脑钠素对老年人心力衰竭诊断和预后评估的价值

Brain natriuretic peptide in elderly patients with heart failure: a study of diagnostic and prognostic value

目的探讨脑钠素(BNP)对老年人心力衰竭诊断和预后评估的价值。方法选择老年无症状性心力衰竭患者21例(aSHF组)和老年症状性心力衰竭患者42例(SHF组),另选18例健康老年人作为对照组,采用放射免疫分析法测定各组血浆BNP水平;比较各组血浆BNP水平和心功能状况及心血管事件发生的关系。结果血浆BNP水平在对照组、aSHF组、SHF组呈递增趋势,且随着纽约心功能分级(NYHA)增高而增加;血浆BNP为70 ng/L时,对诊断aSHF的灵敏度、特异度分别为90.48%、94.44%;根据左心室射血分数值、NYHA、BNP水平3种分级法与专家分级法符合率分别为81.9%、73.0%、85.7%;NYHAⅢ级和NYHAⅣ级患者心血管事件的发生率明显高于aSHF组和NYHAⅡ级患者,发生心血管事件患者的血浆BNP水平高于而LVEF值低于未发生心血管事件的患者。结论血浆BNP水平能反映心力衰竭的严重程度,与左心室的结构和功能相关,检测血浆BNP水平对于aSHF的诊断和鉴别诊断有重要的临床价值,且对于心力衰竭患者近期发生心血管事件具有重要的预测意义。

Objective To investigate the diagnostic and prognostic value of brain natriuretic peptide（BNP） in elderly people with heart failure. Methods Plasma BNP concentration was measured by radioimmunoassay in asymptomatic heart failure patients （aSHF, n =21）, symptomatic heart failure patients （SHF, n = 42） and normal controls（ n = 18）. The cardiovascular events, plasma BNP concentration and heart function were compared. Results Plasma BNP concentration increased progressively in normal controls group, aSHF group and SHF group. It also increased by degrees of classification of NYHA of heart failure. A plasma BNP concentration exceeding 70 ng/L had a sensitivity of 90.48%, specificity of 94.44%, negative predictive value of 90.48 % and positive predictive value of 95 % for detecting patients with aSHF. The accuracy of heart functional classification of NYHA, LVEF and BNP compared with cardiovascular specialists classification was 81.9 %, 73.0 %, and 85.7 %, respectively. In near future, the incidence rate of cardiovascular events between aSHF and group NYHA Ⅱ had not notable difference, but in group Ⅲ and group Ⅳ, it was especially higher than normal controls and aSHF group. The plasma BNP concentration of the patients who had cardiovascular events in SHF group was higher, and LVEF was lower than those who had no cardiovascular events. Conclusion Plasma BNP concentration can reflect severity of heart failure and has correlation with heart structure and function. It is important for diagnosis of aSHF. It might have a prognostic value for cardiovascular events in near future for elderly people with heart failure.