血浆B型钠尿肽水平在心力衰竭诊断中的价值

Plasma brain natriuretic peptide levels in the diagnosis of heart failure

目的研究心力衰竭患者血浆钠尿肽(BNP)水平与心力衰竭严重程度、左室功能等因素的关系。方法采用免疫荧光分析法,测定117例住院心力衰竭患者血浆B型钠尿肽(BNP)水平。用心脏彩色多普勒超声诊断仪测定左室收缩功能。心力衰竭按纽约分级(NYHA)。结果BNP水平随着心功能程度的加重而显著增加,心功能Ⅱ级,BNP水平(440.87±437.34)pg/mL,心功能Ⅲ级,BNP水平(833.98±702.34)pg/mL,心功能Ⅳ级,BNP水平(1348.07±933.46)pg/mL;BNP<400pg/mL的患者,EF值<45%仅占33.0%,而BNP>400pg/ml患者中;EF值<45%占66.7%(P=0.001);在BNP<400pg/mL的患者中,E/A<1占62.1%,而BNP>400pg/ml患者中,E/A<1占39.2%(P=0.014)。其与左室射血分数(LVEF)、E/A比值有明显的相关性。不稳定心绞痛、血肌酐水平升高也是影响BNP的因素。结论心力衰竭患者血浆BNP水平随着心力衰竭严重程度的增加而升高,并能较好反映左室功能。不稳定心绞痛,肾脏功能减退均会影响BNP结果。

【Objective】To investigate the relationship of B-type natriuretic peptide （BNP） levels with the severity of heart failure （HF） , and the left ventricular systolic function in patients with heart failure【.Methods】BNP levels of 117 patients with HF were measured by immunofluorimetry. Colored doppler echocardiography was performed to measure the left ventricular systolic function.【Results】BNP levels increased with the deterioration of the heart failure according to the NYHA classification. Cardiac function grade Ⅱ, BNP level of 440.87 ± 437.34 （pg / ml）, cardiac function grade Ⅲ, BNP level of 833.98 ± 702.34 （pg / ml）, cardiac function grade Ⅳ, BNP levels of 1348.07 ± 933.46 （pg/ml）. BNP 400 pg/ml of patients, EF value of ＂45% of only 33.0%, while BNP 400 pg/ml patients, EF value of＂ 45% accounted for 66.7%（P =0.001）; the BNP400 pg/ml in patients with Chinese, E/A1 accounted for 62.1%, while BNP 400 pg / ml in patients, E / A 1 accounted for 39.2%, （P =0.014）、BNP level was negatively correlated with left ventricular ejection fraction, and was related to the E/A ratio significantly. Unstable angina pectoris and the renal dysfunction were both influencing factors to plasma BNP levels 【.Conclusion】BNP level increased with the degree of the heart failure severity, and it may be important to use BNP to predict left ventricular function.