扩张型心肌病慢性心力衰竭患者血浆脑利钠肽水平的临床意义

Clinical Significance of Dynamic Analysis of Plasma Brain Natriuretic Peptide in Patients with Dilated Cardiomyopathy with Chronic Heart Failure

目的:探究扩张型心肌病慢性心力衰竭患者血浆脑利钠肽水平的临床意义。方法:收集2012年3月至2016年3月我院收治的90例扩张型心肌病慢性心力衰竭患者,将患者按照NYHA心功能分级分为A组(II级)20例、B组(III级)38例、C组(IV级)32例。比较各组患者的血浆脑力钠肽(BNP)以及超声心动图相关指标,包括左心室射血分数(LVEF)、左心房内径(LA)、左室舒张末期内径(LVEDD)以及左室收缩末期内径(LVESD),分析血浆BNP与NYHA分级和超声心动图相关指标的相关性,以及比较血浆BNP和LVEF在慢性心力衰竭病情程度中的能力。结果:C组患者的血浆BNP浓度显著高于A组和B组(P<0.05),而B组患者的血浆BNP浓度显著高于A组,比较差异具有统计学意义(P<0.05)。心脏超声检测发现,C组患者的LA显著高于A组(P<0.05),而LVEF、LVEDD及LVESD比较差异无统计学意义(P>0.05)。血浆BNP与NYHA分级呈正相关关系,但与LVEDD、LVESD、LVEF、LA无明显相关关系(P>0.05)。血浆BNP对评价心力衰竭患者病情程度呈现出较强的能力(受试者工作特征曲线下面积=0.902,P<0.001)。血浆BNP=523.5 pg/mL为中重度心力衰竭患者的诊断最佳值。LVEF对评价心力衰竭患者病情程度无明显能力(受试者工作特征曲线下面积=0.392,P=0.276)。结论:血浆BNP浓度对扩张型心肌病慢性心力衰竭患者的诊断、筛查以及心功能分级具有重要的临床意义。

Objective： To investigate the clinical significance of dynamic analysis of plasma brain natriuretic peptide in patients with dilated cardiomyopathy with chronic heart failure. Methods： Ninety patients with dilated cardiomyopathy with chronic heart failure admitted into our hospital from March 2012 to March 2016 were divided into group A （20 cases）, group B （38 cases）, and group C （32 cases） according to the NYHA grading. The plasma BNP levels and LVEF, LA, LVEDD, and LVESD in the three groups were detected and compared. The correlation of plasma BNP and cardiac function and ultrasonic cardiogram indexes were analyzed. And the capability of plasma BNP and LVEF in diagnosis of patients were analyzed and compared. Results： The plasma BNP level in group C was markedly higher than that of group A and group B （P〈0.05）, and that in group B was much higher than that of group A （P〈0.05）. And LA in group C was significantly higher than that of group A （P〈0.05）, while differences in LVEF, LVEDD, and LVESD were not obvious （P〉0.05）. The plasma BNP was positively correlated to NYHA grading, but had no significant correlation with the LVEF, LVEDD, LVESD, and LA （P〉0.05）. Based on results of receiver operating characteristic curve analysis, plasma BNP =523.5 pg/mL was the threshold value for identification of patients with NYHA Ⅲ and Ⅳ （AUC=0.901, P〈0.001）, while LVEF had not the capability （AUC=0.392, P=0.276）. Conclusion： Detection of plasma BNP level had important clinical significance on diagnosis, screening and cardiac functional grading of patients with dilated cardiomyopathy with chronic heart failure.