急症高血糖对N端脑钠肽原评价心功能的影响(1)
【摘要】目的 对不同血糖状态下的N端脑钠肽原(N terminal proBNP，NT-proBNP)与组织多普勒(TDI)测定的心功能指数(Tei指数)相关性进行分析，探讨急症高血糖状态对NT-proBNP评价心功能的影响。方法 前瞻性纳入广东省人民医院心内科连续收入的急性冠脉综合征患者，根据入院后空腹血糖水平分为急症高血糖组(空腹血糖≥6.1 mmol/L)和正常血糖组(空腹血糖<6.1 mmol/L)，两组均接受经胸超声心动图检查，并应用TDI测定所有患者的Tei指数，比较两组Tei指数与NT-proBNP的相关性。结果 急症高血糖组(27例)TDI-Tei指数较正常血糖组(35例)显著延长[(0.68±0.14) vs. (0.61±0.10)，P=0.03]，相关收缩指数与舒张指数也显著延长[(0.29±0.07) vs. (0.26±0.05)，P=0.045；(0.38±0.08) vs. (0.35±0.05)，P=0.03]；两组TDI-Tei指数与NT-proBNP自然对数值均呈直线关系。高血糖组TDI-Tei=0.175+0.068 ln NT-proBNP，R2=0.702，回归系数检验t=7.675，P<0.01。正常血糖组TDI-Tei=0.185+0.060 ln NT-proBNP，R2=0.405，回归系数检验t=4.738，P<0.01。结论 与正常血糖水平的急性冠脉综合征患者相比，伴急症高血糖状态的患者左室整体功能更差；无论在正常血糖水平，还是在急症高血糖状态下，NT-proBNP与TDI-Tei指数都具有显著的直线回归关系。NT-proBNP可以用于准确评价急症高血糖状态下的急性冠脉综合征患者的心脏整体功能。
, http://www.100md.com
【关键词】高血糖；应激；急性冠脉综合征；利钠肽，脑；心室功能；超声心动图；组织多普勒；Tei指数
Influence of acute hyperglycemia on the assessment of cardiac function with N-terminal pro-brain natriuretic peptide XUE Ling， FU Ming， LUO Jian-fang， WANG Ling，ZHOU Ying-ling，CHEN Ji-yan. Department of Cardiology， Guangdong Cardiovascular Institute， Guangdong Academy of Medical Sciences， Guangdong Provincial People’s Hospital，Guangzhou 510080， China
Corresponding author： LUO Jian-fang， Email：drxue@hotmial.com
, 百拇医药
【Abstract】Objective To investigate the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) derived cardiac function index (Tei index) in patients with acute coronary syndrome under different plasma glucose levels and to evaluate the influence of hyperglycemia on the preciseness of cardiac function assessment with NT-proBNP.Methods Consecutive patients with acute coronary syndrome admitted to the department of cardiology in Guangdong General Hospital were prospectively enrolled. Based on their plasma fasting glucose level，patients were divided into hyperglycemia group (fasting plasma glucose ≥ 6.1 mmol/L) and euglycemia group (fasting plasma glucose< 6.1mmol/L). All the patients underwent transthoracic echocardiagraphy and tissue Doppler imaging (TDI) investigations. Blood samples were obtained within 24 hours of hospitalization for measurment of NT-proBNP level. Relationship between TDI- Tei index and the level of NT-proBNP in the two groups were analyzed respectively. Results The TDI-Tei index， the systolic index and the diastolic index were all significant higher in the hyperglycemia group (n = 27) than those in the euglycemia group(n = 35)(0.68±0.14) vs. (0.61 ±0.10)，P =0.03； (0.29±0.07) vs. (0.26±0.05)，P =0.045；(0.38±0.08)vs. (0.35±0.050，P=0.03， respectively. In both groups， TDI- Tei and ln NT-proBNP showed significant linear regression. In the hyperglycemia group， TDI- Tei = 0.175+ 0.068 ln NT-proBNP， R2 =0.702， P < 0.01. In the euglycemia group， TDI-Tei = 0.185+ 0.060 ln NT-proBNP， R2 =0.405， P < 0.01.Conclusions (1) Compared with patients suffering from an acute coronary syndrome with euglycemia，the global cardiac function of patients with hyperglycemia is poorer； (2) NT-proBNP correlates significantly with TDI-Tei in both hyperglycemia and euglycemia patients with acute heart syndrome. It is appropriate to assess global cardiac function with NT-proBNP in patients suffering from ACS complicated with hyperglycemia.
, 百拇医药(薛凌 付明 罗建方 王玲 周颖玲 陈纪言)
, http://www.100md.com
【关键词】高血糖；应激；急性冠脉综合征；利钠肽，脑；心室功能；超声心动图；组织多普勒；Tei指数
Influence of acute hyperglycemia on the assessment of cardiac function with N-terminal pro-brain natriuretic peptide XUE Ling， FU Ming， LUO Jian-fang， WANG Ling，ZHOU Ying-ling，CHEN Ji-yan. Department of Cardiology， Guangdong Cardiovascular Institute， Guangdong Academy of Medical Sciences， Guangdong Provincial People’s Hospital，Guangzhou 510080， China
Corresponding author： LUO Jian-fang， Email：drxue@hotmial.com
, 百拇医药
【Abstract】Objective To investigate the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) derived cardiac function index (Tei index) in patients with acute coronary syndrome under different plasma glucose levels and to evaluate the influence of hyperglycemia on the preciseness of cardiac function assessment with NT-proBNP.Methods Consecutive patients with acute coronary syndrome admitted to the department of cardiology in Guangdong General Hospital were prospectively enrolled. Based on their plasma fasting glucose level，patients were divided into hyperglycemia group (fasting plasma glucose ≥ 6.1 mmol/L) and euglycemia group (fasting plasma glucose< 6.1mmol/L). All the patients underwent transthoracic echocardiagraphy and tissue Doppler imaging (TDI) investigations. Blood samples were obtained within 24 hours of hospitalization for measurment of NT-proBNP level. Relationship between TDI- Tei index and the level of NT-proBNP in the two groups were analyzed respectively. Results The TDI-Tei index， the systolic index and the diastolic index were all significant higher in the hyperglycemia group (n = 27) than those in the euglycemia group(n = 35)(0.68±0.14) vs. (0.61 ±0.10)，P =0.03； (0.29±0.07) vs. (0.26±0.05)，P =0.045；(0.38±0.08)vs. (0.35±0.050，P=0.03， respectively. In both groups， TDI- Tei and ln NT-proBNP showed significant linear regression. In the hyperglycemia group， TDI- Tei = 0.175+ 0.068 ln NT-proBNP， R2 =0.702， P < 0.01. In the euglycemia group， TDI-Tei = 0.185+ 0.060 ln NT-proBNP， R2 =0.405， P < 0.01.Conclusions (1) Compared with patients suffering from an acute coronary syndrome with euglycemia，the global cardiac function of patients with hyperglycemia is poorer； (2) NT-proBNP correlates significantly with TDI-Tei in both hyperglycemia and euglycemia patients with acute heart syndrome. It is appropriate to assess global cardiac function with NT-proBNP in patients suffering from ACS complicated with hyperglycemia.
, 百拇医药(薛凌 付明 罗建方 王玲 周颖玲 陈纪言)