高龄心衰患者血浆N端脑钠肽前体测定的价值

Clinical study of serum N-terminal pro-brain natriuretic peptide in advanced age patients with heart failure

目的探讨高龄心力衰竭患者N端脑钠肽前体（NT—proBNP）与NYHA心功能分级，左室结构、功能的关系；观察治疗前后NT-proBNP水平的动态变化；评价NT-proBNP在高龄心衰患者病情评估中的临床价值。方法选取仁济医院住院治疗的高龄心力衰竭患者49例，13例健康高龄老人纳入对照组，按照纽约心脏病协会（NYHA）对心衰患者进行分级。在治疗前及治疗后两周检测血浆NT—proBNP的浓度；应用心脏彩色多普勒超声诊断仪测定左室结构、功能。结果高龄心衰组患者血浆NT-proBNP值高于健康对照组（P〈0．001），且随NYHA的心功能分级增高而逐渐升高（P〈0．001）。患者NT—proBNP水平与LVEF呈负相关（P〈0．001），与LVMI、LVST呈正相关（P〈0．05）。多元回归分析结果显示，NT-proBNP水平与NYHA心功能分级、LVEF、LVMI值相关，与性别、年龄、基础疾病史无相关性。NYHAⅢ级及Ⅳ级心衰患者在治疗前后血浆NT—proBNP水平差异有显著统计学意义（P〈O．05）结论血浆NT—proBNP能较好地反映高龄心力衰竭患者心功能状态，是评估左室功能的客观生化指标，可用于疗效评价的参考。

Objective To analyze the relationship between NT-proBNP and heart function, observe the change of NT- proBNP before and after treatment, and investigate the diagnostic value of plasma NT-proBNP in advanced age patients with heart failure （HF）. Methods 49 advanced age patients with HF and 13 healthy senile people were selected. Plasma NT- proBNP was measured using electrochemiluminescent assay before and after treatment. The function and structure of LV were examined with echocardiography. Results Plasma NT-proBNP level increased significantly in advanced age patients with HF compared with controls （P 〈 0.001）, and increased progressively in proportion to the degree of NYHA （P 〈 0.001）. NT-proBNP level was negatively correlated with LVEF （P〈0.001）, and positively with LVST and LVMI （P〈0.05）. Multi-factor linear regression analysis showed that NYHA classification, LVEF and LVMI were correlated with NT-proBNP, and that there was no correlation between serum NT-proBNP and sex, age and past clinical history. Conclusion NT-proBNP level is a sensitive indicator of LV dysfunction in advanced age patients and closely correlated with the degree of severity of HF. It may be a stable mark to evaluate the effect of treatment of HF.