CysC、NT-proBNP、cTnT在急性心力衰竭患者中的水平及其联合检测的诊断价值

摘要

目的:探讨胱抑素C (CysC) 、 N末端脑钠肽前体(NT-proBNP) 、心肌肌钙蛋白 T (cTnT)在急性心力衰竭(AHF)患者中的水平及其联合检测的诊断价值.方法:选择2014年2月～2016年2月于我院接受治疗的AHF患者61例(包括NYHA II级21例、 III级20例和IV级20例) ,另外选择同时期健康体检者61例作为健康对照组.测量比较两组及不同心功能分级组血浆CysC 、 NT-proBNP 、 cTnT水平,比较CysC 、 NT-proBNP 、 cTnT单一及联合检测预测AHF及其预后的价值.结果:与健康对照组比较,AHF组血浆CysC [ (0.89 ± 0.12) mg/L比(1.64 ± 0.61) mg/L]、 NT-proBNP [ (186.24 ± 15.35) ng/L比(2562.44 ± 69.67) ng/L] 和cTnT [ (0.08 ± 0.04) μg/L比(0.32 ± 0.31) μg/L] 水平均显著升高, P均＝0.001 .与NYHA II级组比较, III级、 IV级组血浆CysC [ (1.23 ± 0.47) mg/L比(1.73 ± 0.58) mg/L比(2.11 ± 0.62) mg/L]、 NT-proBNP [ (867.45 ± 48.91) ng/L比(1868.24 ± 79.70) ng/L比(3786.56 ± 89.94) ng/L] 和cTnT [ (0.25 ± 0.08) μg/L比(0.39 ± 0.24) μg/L比(0.49 ± 0.37) μg/L] 水平均显著升高,且IV级组的血浆NT-proBNP水平显著高于 III级组(P＜0.05或＜0.01).与CysC、NT-proBNP、cTnT单一检测比较,三者联合检测预测AHF (49.18%、50.82%、54.10%比90. 16%) 、恶性心律失常(44. 00%、 48.00%、 48.00% 比80.00%)和心衰加重(50.00%、 44. 44%、 38. 89%比83.33%)的阳性率均显著升高, P＜0.05或＜ 0.01 .结论: CysC 、 NT-proBNP 、 cTnT联合检测对AHF危险及预后的评估价值高,值得临床推广.%Objective :To explore levels of cystatin C (CysC) ,N terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) in patients with acute heart failure (AHF) and diagnostic value of their combined de-tection .Methods :A total of 61 AHF patients treated in our hospital from Feb 2014 to Feb 2016 were selected ,in-cluding 21 cases of NYHA class II ,20 cases of class III and 20 cases of class IV .Another 61 healthy subjects under-going physical examination were treated as healthy control group during the same period .Plasma levels of CysC , NT-proBNP and cTnT were measured and compared between two groups and among different cardiac function class group .Predictive value of single and combined detection of CysC ,NT-proBNP and cTnT for AHF and its prognosis were compared .Results : Compared with healthy control group ,there were significant rise in plasma levels of CysC [(0.89 ± 0.12) mg/L vs.(1.64 ± 0.61) mg/L] ,NT-proBNP [(186.24 ± 15.35) ng/L vs.(2562.44 ± 69.67) ng/L] and cTnT [ (0.08 ± 0.04) μg/L vs.(0.32 ± 0.31) μg/L] in AHF group ,P＝0.001 all.Compared with NYHA class II group ,there were significant rise in plasma levels of CysC [ (1.23 ± 0.47) mg/L vs.(1.73 ± 0.58) mg/L vs.(2.11 ± 0.62) mg/L] ,NT-proBNP [ (867.45 ± 48.91) ng/L vs.(1868.24 ± 79.70) ng/L vs.(3786.56 ± 89.94) ng/L] and cTnT [ (0.25 ± 0.08) μg/L vs .(0.39 ± 0.24) μg/L vs.(0.49 ± 0.37) μg/L] in class III group and class IV group ,and plasma NT-proBNP level of class IV group was significantly higher than that of class III group ,P＜0.05 or ＜0.01. Compared with single detection of CysC ,NT-proBNP and cTnT ,there were significant rise in predictive positive rates of AHF (49.18%,50.82%,54.10% vs.90.16%) ,malignant arrhythmia (44.00%, 48.00%,48.00% vs .80.00%) and heart failure aggravation (50.00%,44.44%,38.89% vs.83.33%) of triple detection ,P＜0.05 or ＜0.01. Conclusion :Combined detection of CysC ,NT-proBNP and cTnT possesses high eval-uation and predictive value for AHF risk and prognosis ,which is worth extending .