with acute myocardial infarction (AMI) in 13 cases, ⑤30 cases of normal control group, UAP, AMI diagnostic criteria with reference to the Chinese Medical Association Cardiology Branch and other standards set. BNP levels and differences in each group were compared according to biochemical tests, NYHA functional classification, and sonography to exclude lung disease, valvular heart disease, and renal insufficiency. Results BNP was (49.77 ± 8.62) pg / ml in normal control group, hypertension alone, hypertension complicated with paroxysmal atrial fibrillation, hypertension complicated with unstable angina, hypertension complicated with acute myocardial infarction indicators were BNP (227.48 ± 38.39) pg / ml, (612.75 ± 139.44) pg / ml, (618.78 ± 189.24) pg / ml, (1409.85 ± 417,06) pg / ml, BNP in AMI group hypertension The level of BNP in patients with hypertension complicated by atrial fibrillation and hypertension complicated by unstable angina pectoris was higher than that in patients with simple hypertension, and the level of BNP in patients with simple hypertension was higher than that in the control group (P <0.05). BNP levels in patients with hypertension and LVH were significantly higher than those in patients with hypertension and NLVH. There was a positive correlation between BNP and left ventricular hypertrophy. Conclusions BNP is a strong predictor of hypertension, left ventricular hypertrophy, paroxysmal atrial fibrillation and myocardial injury and necrosis.