B型利钠肽检测在慢性心力衰竭不同分级中的应用

Application of BNP detection in different grades of NYHA classification in chronic heart failure

目的探讨B型利钠肽(BNP)在慢性心力衰竭患者不同分级中的应用。方法选取慢性心衰患者246例,健康对照组30例,慢性心衰患者按美国纽约心脏病协会(NYHA)分级方案将心功能分为Ⅰ～Ⅳ级,分别测定各级患者和健康对照组BNP浓度,对受试者进行BNP工作特征曲线(ROC)分析,通过超声心动图检查计算各级患者左心室射血分数(LEVF%),并比较Ⅲ级、Ⅳ级心力衰竭患者治疗数周前后BNP浓度。结果 BNP诊断心力衰竭的诊断界值(cut off)为98.5pg/mL,诊断灵敏度为84.6%,特异性为94.5%;不同分级衰竭组BNP水平均明显高于健康对照组,差异有统计学意义(P<0.05);246例慢性心力衰竭患者BNP水平与左室射血分数LVEF%呈负相关,相关系数为-0.733(P<0.01);Ⅲ级、Ⅳ级患者治疗数周后BNP水平都有所下降,下降幅度接近30%。结论 BNP是诊断心力衰竭的最佳心肌标志物,可以作为评价心脏功能分级的一个客观指标,帮助指导临床治疗和预后判断都有重要价值。

Objective To discuss the applications B-type natriuretic peptide （BNP） in different grades in the patients with chronic heart failure（CHF）. Methods 246 cases of CHF and 30 cases as the healthy control were selected. CHF patients were divided into the grade Ⅰ- Ⅳ heart functions by the New York Heart Disease Association （NYHA） classification. The BNP concentrations in CHF patients and controls were determined and performed the BNP work features curve （ROC） analysis. In CHF patients,left ventricular ejection fraction （LVEF %） was calculated by ultrasonic cardiogram,and the BNP concentrations in the CHF patients with grade Ⅲ, Ⅳheart function before treatment and after several weeks treatment were compared. Results The cutoff value of BNP for diagnosing heart failure was 98.5 pg/mL, the diagnostic sensitivity was 84.6 % and the specificity was 94.5 %. The BNP levels in different failure grade groups were obviously higher than those in the control group with statistical difference （P〈0.01）. The BNP level in 246 cases of CHF was negatively related with LVEF% with the correlation coefficients of -0. 733（P〈0.01）. The BNP level after several weeks treatment in the patients with grade Ⅲ, Ⅳ heart function were fallen with the decreased amplitude of near 30%. Conclusion BNP is the best myocardial marker for diagnosing heart failure and can be used as an objective indicator for the evaluation of heart function, which has important value in assisting guidance of clinical treatment and judging prognosis.