慢性心衰患者NT-proBNP、血浆肌钙蛋白Ⅰ、hsCRP检测的意义

摘要

目的:探讨检测慢性心力衰竭(CHF)患者氨基末端脑钠肽前体(NT- proBNP)、心肌肌钙蛋白Ⅰ(cTnI)、高敏C反应蛋白(hsCRP)的诊断、预后意义.方法:83例临床诊断为CHF的患者,根据NYHA心功能级别分为Ⅱ级组(27例),Ⅲ级组(29例),Ⅳ级组(27例),各组又根据NT- proBNP下降是否＞30％分为NT- proBNP下降＞30％组和NT- proBNP下降≤30％组,分别在入院时及入院7d后测定患者的左心室射血分数(LVEF),左室舒张末期内径( LVEDd),NT- proBNP、cTnI、hsCRP水平.其中75例随访9～12个月以了解心脏事件发生与NT- proBNP,cTnI,hsCRP关系.结果:随着CHF程度加重,NT- proBNP及cTnI,hsCRP水平均明显升高,LVEDd明显增大,LVEF明显减小(P均＜0.01)；在心功能Ⅳ级组中,与NT- proBNP下降≤30％比较,NT- proBNP下降＞30％患者cTnI,hsCRP水平明显降低(P＜0.01).随访患者入院7d时与未发生心脏事件组比较,发生心脏事件患者cTnI[(0.17±0.03)ng/ml比(0.965±0.24)ng/ml],hsCRP[(1.07±0.05)mg/L比(6.97±0.12)mg/L]、NT- proBNP[ (253.54±57.40)pg/ml比(4358.70±543.22)pg/ml]水平明显升高(P＜0.01).结论:氨基末端脑钠肽前体,心肌肌钙蛋白Ⅰ,高敏C反应蛋白在诊断心衰和评估预后方面有临床意义.%Objective: To explore diagnostic and prognostic significance detecting N terminal pro brain natriuretic peptide (NT- proBNP) , cardiac troponin I (cTnl) and high sensitive C- reactive protein (hsCRP) in patients with chronic heart failure (CHF). Methods: According to New York heart association (NYHA) cardiac classification, a total of 83 CHF patients were divided into NYHA class II group (n = 27), NYHA class m group (n = 29) and NYHA class IV group (n = 27); according to NT - proBNP decreased >30% or not after treatment, each group was further divided into NT- proBNP decreasing >30% group and NT- proBNP decreasing <30% group. Left ventricular ejection fraction (LVEF), left ventricular end - diastolic dimension (LVEDd), levels of NT - proBNP, cTnl and hsCRP were measured in all patients at the beginning and 7d after admission. A total of 75 cases were followed up for 9~12 months to study relationship among NT- proBNP, cTnl, hsCRP and incidence of cardiac events. Re-sultS: As CHF was more severe, there were significant increase in levels of NT - proBNP, cTnl, hsCRP and LVEDd, and significant decrease in LVEF, P<0. 01 all; in NYHA class IV group, compared with NT- proBNP decreasing ≤30% group, there were significant decrease in levels of cTnl and hsCRP in NT- proBNP decreasing > 30% group (P<0. 01). Compared with no cardiac events group on seventh day after admission, there were significant increase in levels of cTnl [ (0.17 ± 0. 03) ng/ml vs. (0. 965 ± 0. 24) ng/ml], hsCRP [ (1. 07 ± 0. 05) mg/L vs. (6. 97 + 0.12) mg/L] and NT- proBNP [ (253. 54 ± 57. 40) pg/ml vs. (4358. 70 ± 543. 22) pg/ml] in group with cardiac events (P<0. 01). Conclusion: NT-proBNP, cTnl and hsCRP possess important significance in diagnosis and evaluation of prognosis of chronic heart failure.