目的：探讨心力衰竭高敏C反应蛋白( hs-CRP)和脑钠肽( BNP)变化及其与心功能的关系。方法选取2012年12月至2014年12月都江堰市医疗中心治疗的69例慢性心力衰竭患者,根据纽约心脏病协会( NYHA)心功能分级标准分成NYHA Ⅱ级组、NYHA Ⅲ级组以及NYHA Ⅳ级组,各23例。另外选取同期20例入院检查正常人作为对照组,比较患者的BNP、hs-CRP、左心室射血分数( LVEF)以及左心室舒张末期内径( LVDD )水平,以及治疗后指标的变化情况。结果①心力衰竭组的BNP、hs-CRP 以及LVDD水平显著高于对照组[(481±18) ng/L 比(35±15) ng/L,(12．2±2．3) mg/L比(3．2±1．4) mg/L,(59．7±2．2) mm 比(43．2±2．5) mm],差异有统计学意义(P<0．01)；NYHAⅢ级组和Ⅳ级组BNP、CRP以及LVDD高于NYHA Ⅱ级组患者,且NYHA Ⅳ级组上述各指标高于NYHA Ⅲ级组(P<0．05)。心力衰竭组的LVEF水平显著低于对照组[(51±4)%比(65±5)%],NYHAⅢ级组和Ⅳ级组LVEF显著低于NYHAⅡ级组患者,且NYHAⅣ级组显著低于NYHAⅢ级组(P<0．05)；②慢性心力衰竭患者的BNP水平与患者的心功能分级和LVDD水平均呈正相关(r=0．746,0．735,P <0．05),而与慢性心力衰竭患者的LVEF水平呈显著负相关(r=-0．832,P<0．05)；③慢性心力衰竭患者已发生心血管事件(心血管事件组)12例,未发生心血管事件(未发生心血管事件组)57例,心血管事件组BNP、hs-CRP以及LVDD显著高于未发生心血管事件组[(723±36) ng/L 比(316±15) ng/L,(7．1±2．4) mg/L比(2．0±0．5) mg/L,(59．2±2．8) mm 比(46．4±2．0) mm],而LVEF水平显著低于未发生心血管事件组[(51±5)%比(60±7)%],差异有统计学意义(P<0．01)。结论联合检测BNP、CRP、LVEF以及LVDD水平是诊断慢性心力衰竭患者灵敏、稳定的标志物,可以诊断慢性心力衰竭的病理具有重要临床价值,还可以对慢性心力衰竭患者进行分级,为临床治疗提供有效的参考。%Objective To investigate changes of high sensitivity C reactive protein ( hs-CRP ) and brain natriuretic peptide( BNP ) in patients with congestive heart failure and its relationship with heart function. Methods A total of 69 patients with chronic heart failure treated in Dujiangyan Medical Center from Dec. 2012 to Dec. 2014,were randomly divided into three groups according to New York Heart Association(NYHA):group NYHAⅡ,group NYHA Ⅲ and NYHA Ⅳ group,23 cases in each group,and 20 normal persons for health checkup during the same period were selected as control group, levels of BNP,hs-CRP,left ventricular ejection fractions( LVEF) and left ventricular diastolic dimension( LVDD) after treatment,and the changes of the index were compared. Results ① BNP,hs-CRP and LVDD of the heart failure group were higher than the control group[(481 ±18) ng/L vs (35 ±15) ng/L,(12.2 ±2.3) mg/L vs (3.2 ±1.4) mg/L,(59.7 ±2.2) mm vs(43.2±2.5)mm](P<0.01); BNP,hs-CRPandLVDDlevelofNYHA Ⅲ and Ⅳ groupwerehigher than NYHAⅡgroup,and NYHAⅣgroup were higher than NYHAⅢgroup(P<0. 05). The level of LVEF in heart failure group was significantly lower than the control group [ ( 51 ± 4 )% vs ( 65 ± 5 )%] , and LVEF of NYHA Ⅲ and Ⅳ group was significantly lower than NYHAⅡ group, and NYHAⅣ group was significantly lower than NYHAⅢ group(P <0. 05); ②there was significant positive correlation between BNP level in patients with chronic heart failure patients with heart function classification and LVDD level(r=0. 746,0. 735, P<0. 05),and was significantly negatively correlated with the level of LVEF in patients with chronic heart fail-ure (r=-0. 832,P<0. 05); ③Twelve cases in the heart failure group had cardiovascular events(cardiovascu-lar event group) ,57 coses did not( no-cardiovascular events group) ,BNP,hs-CRP and LVDD of cardiovascular event group were significantly higher than the no-cardiovascular events group[(723 ±36) ng/L vs (316 ±15) ng/L,(7.1±2.4)mg/Lvs(2.0±0.5)mg/L,(59.2±2.8)mmvs(46.4±2.0)mm],andLVEFwas significantly lower than the no-cardiovascular events group[(51 ±5)% vs (60 ±7)%],the difference was sta-tistically significant(P<0. 01). Conclusion The combined detection of BNP,CRP,LVEF and LVDD levels in patients with chronic heart failure is a sensitive and stable marker for the diagnosis,which can diagnose the pathology of chronic heart failure with important clinical value,and contribute to the grading of chronic heart failure,and provide reference for the clinical treatment.
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