老年心功能不全患者血清氨基末端脑钠肽前体的变化及其临床意义

Changes and clinical significance of serum N-terminal pro-brain natriuretic peptide levels in the elderly patients with cardiac dysfunction

目的 探讨老年心功能不全患者血清氨基末端脑钠肽前体 (NT BNP)水平变化及其临床意义。方法 采用电化学发光免疫技术检测 90例老年患者和 16例健康老年人血清NT BNP浓度 ,以心脏彩色多普勒超声诊断仪测定心室结构功能 ,分为收缩性心功能不全组 (2 2例 )、单纯舒张性心功能不全组 (34例 )和无症状舒张功能不全组 (34例 )。结果 老年心功能不全患者血清NT BNP浓度升高 ,且随心功能不全的严重程度增加 ,与NYHA分级正相关。以血清NT BNP浓度 >10 2 .75pg ml为界值 ,判断心功能不全的敏感性 91.1%、特异性 87.5 %、准确性90 .6 %。多元线性回归分析显示 ,左室射血分数、NYHA分级是影响血清NT BNP的因素。对老年单纯舒张功能不全患者 ,NT BNP亦有良好的敏感性和特异性。无症状舒张功能不全时血清NT BNP与正常组无明显差异 (P >0 .0 5 )。单纯舒张功能不全患者中限制充盈型血清NT BNP浓度高于松弛受损型 (196 1.2± 30 4 .9)与 (46 0 .1± 92 .7)pg ml,(P <0 .0 0 1)。结论 老年心功能不全患者血清NT BNP水平升高 ,且随心功能不全的严重程度增加 ,能较好反映左室功能状态。老年单纯舒张性心功能不全患者血清NT BNP也升高 ,与舒张功能受损的程度一致。血清NT BNP水平对诊断老年心功能不全 。

Objective To investigate the changes and clinical significance of serum N terminal pro brain natriuretic peptide (NT BNP) levels in the elderly patients with cardiac dysfunction. Methods The serum NT BNP levels were measured by electrochemiluminescence immunoassay in 90 elderly patients and 16 elderly healthy subjects served as control group. Colored Doppler echocardiography was performed to evaluate the left ventricular function. The patients were divided into 3 subgroups: systolic heart failure( n =22), isolated diastolic heart failure( n =34)and asymptomatic diastolic ventricular dysfunction( n =34). Results The serum NT BNP levels in the elderly patients with cardiac dysfunction increased with degree of severity of cardiac dysfunction according to the NYHA classifications. A NT BNP cut off value of 102.75 pg/ml showed a sensitivity of 91.1%, specificity of 87.5% and an accuracy of 90.6% for diagnosing cardiac dysfunction. Multivariate linear regression analysis showed that LVEF and NYHA classifications were factors influencing NT BNP. In the elderly patients with isolated diastolic dysfunction, NT BNP also had a good sensitivity and specificity. The difference in NT BNP between the asymptomatic diastolic ventricular dysfunction group and control group was not significant( P >0.05).Patients with restrictive filling patterns on echocardiography had higher NT BNP levels than those of impaired relaxation patterns (1961.2±304.9) versus (460.1±92.7)pg/ml, P <0.001). Conclusions In the elderly patients with cardiac dysfunction NT BNP levels increase and correlate with the degree of severity of cardiac dysfunction. NT BNP can reliably reflect the left ventricular function. The serum NT BNP concentration also significantly increases in elderly patients with isolated diastolic abnormalities and is related with diastolic dysfunction. The level of serum NT BNP has important clinical value in diagnosis of elderly patients with cardiac dysfunction.