血浆B型钠尿肽测定在慢性心力衰竭患者诊断及预后中的临床价值

Evaluating the clinical value of plasma B-type natriuretic peptide in diagnosis and prognosis of chronic heart failure

目的探讨血浆B型钠尿肽（BNP）对慢性心力衰竭的诊断意义、与左心室功能的关系,以及在评估慢性心力衰竭预后中的意义。方法选择2010年4月至2013年4月该院心内科收治的慢性心力衰竭患者共100例,采用免疫荧光法定量测定每例患者入院、出院时的BNP水平。入院时测定患者左心房舒张末期内径（LADD）、左心室舒张末期内径（LVDD）、左心室射血分数（LVEF）及心胸比等指标,所有患者入院后均进行正规的抗心力衰竭治疗2-4周,根据患者出院时的BNP水平,将其分成观察组48例（BNP≥400 pg/m L）和对照组52例（BNP〈400 pg/m L）,并随访1年,观察所有患者心脏不良事件（指心源性死亡和30 d内因心力衰竭加重再住院）发生情况,心力衰竭按美国纽约心脏病学会（NYHA）标准分级。结果 BNP水平随着NYHA心功能分级的增加而显著增加,差异均有统计学意义（P〈0.05）。左心室功能异常患者（LADD≥35 mm、LVDD≥50 mm、LVEF〈50%）的BNP水平明显高于左心室功能正常患者,差异有统计学意义（P〈0.05）,且BNP与LADD、LVDD、LVEF均呈正相关（r=0.79、0.71、0.48,P〈0.05）。患者的心胸比越大,其BNP水平就越高,差异均有统计学意义（P〈0.05）。在1年的随访中,观察组48例患者中4例失访,44例随访患者中发生心脏不良事件23例,发生率52.3%;对照组52例患者中5例失访,47随访患者中发生心脏不良事件7例,发生率14.9%,两组比较,差异有统计学意义（P〈0.05）。结论 BNP能准确地评价左心室的功能改变,有助于高危人群的筛查和慢性心力衰竭的早期诊断,慢性心力衰竭经治疗后BNP水平仍高（≥400 pg/m L）的患者预后不良。

Objective To approach the clinic value of the plasma B-type natriuretic peptide（BNP） in the diagnosis of chronic heart failure（CHF）,and the relationship between BNP and left ventricle as well as role of evaluating CHF prognosis.Methods A total of 100 patients with CHF from April 2010 to April 2013 in the Department of Cardiology of this hospital were received and measured their BNP level when they were admitted to the hospital by immunofluorescence method;meanwhile,the several indexes such as cardio-thoracic proportion,left atrial diameter（LADD）,left ventricular end diastolic diameter（LVDD）and left ventricular ejection fraction（LVEF） were measured too. A Followed-up study lasted one year were conducted to track their adverse events（such as cardiac death or rehospitalization because of heart failure within 30 days） and evaluate the grading of heart failure by the New York Heart Association（NYHA）. Results The BNP value were significantly increased with respect to worsening of heart function in line with NYHA,whose difference had statistical significance（P〈0.05）;Compared to the patients with normal left ventricular function,those with left ventricular dysfunction（LADD≥35 mm,LVDD≥50 mm,LVEF〈50%） had higher BNP values（P〈0.05） and BNP had a positive correlation with LVEF,LVDD and LADD（r=0.79、0.71、0.48,P〈0.05）. The larger that the cardio-thoracic proportion was,the higher the BNP value became. There are statistal signifcance in difference（P〈0.05）. In the one-year followed-up study,4 failed to be followed up aomg the 48 patients（BNP≥400 pg/m L as discharge from the hospital）.The heart function adverse events occurred in 23 out of 44 cases,accounting for 52.3%;There are 5 persons in loss of follow-up among the 52 patients（BNP400 pg/m L as discharge from the hospital）. The heart function adverse events occurred 7 out of 47 cases,accounting for 14.9%. It had statistically significant difference（P〈0.05）. Conclusion BNP value may accurately evaluate the function change in left ventricle,being benefital to screening of high-risk groups and early diagnosis of CHF. Patients treated with high BNP value（BNP≥400 pg/m L） are poor in prognosis.