危重患者血浆脑钠肽升高的意义

The Significance of Elevation of plasma Brain Natriuretic Peptide in Critically ill Patients

目的 探讨血浆脑钠肽（Brain Natriuretic Peptide,BNP）水平对危重患者心功能衰竭诊断的意义.方法 收集伴有血浆BNP前体N-末端片段（NT-proBNP）水平升高的危重患者50例,分为两组,一组有心衰发生（n=27）,其中心衰初发作15例,有心衰既往史12例;另一组未发生心功能衰竭（n=23）.比较两组患者的NT-proBNP水平及NT-proBNP水平与左室射血分数（LVEF）间的相关性.结果 心衰组血浆NT-proBNP水平高于非心衰组,差异有统计学意义（P＜0.01）;心衰组中有心衰发作史的患者血浆NT-proBNP水平高于心衰初次发作患者（P＜0.05）.心衰组中心衰初次发作和有心衰既往史患者NT-proBNP水平与LVEF均呈负相关（r=-0.8632,P＜0.001;r=-0.7742,P=0.0031）;未发生心衰组患者间无统计学相关性（r=-0.4033,P=0.0563）.结论 血浆NT-proBNP水平可以反映患者心功能状态,但它用于病情复杂的危重患者心功能衰竭的诊断时应更多结合临床症状和体征.

Objective To investigate the significance of the level of Brain Natriuretic Peptide（BNP） in the diagnosis of heart failure in critically ill patients. Methods 50 patients with increased level of NT - proBNP in Department of Critical Care Medicine are collected and divided into two groups ：one group with heart failure（ n = 27）and another group without heart failure（ n = 23 ）. Levels of plasma NT -proBNP are compared and their correlationship with left ventricular ejection fraction（LVEF） are analyzed. Results Levels of NT - proBNP are significantly higher in patients with heart failure than in patients without heart failure（ P 〈 0.01 ）. Moreover, levels of NT- pmBNP in patients who are diagnosed heart failure for the first time are statistically lower than those in patients who have a history of heart failure（ P 〈 O. 05 ）. Levels of NT -proBNP are negatively correlated with levels of LVEF for both patients with heart failure（r = -0.8632,P 〈0.001 ;r = -0.7742,P =0.0031 ） ,but for patients without heart failure,no correla- tion between levels of NT - proBNP and LVEF （ r = - 0. 4033, P = 0. 0563 ）. Conclusions level of plasma NT - proBNP can be an important index for evaluation of heart function, but for critically ill patients, its application in heart failure diagnosis should rely more on clinical symptoms and physical signs.