脑钠肽、尿微量白蛋白在心力衰竭患者中的临床诊断价值

摘要

目的:观察不同心力衰竭患者血浆脑钠肽(BNP)和尿微量白蛋白(UMA)水平及其相关性.方法:选择180例心内科住院病人为研究对象,根据NYHA心功能分级和左室功能,患者被分为无心衰对照组(32例)、舒张性心力衰竭(DHF)组(72例)和收缩性心力衰竭(SHF)组(76例).测定比较以上三组心功能组的血浆BNP和尿UMA水平,并分析二者的相关性.结果:与无心衰对照组比较,DHF组和SHF组的血浆BNP[(15.42±8.04) pg/ml比(69.48±55.16) pg/ml比(456.23±386.19) pg/ml]和尿UMA水平[(27.92±6.51) mg/L比(72.19±26.35) mg/L比(142.39±35.41) mg/L]均显著升高;且SHF组血浆BNP和尿UMA水平显著高于DHF组,P均<0.01.随着NYHA心功能等级的升高(Ⅰ,Ⅱ,Ⅲ,Ⅳ),血浆BNP[(45.42±8.04) pg/ml比(127.23±79.64) pg/ml比(418.35±187.36) pg/ml比(1257.62±454.26) pg/ml]和尿UMA水平[(47.92±16.51) mg/L比(74.68±27.02) mg/L比(131.05±33.68) mg/L比(263.14±104.69) mg/L]也逐渐升高,各组间比较均有显著差异,P<0.05或<0.01. 简单线性回归分析显示血浆BNP与尿UMA水平呈显著正相关(r=0.544, P=0.001).结论:血浆脑钠肽和尿微量白蛋白浓度随心衰的程度的加重而升高,且呈正相关关系,对诊断、评估严重程度、预后等均有较高价值.%Objective: To observe plasma level of brain natriuretic peptide (BNP) and urine microalbuminuria (UMA) level and their correlation in patients with different heart failure (HF).Methods: A total of 180 patients hospitalized in our department were selected.According to NYHA heart function classification and left ventricular function, patients were divided into no HF control group (n=32), diastolic HF (DHF) group (n=72) and systolic HF (SHF) group (n=76).Plasma BNP and UMA levels were measured and compared among above three groups and groups with different NYHA classes, and correlation between BNP and UMA was analyzed.Results: Compared with no HF control group, there were significant rise in plasma BNP level [(15.42±8.04) pg/ml vs.(69.48±55.16) pg/ml vs.(456.23±386.19) pg/ml] and UMA level [(27.92±6.51) mg/L vs.(72.19±26.35) mg/L vs.(142.39±35.41) mg/L] in DHF group and SHF group;and those of SHF group were significantly higher than those of DHF group, P<0.01 all.Along with NYHA class increased(Ⅰ,Ⅱ,Ⅲ,Ⅳ), there were significant rise in plasma BNP level [(45.42±8.04) pg/ml vs.(127.23±79.64) pg/ml vs.(418.35±187.36) pg/ml vs.(1257.62±454.26) pg/ml] and UMA level [(47.92±16.51) mg/L vs.(74.68±27.02) mg/L vs.(131.05±33.68) mg/L vs.(263.14±104.69) mg/L], and there existed significant difference between any two groups, P<0.05 or <0.01.Simple linear regression analysis indicated that plasma BNP level was significant positively correlated with UMA level (r=0.544, P=0.001).Conclusion: Plasma brain natriuretic peptide level is significantly positively correlated with urine microalbuminuria concentrations along with heart failure aggravating, and they possess high value for diagnosis, assessment of severity and prognosis etc.