B型钠尿肽测定在严重急性心力衰竭患者临床应用中的意义

Role of plasma B type natriuretic peptide concentration in the clinical application of patients with severely acute heart failure

目的探讨血浆B型钠尿肽(B type natriuretic peptide,BNP)水平测定在严重急性心力衰竭(heart failure,HF)患者临床应用中的意义。方法以38例经常规处理效果不佳的严重急性HF患者为研究对象,尽早留置漂浮导管,留置漂浮导管后0.5h和48h,记录肺毛细血管楔压(PCWP),同步采用干式快速免疫荧光定量分析法检测血浆中的BNP水平,然后根据情况选用各种药物治疗。HF患者根据出院时预后分为病情好转组和病情恶化组,对两组患者留置漂浮导管后0.5h和48h PCWP和BNP变化进行比较。结果病情好转组患者留置漂浮导管治疗后PCWP(13.4±1.2)mm Hg较治疗前(19.1±1.4)mm Hg明显下降(P<0.01),病情恶化组患者留置漂浮导管治疗后PCWP(25.8±4.2)mm Hg与治疗前(21.5±4.5)mm Hg比较差异无统计学意义(P>0.05)。病情好转组患者应用监测漂浮导管治疗后BNP(1237.4±125.3)ng/L较治疗前(1489.3±158.0)ng/L有所下降,但差异无统计学意义(P>0.05),病情恶化组患者应用监测漂浮导管治疗后BNP(1541.0±151.7)ng/L较治疗前(1209±119.6)ng/L有所升高,但差异无统计学意义(P>0.05)。急性HF患者血浆BNP水平和PCWP呈正相关(r=0.37,P=0.049)。结论血浆BNP测定在严重急性HF患者的诊断和病情评估中具有重要的临床价值。

Objective To study role of plasma B type natriuretic peptide（BNP）concentration in the clinical application of patients with severely acute heart failure（HF）.Methods Pulmonary capillary wedge pressure（PCWP）was determined by Swan-Ganz catheter in 38 patients with severely acute heart failure who exacerbated after routine treatment at half an hour and 48 hours.At the same time BNP was measured with immunofluorescent assay.The HF patients were classified into 2 groups according to prognosis before the discharge：the better patients and the exacerbated patients.PCWP and BNP were compared respectively in the two groups at half an hour and 48 hours.Results PCWP in the better patients decreased（19.1 ±1.4）mm Hg vs（13.4±1.2）mm Hg,P〈0.01,PCWP in the exacerbated patients increased,but no significantly（21.5±4.5）mm Hg vs（25.8±4.2）mm Hg,P〉0.05.BNP in the better patients decreased,but no significantly（1489.3±158.0）ng/L vs（1237.4±125.3）ng/L,P〉0.05,BNP in the exacerbated patients increased,but no significantly（1209±119.6）ng/L vs（1541.0±151.7）ng/L,P〉0.05.BNP levels were positively related to PCWP（r=0.37,P=0.049）.Conclusion B type natriuretic concentration play an important role in the clinical diagnosis and evaluation of patients with severely acute heart failure.