肺部感染并发心力衰竭患者血清心肌酶谱及B型尿钠肽水平变化研究

Study on change of levels of serum myocardial enzymes and B-type natriuretic peptide in heart failure patients complicated with pulmonary infections

目的探讨肺部感染合并心力衰竭患者血清心肌酶谱及B型尿钠肽(BNP)水平变化,作为动态观察患者情况的敏感性指标。方法收集2009年7月-2012年7月入住医院的老年性肺部感染并排除心脑血管及其他疾病180例患者临床资料,分为单纯肺部感染患者组82例,肺部感染合并心力衰竭患者组98例,观察上述两组患者血清心肌酶谱及BNP水平变化情况。结果血清心肌酶谱水平比较:单纯性肺部感染患者组α-羟丁酸脱氢酶(α-HBD)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)以及天冬氨酸氨基转移酶(AST)的浓度分别为(133.1±13.2)、(199.9±53.2)、(157.7±35.4)、(17.2±6.5)、(31.1±11.5)U/L,肺部感染伴心力衰竭患者组上述各指标分别为(221.3±77.3)、(292.9±90.7)、(208.7±75.3)、(39.9±11.2)、(66.7±22.6)U/L,两组患者各指标差异均有统计学意义(P<0.05);肺部感染合并心力衰竭患者血清BNP浓度(25.8±3.6)pg/ml,要明显高于单纯肺部感染患者血清BNP浓度(11.3±1.3)pg/ml,二者差异有统计学意义(P<0.01);NYHA分级Ⅳ级患者均高于Ⅱ级及Ⅲ级患者,且差异有统计学意义(P<0.05)。结论血清心肌酶谱及BNP水平变化可以作为动态观察肺部感染并发心力衰竭的敏感性指标。

OBJECTIVE To investigate the changes of levels of myocardial enzymes and B-type natriuretic peptide（BNP）in heart failure patients complicated with pulmonary infections so as to provide sensitive indicators for the dynamic observation of the patient＇s condition.METHODS From Jul 2009 to Jul 2012,totally 180 cases of senile patients with pulmonary infections,who were excluded the cardiovascular and cerebrovascular and other diseases,were enrolled in the study and divided into the simple lung infection group with 82cases and the lung infections complicated with heart failure group with 98 cases,then the change of the levels of the serum myocardial enzymes and BNP was observed and compared between the two groups.RESULTS As compared with the level of serum myocardial enzyme,the concentrations ofα-HBD,LDH,CK,CK-MB,and AST were respectively（133.1± 13.2）U/L,（199.9±53.2）U/L,（157.7±35.4）U/L,（17.2±6.5）U/L,and（31.1±11.5）U/L in the simple lung infection patient group and were respectively（221.3±77.3）U/L,（292.9±90.7）U/L,（208.7±75.3）U/ L,（39.9±11.2）U/L,and（66.7±22.6）U/L in the lung infections complicated with heart failure patient group,the difference in each of the indexes above between the two groups was significant（P0.05）;the serum BNP concentration of the lung infections complicated with heart failure patient group was（25.8±3.6）pg/ml,significantly higher than（11.3±1.3）pg/ml of the simple lung infection patients group,the difference was significant（P0.01）;the NYHA gradeⅣ patients were higher than those in patients with classⅡandⅢ,the difference was significant（P0.05）.CONCLUSIONThe change of the serum myocardial enzymes and BNP can be used as sensitive indicator for the dynamic observation of the lung infections complicated with heart failure.