生长激素、脑利钠肽和肾上腺髓质素在心力衰竭中的变化及其临床意义

Change and significance of growth hormone,brain natriuretic peptide and adrenomedullin in congestive heart failure

目的通过观察不同病因所致充血性心力衰竭(CHF)患者血清生长激素(GH)、脑利钠肽(BNP)和血浆肾上腺髓质素(ADM)的水平变化,比较三者在CHF中的诊断价值及其灵敏度和特异度。方法将受试对象分为非心力衰竭组30例和心力衰竭组72例。心力衰竭组中冠心病31例,高血压病12例,风湿性心脏病16例,扩张型心肌病13例。其中NYHA心功能分级Ⅱ级组22例,Ⅲ级组20例,Ⅳ级组30例。分别用放射免疫法和酶联免疫法测定血浆ADM、血清BNP和GH的浓度,同时行心脏彩色多普勒超声测定左室舒张末内径(LVED)和左室射血分数(LVEF)。结果心力衰竭组GH和BNP的水平较非心力衰竭组升高,分别是(0.83±1.06)μg/L vs(0.15±0.42)μg/L和(115.31±191.16)ng/L vs(33.51±49.85)ng/L(均P<0.01);ADM两组间比较,差异无统计学意义(P>0.05)。不同病因组间BNP和GH比较,差异无统计学意义(P>0.05)。不同心功能级别间BNP和GH比较,差异有统计学意义(P<0.05)。GH和BNP均与心功能级别呈正相关(P<0.001)。对GH和BNP的ROC曲线下面积做是否为0.5的假设检验,差异无统计学意义(均P<0.001)。BNP诊断心力衰竭的敏感度为89.3%,特异度为63.0%;GH诊断心力衰竭的灵敏度为85.7%,特异度为59.3%。BNP和GH联合使用,诊断心力衰竭的灵敏度为75.0%,特异度为74.0%。结论GH和BNP有助于CHF的诊断,ADM对CHF的诊断价值不大;BNP诊断CHF的敏感度和特异度均优于GH;BNP与GH联合应用诊断心力衰竭好于二者单用。

Objective To evaluate the diagnostic value of growth hormone（GH） ,brain natriuretic peptide（BNP） and adrenomedullin（ADM）,and contrast their sensitivity and specificity in the patients with congestive heart failure. Methods The blood samples were obtained from 72 patients with congestive heart failure（CHF） and 30 patients without CHF,and their serum/plasma levels of GH,BNP and ADM were measured by enzyme-labeled immunosorbent assay（ELISA） and radioimmunoassay. At the same time all the patients received colorful Doppler ultrasonocardiogram to determine left ventricular end-dilation diameter（LVED） and left ventricular ejection fraetion（LVEF）. Results GH and BNP levels in CHF group were higher than those in non-CHF group（0.83±1.06）μg/L vs （0.15±0.42） μg/L and （115.31±191.16） ng/L vs （33.51 ± 49.85） ng/L, respectively（all P 〈0.01）. ADM level was no statistical significance between CHF group and non-CHF group. GH and BNP had positive correlations to different classification of heart function（ P 〈0. 001）. A hypothesis test to the area under the receiver operating characteristic（ROC） curve of BNP and GH showed statistic significance （ P 〈0. 001）. The sensitivities and specificities of BNP were 89.3 % and 63.0%, those of GH were 85.7 % and 59.3%, BNP combined with GH were 75.0% and 74.0 %. Conclusion GH and BNP can help to establish the diagnosis of different classification of heart function. ADM is not helpful to the diagnosis of CHF. The sensitivity and specificity of BNP are better than those of GH. The combination of GH and BNP is better than the application alone in the diagnosis of CHF.