血浆氨基末端B型钠尿肽原在心功能损伤早期的变化

Early changes of plasma N-terminal pro-B-type natriuretic peptide in cardiac function injury

目的探讨血浆氨基末端B型钠尿肽原(NT-proBNP)在高血压合并冠心病、临床无肾功能异常症状糖尿病患者心功能损伤早期的变化,及其在高血压合并冠心病治疗前、后的变化情况。方法将206例高血压合并冠心病患者、65例糖尿病患者按纽约心脏协会心功能分级标准(NYHA)分为Ⅰ～Ⅱ级组、Ⅲ～Ⅳ级组,同时选取37例排除高血压、冠心病和糖尿病病史的伤骨科患者作为对照组。检测所有病例NT-proBNP水平。选取37例高血压合并冠心病患者临床治疗前、后NT-proBNP浓度进行对照,观察NT-proBNP与治疗和预后的关系。结果高血压合并冠心病组、糖尿病组NT-proBNP水平高于对照组(P<0.01),高血压合并冠心病NYHAⅠ～Ⅱ级组NT-proBNP水平高于糖尿病NYHAⅠ～Ⅱ级组(P<0.05),但高血压合并冠心病NYHAⅢ～Ⅳ级组与糖尿病NYHAⅢ～Ⅳ级组比较差异无统计学意义(P>0.05);高血压合并冠心病组治疗后的NT-proBNP水平明显低于治疗前(P<0.01)。结论 NT-proBNP可以用于高血压合并冠心病心功能早期损伤的实验室诊断,并且与治疗和预后有关联。NT-proBNP在糖尿病发展早期可灵敏反映心功能的改变。

Objective To investigate the changes of plasma N-terminal pro-B-type natriuretie peptide （NT- proBNP） in hypertension and coronary heart disease and the cardiac function early injury in patients with diabetes mellitus and without abnormal renal function, and observe the change of NT -proBNP in hypertension and coronary heart disease before and after treatment. Methods The 206 patients with hypertension and coronary heart disease and 65 patients with diabetes mellitus were classified into I - lI grade group and If[ -IV grade group according to the New York Heart Association （NYHA） heart pathological grading,and 37 patients without hypertension, coronary heart disease and diabetes mellitus in the department of bone traumatology were enrolled as controls. The NT-proBNP concentrations were detected. A total of 37 patients with hypertension and coronary heart disease were selected and compared for NT-proBNP concentrations before and after the treatment. The relationship of treatment and prognosis with NT-proBNP was observed. Results The NT-proBNP levels in hypertension and coronary heart disease group and diabetes mellitus group were higher than those in the control group （P 〈 0.01 ）. The NT-proBNP levels in hypertension and coronary heart disease NYHA I - II grade group were higher than those in diabetes meflitus NYHA I - 11 grade group （ P 〈 O. 05 ） , but there was no statistical difference in the NT-proBNP levels between hypertension and coronary heart disease NYHA m-IV grade group and diabetes mellitus NYHA llI-IV grade group （ P 〉 0.05 ）. The NT-pmBNP levels in hypertension and coronary heart disease group after the treatment were significantly lower than those before the treatment （P 〈 0.01 ）. Conclusions NT-proBNP can be used for the laboratory diagnosis of hypertension and coronary heart disease in cardiac function early injury, and associates with treatment and prognosis. NT-proBNP can reflect the change of cardiac function sensitively in the early development of diabetes mellitus.