慢性心力衰竭患者血浆N端片段脑钠肽与心脏功能指标的相关性研究

Correlation between Plasma Level of N-terminal Pro-brain Natriuretic Peptide and Cardiac Functional Parameter in Patients with Chronic Heart Failure

目的探讨慢性心力衰竭(CHF)患者血浆N端片段脑钠肽(NT-proBNP)水平与心功能的相关性及其临床意义。方法本实验为病例-对照研究。选取74例为CHF组和26例健康对照组,心力衰竭的诊断标准采用欧洲心脏病学会(ESC)心力衰竭工作组推荐的标准,心功能按纽约心脏病学会(NYHA)分级,将CHF患者分4个亚组:Ⅰ级11例、Ⅱ级18例、Ⅲ级25例、Ⅳ级20例。用化学发光免疫分析法测定CHF患者(CHF组,心功能Ⅰ～Ⅳ级)及26例体检正常者(对照组)血浆NT-proBNP的水平,超声心动图测定CHF组及对照组左室射血分数(LVEF)和左室舒张末期内径(LVEDD),统计学方法以SPSS11.5软件包进行统计分析,计量资料以均数±标准差(χ—±s)表示,计量资料组间比较采用非配对t检验,结果以P<0.05具有统计学意义,各变量间进行Pearson相关分析。结果①CHF组与对照组患者血浆BNP水平比较及其与心功能分级的关系:对照组和CHF组心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者NT-proBNP平均水平分别为(161±114)和(466.6±8.65)、(559±88)、(1359.52±408)、(5114±2535)pg/mL,CHF组各亚组的NT-proBNP水平与对照组比较,有显著性差异(P<0.01)。CHF组组间两两比较NT-proBNP水平,有显著性差异(P<0.01),并随着心功能分级的增加和心功能的恶化,NT-proBNP水平逐渐增加,二者呈正相关(r=0.708,P<0.01)。②心力衰竭组患者按LVEDD分两组,LVEDD≥60mm组16例,LVEDD<60mm组58例,前者血浆NT-proBNP水平[(5812±2354)pg/mL]显著高于后者[(1008±607)pg/mL,P<0.01],而LVEDD<60mmCHF组血浆NT-proBNP水平与对照组比较显著升高(P<0.01)。CHF组LVEF<40%患者的血浆NT-proBNP水平([3059±2558)pg/mL]显著大于LVEF>50%患者([562±177)pg/mL,P<0.01]。血浆NT-proBNP水平与LVEF呈负相关(r=-0.848,P<0.01),与LVEDD呈正相关(r=0.935,P<0.01)。结论NT-proBNP是反映心功能受损的敏感指标,与心功能状态及左心室重塑有明显的相关性。NT-proBNP的检测可对不同程度的CHF患者进行评估,对指导CHF治疗、评价预后均具有重要临床价值。

Objective To investigate the N-terminal pro-brain natriuretic peptide （NT-proBNP） level in patients with chronic congestive heart failure, by which to evaluate its relationship with, and its diagnostic value of heart function. Methods Seventy-four patients with chronic heart failure （Group CHF）, whom was diagnosed according to guidelines of European Society of Cardiology （ESC）, and 26 healthy cases （Group control） were enrolled in this study. In Group CHF, the patients were further divided into 4 subgroups according to the classification of New York Heart Academy （NYHA）, including 11, 18, 25 and 20 patients in Class Ⅰ, Ⅱ, Ⅲand Ⅳ, respectively. Concentration of the plasma NT-proBNP was measured by chemiluminescence immune assay in both groups. Left venlricular ejection fraction （LVEF） and left ventricular end-diastolic diameter （LVEDD） were also evaluated by echocardiography in these cases. SPSSll.5 was used for statistical analysis. Continuous variables are reported as mean±SD, and comparison between the groups was performed with the Student＇s t-test. The relationships between the coneentrations of NT-proBNP and the other heart function parameters were evaluated by Pearson＇s coefficient of correlation analysis. Statistical significance was established at P〈0.05. Results （1）Relationship between the NT-proBNP level and NYHA cardiac function： Plasma NT-proBNP concentration in Group Control was （161±114）pg/mL. In Group CHF, however, the NT-proBNP was significantly increased with the heart function deteriorated, as observed of （466.6±8.65）, （559±88）, （1359.52±408）, （5 114±2535）pg/mL in the subgroups of NYHA Class Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively, which were all significant greater than that in Group Control. The positive linear correlation between the NT-proBNP concentration and the cardiac function was also found （r=0.708, P〈0.01）. （2）Relationship between the NT- proBNP level and the parameters from echocardiography. According to the LVEDD, the patients with heart failure were further divided into two groups, with 16 cases more and 58 cases less than 60 mm LVEDD. The NT-proBNP concentration of the former[（5812±2354）pg/mL] was significantly higher than that of the later group[（1008±607）pg/mL]（P〈0.01）, and the NT-proBNP of each group was both significantly higher than that of the control group （P〈0.01）. When the LVEF was considered, the NT-proBNP concentration of the patients with LVEF less than 0.40 [（3059±2558）pg/mL] was significantly higher than those with LVEF more than 0.50[（562±177）pg/mL]. Over all, the plasma NT-proBNP level was negatively correlated with LVEF （r=0.848, P〈0.01）, while positively correlated with LVEDD （r=0.935, P〈0.01）. Conclusions As a sensitive marker reflecting the extent of impairment of cardiac function, the plasma NT-proBNP highly associated with the heart function and the left ventricle remodeling. The detection of the plasma NT-proBNP may help to evaluate the heart function, and may further guide the Weatment and prognosis evaluation in heart failure patients.