脑钠素对心功能不全的诊断价值

Value of brain natriuretic peptide in assessment of patients with heart failure

目的进一步探讨血浆脑钠素浓度对诊断心力衰竭及判断心功能状态的意义。方法心力衰竭患者70例,排除肾功能异常者(血肌酐值大于176.8μmol/L)。按NYHA心功能分级,将心力衰竭组依次分为4组,又以LVEF>55%,45%～55%,35%～45%,<35%将心力衰竭组分为4组。用ELISA法分别测量其血浆BNP浓度。健康个体60例作为正常对照组。所有入选者进行胸部X线、心电图检查,并进行超声心动图检查测量左室射血分数(LVEF),左室舒张末容积(LVEDV),左室收缩末容积(LVESV),左室舒张末内径(LVDd),室间隔厚度(VST),左室后壁厚度(LVPWT),舒张早期与舒张晚期二尖瓣峰值流速比(E:A),计算左室质量(LVM)。采用SPSS11.5统计软件进行数据处理。结果心力衰竭组的LVDd、LVM、LVEF、BNP较对照组差异显著(P<0.05),陈旧性心肌梗塞的心力衰竭患者BNP最高;血浆BNP浓度与NYHA心功能分级成正相关;logBNP与LVEF呈明显负相关关系,与E∶A值呈负相关与心胸比例成正相关关系,与左室直径、左室质量成正相关关系。结论①血浆BNP水平在心力衰竭组升高,可以对慢性充血性心力衰竭患者作出诊断。②不同程度的充血性心力衰竭时,血浆脑钠素浓度与病情轻重密切相关。③NYHAⅠ级患者的BNP水平升高,提示血浆BNP水平在较早期充血性心力衰竭中存在诊断价值。

Objective To research certain brain natriuretic＇s value in the diagnosis of congestive heart failure.Methods Select 70 patients with congestive heart failure certainod by NYHA cardiac function classification and 60 normal subjects. The participants were free of renal dysfunction （Cre〉176.8μmol/l）.Patients with CHF were grouped into four parts by NYHA-class and LVEF respectively. All subjects with check of chest radiography, meanwhile underwent common ECG and standard M-mode and two dimensional UCG. Left ventricular ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left ventricular end-diastolic dimension （LVDd）, ventricular septal thickness （VST）, posterior wall thickness （LVPWT）, left ventricular mass （LVM） were measured, BNP was easured by ELISA method. All data was tested with SPSSI 1.5 software. Results BNP level CHF groups higher than that of normal control group （P〈 0.05 ）, the highest BNP concentration was obsolete myocardial infarction patients. There were significant positive correlations between BNP and NYHA-class, LogBNP correlated positively with left ventricular diameter, with left ventricular mass, and inversely left ventricular ejection fraction. Conclusions ①Plasma BNP level can be considered as a method to diagnose CHF. ②Plasma BNP level can be considered to monitor the developing of patients with CHF so as to guide the treatment of patients with CHF.③The higher BNP level in NYHA I suggests its value in the diagnosis of CHF in early stage.