脑钠肽在老年慢性心力衰竭诊断及预后评估中的应用价值

摘要

目的 观察血浆脑钠肽(BNP)水平与老年慢性心力衰竭(CHF)患者心功能分级的关系,探讨BNP在老年CHF早期诊断及预后评估中的临床应用价值.方法 选择老年CHF患者183例(CHF组)和健康老年人62例(对照组),比较不同心功能分级老年CHF患者血浆BNP和心肌肌钙蛋白I(cTnI)水平,并分析老年CHF患者血浆BNP水平与左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)的关系.结果 CHF组心功能Ⅰ级患者血浆BNP水平与对照组比较差异无统计学意义(P＞0.05),CHF组心功能Ⅱ、Ⅲ、Ⅳ级患者血浆BNP水平显著高于对照组(P＜0.05),心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者血浆BNP水平两两比较差异均有统计学意义(P＜0.05).CHF组心功能Ⅰ、Ⅱ级患者cTnI水平与对照组比较差异均无统计学意义(P＞0.05),CHF组心功能Ⅲ、Ⅳ级患者cTnI水平显著高于对照组(P＜0.05),CHF组心功能Ⅲ、Ⅳ级患者cTnI水平显著高于心功能Ⅰ、Ⅱ级患者(P＜0.05),CHF组心功能Ⅳ级患者cTnI水平显著高于心功能Ⅲ级患者(P＜0.05),CHF组心功能Ⅰ、Ⅱ级患者cTnI水平比较差异无统计学意义(P＞0.05).CHF患者血浆BNP和cTnI水平与心功能分级均呈显著正相关(P＜0.05).血浆BNP水平与LVEDD呈显著正相关(P＜0.05),而与LVEF呈显著负相关(P＜0.05).结论 BNP在老年CHF的诊断及预后评估中有重要的临床价值.%Objective To study the relationship between plasma brain natriuretic peptide (BNP) level and cardiac function classification in elderly patients with chronic heart failure (CHF),and to explore the clinical value of BNP in the early diagnosis and prognostic evaluation of elderly patients with CHF.Methods One hundred and eighty-three patients with CHF(CHF group) and sixty-two healthy elderly people (control group) were selected,the levels of plasma BNP and cardiac troponin I (cTnI) in elderly CHF patients with different cardiac function classification were compared,and the relationship between plasma BNP level and left ventricular ejection fraction(LVEF) or left ventricular end-diastolic dimension(LVEDD) in elderly patients with CHF was analyzed.Results There was no significant difference in plasma BNP level between the patients with heart function class Ⅰ in CHF group and control group (P ＞ 0.05) ;but the BNP level in patients with heart function class Ⅱ,Ⅲ and Ⅳ in CHF group was significantly higher than that in control group(P ＜ 0.05) ;there was significant difference in plasma BNP level among the CHF patients with heart function class Ⅰ,Ⅱ,Ⅲ and Ⅳ by pairwise comparison (P ＜ 0.05).There was no significant difference in cTnI level between the patients with heart function class Ⅰ,Ⅱ in CHF group and control group(P ＞ 0.05) ; but the cTnI level in patients with heart function class Ⅲ and Ⅳ in CHF group was significantly higher than that in control group(P ＜0.05).In CHF group,the cTnI level in the patients with heart function class Ⅲ and Ⅳ was significantly higher than that in the patients with heart function class Ⅰ and Ⅱ (P ＜ 0.05) ; the cTnI level in the patients with heart function class IV was significantly higher than that in the patients with heart function class Ⅲ (P ＜ 0.05) ; but there was no significant difference in cTnI level between the patients with heart function class Ⅰ and the patients with heart function class Ⅱ (P ＞ 0.05).The plasma BNP and cTnI levels were positively correlated to heart function class (P ＜ 0.05).The plasma BNP level was positively correlated to LVEDD(P ＜ 0.05),but it was negatively correlated to LVEF(P ＜ 0.05).Conclusion BNP in the diagnosis and prognostic evaluation of elderly patients with CHF has important clinical value.