扩张型心肌病患者心功能与血浆B型利钠肽的关系

Association between NYHA Grade of Cardiac Function and the Level of Plasma B-type Natriuretic Peptide in Dilated Cardiomyopathy Patients

目的探讨扩张型心肌病（DCM）患者的B型利钠肽（BNP）水平与心功能的相关性,选择DCM心力衰竭后的最佳诊断及随访指标。方法选择住院DCM患者63例及其对照组50例,按照NYHA分级进行分组并测定BNP、左心室射血分数（LVEF）、左心室舒张末径（LVEDd）,因BNP不符合正态分布,经自然对数（ln）处理后lnB-NP符合正态分布,对比不同心功能分组之间的lnBNP、LVEF、LVEDd之间的差异,确定DCM患者心力衰竭诊断及随访的最佳指标。结果 DCM患者lnBNP随着NYHA分级（Ⅰ-Ⅳ级）升高而梯次升高（P〈0.05）,LVEF、LVEDd在NYHA分级（Ⅰ-Ⅲ级）之间而梯次升高（P〈0.05）,lnBNP与NYHA的相关性最高（r=0.64,P〈0.05）。结论 BNP不仅可以诊断DCM患者心力衰竭而且可以反映心力衰竭过程中的即刻变化,建议将BNP作为DCM患者心力衰竭的诊断及随访指标。

Objective To investigate the correlation between NYHA grade of cardiac function and the level of plasma B-type natriuretic peptide（BNP） in dilated cardiomyopathy patients,and to choose the suitable indexes of diagnosis and prediction in heart failure patiens with dilated cardiomyopathy.Methods Data of plasma level of B-type natriuretic peptide（BNP） and echocardiographic derived parameters of cardiac function were obtained in 63 dilated cardiomyopathy patients and 50 normal control subjects.To assess cardiac function in 63 dilated cardiomyopathy patients,and to compare the data of natural logarithm of plasma level of B-type natriuretic peptide（InBNP）,left ventricular ejection fraction（LVEF）,and left ventricular end-diastolic diameter（LVEDd） in different NYHA grade groups.Results The natural logarithm of plasma level of B-type natriuretic peptide（InBNP） increased gradually with the aggravation of cardiac function by NYHA grade（Ⅰ-Ⅳ）（P0.05）.Left ventricular ejection fraction（LVEF） and left ventricular end-diastolic diameter（LVEDd） increased gradually with the aggravation of cardiac function by NYHA grade（Ⅰ-Ⅲ）（P0.05）.There were significantly correlation（r=0.64,P0.05） between natural logarithm of plasma level of B-type natriuretic peptide（InBNP） and NYHA grade.Conclusion Plasma B-type natriuretic peptide can not only be used to diagnose heart failure,but also predict the change of heart failure degree in dilated cardiomyopathy patients.Plasma B-type natriuretic peptide is the suitable indexes of diagnosis and prediction in heart failure patiens with dilated cardiomyopathy.