老年慢性心力衰竭患者血浆B型利钠肽与糖类抗原125水平的变化

Changes in plasma B-type natriuretic peptide and carbohydrate antigen 125 levels in elderly chronic heart failure

探讨血浆B型利钠肽（BNP）与糖类抗原125（CA125）在不同严重程度的老年慢性心力衰竭（CHF）患者中的水平及相关性,评价其临床意义. 方法 124例老年患者按照纽约心脏学会（NYHA）分级,分为心功能Ⅱ、Ⅲ、Ⅳ级组,随机选取35例健康体检者作为对照组.将各组的BNP及CA125值进行比较,分别做相关性分析,并对60例经治疗好转的Ⅲ、Ⅳ级慢性心衰患者随访分析治疗前后各指标的变化. 结果 血浆BNP与CA125水平在CHF组高于对照组（P＜0.01）,心功能Ⅱ级与Ⅲ级、Ⅲ级与Ⅳ级比较,差异有统计学意义（P＜0.01）.BNP、CA125水平与左心室射血分数呈负相关（r值分别为-0.75、0.73,均P＜0.01）,与左室舒张末内径呈正相关（r值分别为0.72、0.63,均P＜0.01）,与左心房内径呈正相关（r值分别为0.25、0.22,均P＜0.05）.CA125、BNP水平在慢性心衰患者合并心房颤动与无房颤患者比较,差异无统计学意义（P＞0.05）. 结论 血浆BNP与CA125升高与NYHA分级有相关,可作为诊断CHF的筛查指标并用于指导治疗、观察预后.

Objective To investigate the correlations of plasma B-type natriuretic peptide （BNP） and carbohydrate antigen 125 （CA125） levels in elderly patients with chronic heart failure （CHF） and to evaluate the clinical value.Methods A total of 124 elderly patients diagnosed as chronic heart failure were recruited.Patients with CHF were divided into the stage Ⅱ group,stage Ⅲ group and stage Ⅳ group according to the New York Heart Association （NYHA） classification.35 health subjects were randomly enrolled as the control group.The plasma levels of BNP and CA125 between different groups were compared.The correlations of the plasma BNP and CA125 levels with chronic heart failure were analyzed.60 cases with clinical improvement by aggressive treatment were followed up and the plasma levels of CA125 and BNP in them were tested.The changes in heart failure indicators were analyzed before and after treatment.Results The plasma BNP and CA125 levels were higher in patients with CHF than in control subjects （all P〈0.01）.The plasma BNP and CA125 levels were gradually increased in the stage Ⅱ,Ⅲ and Ⅳ group （all P〈0.01）.The plasma levels of BNP and CA125 were negatively correlated with left ventricular ejection fraction and positively correlated with left ventricular end-diastolic diameter （r=-0.75,-0.73,0.72,0.63,respectively,both P〈0.01）.There were no significant differences in the plasma levels of BNP and CA125 between patients with or without atrial fibrillation （both P 〉0.05）.Conclusions Plasma BNP and CA125 levels are correlated with NYHA classification in CHF,which can be used as indexes for the diagnosis,treatment and prognosis of CHF.