强离子隙在慢性心力衰竭患者中的水平改变及临床意义

Change of strong ion gap in chronic heart failure patients and its clinical significance

目的探讨强离子隙(SIG)水平在慢性心力衰竭(CHF)患者中的改变及其与CHF患者心功能、N末端B型利钠肽前体(NT-proBNP)水平的相关性。方法选择CHF患者90例,根据心功能(NYHA)分级分为心功能Ⅱ级组30例、心功能Ⅲ级组30例和心功能Ⅳ级组30例;根据CHF病因分为冠心病组25例、高血压性心脏病组45例和扩张型心肌病组20例;选择健康体检者35例作为对照组,在测定血气、电解质等的基础上,应用Stewart-Figge方法学的方程式计算SIG,采用电化学免疫法测定NT-proBNP。结果与对照组比较,心功能Ⅱ、Ⅲ和Ⅳ级组患者SIG[(5.54±2.23)mmol/L、(7.65±3.12)mmol/L和(10.54±3.84)mmol/L vs(1.70±0.81)mmol/L]、NT-proBNP[(114.85±36.23)ng/L、(476.30±79.45)ng/L和(782.50±99.38)ng/L vs(42.74±11.29)ng/L]水平明显升高;且心功能Ⅱ、Ⅲ和Ⅳ级组间SIG水平比较,差异有统计学意义(P<0.05)。与治疗前比较,不同心功能组治疗后SIG和NT-proBNP水平明显下降,差异有统计学意义(P<0.01)。GHF患者SIG与NT-proBNP呈正相关(r=0.424,P<0.01)。结论 CHF患者血清SIG水平明显升高,且随着心功能不全程度的加重而升高,与NT-proBNP存在一定的相关性,对CHF的早期诊断、风险评估及治疗评价均具有指导意义。

Objective To study the change of strong ion gap（SIG）in chronic heart failure（CHF） patients and its correlation with heart function and NT-proBNP level.Methods Ninety CHF patients were divided into gradeⅡcardiac function group,gradeⅢcardiac function group and grade Ⅳcardiac functiongroup（30in each group）according to their NYHA,and into CHD group（n= 25）,hypertensive heart disease group（n=45）and dilated cardiomyopathy group（n=20）according to their CHF etiology.Thirty five healthy subjects served as a control group.SIG was calculated according to the Stewart-Figge equation after blood gas and electrolytes were assayed.Serum NT-proBNP level was measured by electrochemical immunoassay.Results The SIG and serum NT-proBNP level were significantly higher in heart function groups than in control group（P 〈0.05）,the difference in SIG between the heart function groups was statistically significant（P 〈0.05）.The SIG and serum NT-proBNP level were significantly lower in heart function groups after treatment than before treatment（P〈0.01）.The SIG was positively related with the serum NT-proBNP level in CHF patients（r=0.424,P〈0.01）.Conclusion The SIG increases with the cardic insufficiency,which is related with the serum NT-proBNP level,thus contributing to the early diagnosis,risk assessment and treatment of CHF.