氨基末端脑利钠肽前体和左心室射血分数在老年慢性充血性心力衰竭评估中的作用

The role of plasma amino-terminal brain natriuretic peptide precursor and left ventricular ejection fraction in evaluation of chronic congestive heart failure in the elderly

目的探讨老年心力衰竭患者血浆氨基末端脑利钠肽前体(NT-proBNP)、左心室射血分数(LVEF)与纽约心功能分级(NYHA)的关系。方法入选2006年1月至2011年10月在我院住院的年龄≥60岁NYHAⅡ～Ⅳ级的慢性心力衰竭患者308例,分为收缩性心力衰竭(SHF)(LVEF<50%)组210例、射血分数正常的心力衰竭(HFNEF)(LVEF>50%)组98例,同期非心力衰竭住院无器质性心脏病患者150例作为对照组,采用电化学发光免疫法检测血浆NT-proBNP浓度,心脏彩色多普勒超声测定左心室结构和LVEF、左心室舒张功能(Ea/Aa)。结果血浆NT-proBNP水平随NYHA分级的增加而升高,二者呈正相关(r=0.862,P<0.01);LVEF与NYHA分级呈负相关(r=-0.614,P<0.05);血浆NT-ProBNP水平与LVEF无明显相关性(r=-0.136,P=0.09)。在SHF组NT-proBNP水平与LVEF呈负相关(r=-0.735,P=0.008),在HFNEF组NT-proBNP水平与Ea/Aa呈正相关(r=0.614,P=0.009)。结论血浆NT-proBNP水平能较好地反映老年慢性心力衰竭患者的心功能状态,LVEF与NT-proBNP结合应用不仅能更好地反映患者心功能状态,同时有助于HFNEF的诊断。

Objective To investigate the relationship between plasma amino-terminal brain natriuretic peptide precursor（NT-proBNP）,left ventricular ejection fraction（LVEF） and New York Heart Association（NYHA） classification in elderly patients with chronic congestive heart failure. Methods From January 2006 to October 2011,308 patients（aged more than 60 years） with chronic congestive heart failure were enrolled and divided into systolic heart failure group（SHF group,LVEF50%,n=210） and diastolic heart failure group（DHF group,LVEF 50%,n=98）.Selected 150 patients without structural heart disease and hospitalized during the same period as control group.Plasma NT-proBNP was measured by electrochemistry luminescence immunoassay.Color Doppler echocardiography was done to evaluate left ventricular structure,systolic function（LVEF） and diastolic function（Ea/Aa）. Results Plasma NT-proBNP level was positively correlated with NYHA classification（r=0.862,P0.01）.LVEF was negatively correlated with NYHA grading（r=-0.614,P0.05）.And plasma level of NT-proBNP was not correlated with LVEF（r=-0.136,P=0.09）.Plasma NT-proBNP was negatively correlated with LVEF（r=-0.735,P=0.008）in SHF group,and positively correlated with Ea/Aa ratio in DHF group（r=0.614,P=0.009）. Conclusions Both plasma level of NT-proBNP and LVEF can reflect the cardiac function in elderly patients with chronic heart failure.LVEF combined with plasma NT-proBNP can help to diagnose patients with diastolic heart failure in the elderly.