目的：通过检测慢性心力衰竭（CHF）患者急性心力衰竭（AHF）发作时血浆标志物的变化，探讨其在CHF患者AHF发作的早期诊断、预后评估中的价值。方法选择CHF患者200例作为研究对象，入院后病情加重出现AHF发作者86例为观察组，病情逐渐好转无AHF发作者114例为对照组，观察组于入院第2天清晨、AHF发作时分别采静脉血，对照组于相应日期采静脉送检验科检测血超敏C反应蛋白（hs- CRP）、血清胱抑素C（Cys- C）、尿酸（UA）、N末端B型脑钠肽前体（NT- proBNP）、白细胞计数、中性粒细胞百分比、肌酐、尿素氮等。结果患者AHF发作后血浆hs- CRP、Cys- C、UA、NT- proBNP、白细胞计数、中性粒细胞百分比较入院时及对照组升高，差异均有统计学意义（均P＜0.05）；但血尿素氮、血肌酐较入院时差异均无统计学意义（均P＞0.05），较对照组略升高，但差异亦无统计学意义（P＞0.05）。hs- CRP、Cys- C、UA、NT- proBNP与AHF发作呈正相关（均P＜0.05）。结论对于CHF患者，可通过检测血Cys- C、UA、CRP及NT- proBNP等血浆标志物，评估患者病情严重程度、肾功能保护及心肌能量代谢情况，早期诊断AHF发作，早期治疗，提高患者生存率及生活质量。%Objective To investigate the relationship between plasma marker levels and acute heart failure in patients with chronic heart failure. Methods Two hundred patients with chronic heart failure (CHF) were enrol ed in the study, among whom 86 cases developed acute heart failure (AHF) after admission (study group) and 114 cases had no acute heart failure (control group). Venous blood samples were col ected on day 2 after admission and the same day of acute heart failure in both groups. Plasma hs- CRP, Cys- C, UA, NT- proBNP, WBC count, neutrophil percentage, urea nitrogen, creatinine were measured. Results Plasma hs- CRP, Cys- C, UA, NT- proBNP, WBC count, neutrophil percentage in study group at onset of AHF were elevated compared to admission time and control group (al P<0.05). Plasma hs- CRP, Cys- C, UA, NT- proBNP were associated with the onset of acute heart failure (al P<0.05). Conclusion Assessment of plasma markers levels may be of value in early diagnosis of acute onset of heart failure in patients with chronic heart failure.
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