老年慢性心力衰竭稳定期病人心肺功能、运动耐力特征及NT-proBNP和TNT分析

Characteristics of cardiopulmonary function, exercise endurance, and the levels of NT-proBNP and TNT in elderly patients with stable chronic heart failure

目的 观察并分析老年慢性心力衰竭(CHF)稳定期病人的心肺功能、运动耐力特征及外周血N末端脑钠肽前体(NT-proBNP)、肌钙蛋白T(TNT)水平。方法 收集2020年10月至2022年10月期间于本院就诊的稳定期CHF病人102例(CHF组),另选同期健康体检人群50例为对照组。检测并比较2组心功能指标、肺功能指标、NT-proBNP水平、TNT水平及6 min步行距离(6MWD)。结果 CHF组中61例(59.80%)发生肺功能损伤,且NYHAⅢ级组肺功能损伤发生率显著高于Ⅰ/Ⅱ级组(69.23%比53.97%,P<0.05)。CHF组的LVEF、FVC、FEV1、FEV1/FVC、肺总量(TLC)、肺一氧化碳弥散量(DLCO)和6MWD显著低于对照组,且NYHAⅢ级组上述指标亦显著低于Ⅰ/Ⅱ级组;CHF组的左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心房内径(LAD)及血NT-proBNP、TNT水平均显著高于对照组,且NYHAⅢ级组上述指标亦显著高于Ⅰ/Ⅱ级组(P<0.01)。Pearson相关分析显示,CHF病人的LVEF、6MWD与FVC、FEV1、FEV1/FVC、TLC、DLCO均呈显著正相关,而LVEDD、LVESD、LAD、NT-proBNP、TNT与FVC、FEV1、FEV1/FVC、TLC及DLCO均呈显著负相关(P<0.05)。结论 老年稳定性CHF病人具有不同程度的心肺功能及运动耐力下降,且随着心功能不全加重,肺功能损伤及运动耐力下降明显加重。

Objective To observe and analyze the characteristics of cardiopulmonary function and exercise endurance,the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and Troponin T(TNT)in the elderly patients with stable chronic heart failure(CHF).Methods A total of 102 patients with stable CHF in our hospital from October 2020 to October 2022 were collected,and 50 healthy individuals who received physical examination during the same period were selected as control group.The cardiac function indexes,lung function indexes and serum levels of NT-proBNP,TNT and the 6-min walk distance(6MWD)were observed and compared among the groups.Results A total of 61 cases(59.80%)in the CHF group had lung function impairment,and the incidence rate of lung function impairment was higher in NYHA gradeⅢgroup than that in gradeⅠ/Ⅱgroup(69.23%vs 53.97%,P<0.05).The levels of left ventricular ejection fraction(LVEF),forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC,total lung capacity(TLC),diffusion capacity for carbon monoxide of the lung(DLCO)and 6MWD in CHF group were significantly lower than those in control group,and were significantly lower in NYHA gradeⅢgroup than those in gradeⅠ/Ⅱgroup.The levels of left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left atrial diameter(LAD)and blood NT-proBNP and TNT levels in CHF group were significantly higher than those in control group,and were significantly higher in NYHA gradeⅢgroup than those in gradeⅠ/Ⅱgroup(P<0.01).Pearson correlation analysis showed that the levels of LVEF and 6MWD in CHF patients were positively correlated with the levels of FVC,FEV1,FEV1/FVC,TLC and DLCO,while the levels of LVEDD,LVESD,LAD,NT-proBNP,TNT were negatively correlated with the levels of FVC,FEV1,FEV1/FVC,TLC and DLCO(P<0.05).Conclusions The elderly patients with stable CHF present with decline in cardiopulmonary function and exercise endurance,which are significantly correlated with the severity of cardiac dysfunction.