老年冠心病慢性心力衰竭患者N末端B型利钠肽原与血清半胱氨酸蛋白酶抑制素C水平的变化

摘要

目的：观察老年冠心病慢性心力衰竭( chronic heart failure, CHF)患者N末端B型利钠肽原( N-termi-nal-pro-B-type natriuretic peptide, NT-proBNP)和血清半胱氨酸蛋白酶抑制素C(Cystain C, Cys-C)的水平变化,探讨NT-proBNP和血清Cys-C相关性及临床意义。方法选取2012年10月—2013年9月在我院老年病科住院治疗的老年冠心病CHF 54例作为冠心病CHF组,选择同期住院的老年冠心病无心力衰竭30例作为对照组；根据美国纽约心脏病学会( NYHA)制定的心功能分级标准将冠心病CHF组54例分为NYHAⅡ级组和NYHA Ⅲ~Ⅳ级组。比较冠心病CHF组与对照组、NYHAⅡ级组与NYHAⅢ~Ⅳ级组NT-proBNP和血清Cys-C水平,并对NT-proBNP的影响因素进行分析。结果冠心病CHF组左室舒张末期内径、肌酐、尿素、NT-proBNP、血清Cys-C值高于对照组,左室射血分数及白蛋白值低于对照组,两组比较差异均有统计学意义(P<0.05或P <0.01)。 NYHAⅡ级组NT-proBNP及血清Cys-C水平均低于NYHA Ⅲ~Ⅳ级组,差异有统计学意义(P<0.05或P <0.01)。 Pearson相关分析结果显示NT-proBNP与年龄、血清Cys-C、左室舒张末期内径、肌酐、尿素呈正相关,与体重指数、左室射血分数、估计肾小球滤过率呈负相关。多元线性逐步回归分析结果显示体重指数、血清Cys-C、估计肾小球滤过率与NT-proBNP独立相关。结论老年冠心病CHF 患者NT-proBNP 和血清Cys-C 明显相关,NT-proBNP 和血清Cys-C 可作为评价CHF 严重程度及反映心功能状态的指标。%Objective To evaluate changes of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and serum cystain C( Cys-C) in elderly patients with chronic heart failure( CHF) and coronary artery disease, and explore their correla-tion and clinical significance. Methods A total of 54 elderly CHF patients with coronary artery disease who were treated in Department of Geratology from October 2012 to September 2013 were selected as CHF group. And 30 elderly patients with cor-onary artery disease and compensated heart function were selected as control group. According to the New York Heart Associa-tion ( NYHA) cardiac functional standard, 54 patients in CHF group were divided into NYHA Ⅱ group and NYHA Ⅲ-Ⅳgroup. NT-proBNP as well as serum Cys-C level in CHF group and control group was compared. Those between NYHAⅡand NYHA Ⅲ-IV group were also compared. NT-proBNP influence factors were analyzed. Results Left ventricular end-diastolic dimension( LVEDD) , serum creatinine, blood urea nitrogen, serum NT-proBNP and Cys-C level in CHF group were signifi-cantly higher than those in control group (P<0. 05 or P<0. 01), but left ventricular ejection fraction (LVEF) and albumin were significantly lower than those in control group (P<0. 05 or P<0. 01). Serum NT-proBNP and Cys-C level in NYHAⅡgroup were significantly lower than those in NYHAⅢ-Ⅳgroup (P<0. 05 or P<0. 01). Pearson correlation analysis showed that NT-proBNP was positively correlated with age, serum Cys-C, serum creatinine, blood urea nitrogen and LVEDD;but NT-proBNP was negatively correlated with BMI, LVEF and eGFR. Multiple linear regression analysis showed that BMI, Cys-C and eGFR were independently correlated with NT-proBNP. Conclusion NT-proBNP and serum Cys-C level have obvious correlation in elderly CHF patients with coronary artery disease. Both are good indicators in evaluating the severity of CHF and reflecting the heart function.