心衰康复治疗中脑利钠肽的恢复与心功能改善的关系

Dynamic change of brain natriuretic peptide during the improvement of heart failure

目的:评价慢性充血性心力衰竭(CHF)患者标准化抗心衰康复治疗中血浆脑利钠肽(BNP)水平、心功能各参数的动态变化,探讨心衰康复过程中心脏内分泌的病理生理变化及临床意义。方法:CHF组54例,另52例为健康对照组。分别于心衰治疗前、治疗后1个月、3个月时以放射免疫法测定BNP,BITTNER方案行6min步行试验(6MWT)及超声测量心功能参数。结果:治疗前心衰组BNP显著增高;康复治疗1个月后BNP明显降低,各项心功能参数无显著变化;康复治疗3个月后BNP进一步下降,6MWT、心输出量、心脏指数、左室射血分数显著增加,患者症状、运动耐量明显改善。结论:CHF患者康复治疗后,BNP的下降先于心脏功能指标的恢复,这种心脏内分泌变化可能有助于心衰预后的判断。

Objective To investigate the dynamic change of brain natriuretic peptide （BNP） in chronic heart failure （CHF） and the relationship between BNP and the improvement of heart failure. Methods We studied 54 patients with CHF [32 males and 22 females, average age （58. 63 ± 10.32） years] and 52 healthy individuals [30 males and 22 females, average age （57.36±11.41） years] were recruited to control group. Plasma level of BNP was measured by IMRA method and all patients with CHF underwent 6MWT based on Bittner before and 1 month and 3 months after standard anti-CHF therapy. Other parameters of cardiac function were measured by ultrasound. Res ults The plasma BNP level in the patients with CHF was markedly increased but it was significantly reduced 1 month after treatment while the parameters of the cardiac function have no change. The plasma level of BNP was further reduced with a notable increase of 6MWT, CO, CI, and EF 3 months after treatment. And the patients＇ symptoms and tolerance of exercise were greatly improved. Conclusion The decrease of BNP in CHF was prior to the changes of the parameters of the cardiac function and this change of cardiac endocrine could be beneficial to the improvement of heart failure.