论文部分内容阅读
目的探讨以利钠多肽评价伴睡眠呼吸暂停慢性心力衰竭患者心功能的可能性。方法64例慢性充血性心力衰竭(心衰)住院患者,经多导睡眠监测分为两组,心衰伴睡眠呼吸暂停组36例和心衰不伴睡眠呼吸暂停组28例。观察两组患者的一般资料、血气分析、心功能和体液因子变化,采用双抗夹心ELISA定量和竞争EIA定量法测定心钠素和脑钠素水平。结果心衰伴睡眠呼吸暂停组左室舒张末期内径、左房前后径、纽约心功能分级、房性利钠多肽前体(proANP)、N-端室性利钠多肽前体(Nt-proBNP)水平增加;左室射血分数、血氧饱和度(SaO2)下降。左室射血分数< 45％心衰患者较≥45％心衰患者原发性心肌病多见;心功能各项检查的多元相关分析:左室射血分数与左室舒张末期内径和Nt-proBNP呈负相关(r=-0．662,P=0．000和r=-0．307 P=0．009);左室舒张末期内径与左房前后径呈正相关(r=0．491,P=0．000);左房前后径与proANP和Nt-proBNP呈正相关(r=0．432,P=0．000和r=0．295,P=0．012);proANP与Nt-proBNP呈正相关(r=0．784,P=0．000)。心衰的多种影响因素多元线性回归分析:冠心病、纽约心功能分级、左室舒张末期内径、proANP和Nt-proBNP与左室射血分数呈负相关(P=0．000、P=0．031、P=0．000、P=0．004、P=0．000)。结论睡眠呼吸暂停对64例心衰住院患者的心功能产生影响;利钠多肽与心脏超声所测左室射血分数在评价心功能方面呈负相关。
Objective To investigate the possibility of using natriuretic peptide to assess cardiac function in patients with chronic heart failure accompanied by sleep apnea. Methods Sixty-four inpatients with chronic congestive heart failure (CHF) were divided into two groups according to polysomnography: 36 cases of heart failure with sleep apnea and 28 cases of heart failure without sleep apnea. The general data, blood gas analysis, cardiac function and humoral factors of two groups were observed. The levels of atrial natriuretic peptide and brain natriuretic peptide were measured by double-antibody sandwich ELISA and competitive EIA. Results Left ventricular end-diastolic diameter, left atrium dimension, NYC functional class, atrial natriuretic peptide precursor (proANP), Nt-proBNP (Nt-proBNP) Level increased; left ventricular ejection fraction, blood oxygen saturation (SaO2) decreased. Left ventricular ejection fraction <45% of patients with heart failure more than 45% of patients with heart failure in primary cardiomyopathy more common; multiple tests of cardiac function correlation analysis: left ventricular ejection fraction and left ventricular end diastolic diameter and Nt- (r = -0.662, P = 0.000, r = -0.307 P = 0.009). There was a positive correlation between left ventricular end diastolic diameter and anteroposterior diameter (r = 0.491, P = 0.000). The anteroposterior diameter of left atrium was positively correlated with proANP and Nt-proBNP (r = 0.432, P = 0.000 and r = 0.295, P = 0.012) (R = 0.784, P = 0.000). Multiple linear regression analysis showed that coronary heart disease, New York Heart Association score, end-diastolic diameter, proANP and Nt-proBNP were negatively correlated with left ventricular ejection fraction (P = 0.000, P = 0 .031, P = 0.000, P = 0.004, P = 0.000). Conclusions Sleep apnea affects the cardiac function of 64 hospitalized patients with heart failure. Natriuretic peptide and left ventricular ejection fraction measured by echocardiography are negatively correlated with cardiac function.