B型钠尿肽在诊断慢性心力衰竭患者中的临床应用价值

Clinical significance of the detection of brain natriuretic peptide in diagnosis of chronic heart failure

目的评估B型钠尿肽（BNP）在慢性心力衰竭患者诊断的临床价值。方法2009年1月至2012年3月人选心内科慢性心力衰竭患者306例，按照NYHA心功能分级标准。采用快速免疫荧光法测定患者血浆BNP水平及血浆肌钙蛋白Ⅰ，心脏彩色多普勒超声诊断仪测量左心室结构和功能：左室射血分数（LVEF）、左室舒张末内径（LVEDD），分析BNP水平与心脏结构指标问相关性。以上计量资料组间比较采用t检验，多组间采用单因素方差分析，计数资料比较采用∥检验。结果（1）患者BNP水平随着心功能NYHA分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级升高而增高，与正常对照组比较差异有统计学意义（P〈0．01）；心功能Ⅳ级患者BNP水平显著高于Ⅲ级和Ⅱ级[Ⅳ级（11609±11575）ng/L、Ⅲ级（6343±7954）ng／L、11级（3423±5919）ng／L；t=-4．34，P〈0．01；t=-6．38，P〈0．01]。（2）心衰组LVEF显著低于正常组[（42±14）％比（68±14）％，t=2．86，P〈0．01]；LVEDD显著高于正常组[（55±12）mm比（46±11）mm，t=2．58，P〈0．01]。（3）冠心病、扩张性心肌病、风心病、高血压性心脏病和瓣膜性心脏病患者血浆中BNP水平差异无统计学意义（P〉0．01）。（4）慢性心力衰竭患者BNP水平与血浆肌钙蛋白Ⅰ存在明显相关性（r=0．29，P〈0．01）。结论血浆BNP水平与心功能分级、心脏结构显著相关，是诊断慢性心力衰竭的敏感指标，具有重要的临床意义。

Objective To evaluate the clinical value of brain natriuretic peptide （BNP） in patients with chronic heart failure （ CHF ）. Methods According to NYHA classification, 306 patients with heart failure were involved. The plasma BNP and cTnI levels , indicators of cardiac structure such as LVEF and LVEDD in 306 CHF patients were measured in our department. Analyzed the relationship between BNP levels and indicators of cardiac structure, LVEF and LVEDD, which were measured by echocardiography. Results （ 1 ） Compared with control group, BNP levels in CHF patients changed significantly （ P 〈 0.01 ）. Besides, BNP levels increased progressively with the NYHA grades raised. NYHA IV were significantly higher than in NYHA Ⅲ and NYHA Ⅱ [ BNP levels of grade Ⅳ, Ⅲ, Ⅱ was （ 11 609 ± 11 575 ） ng/L, （6 343 ±7954）ng/L,（3423±5919） ng/L;t= -4.34,P〈0.01）, t= -6.38,P〈0.011. （2）LVEFof heart failure group was significantly lower than the control group [ （42 ±14 ）% vs （68 ±14 ）% , t = 2.86, P 〈 0. 01 ] ; While LVEDD of heart failure group was significantly higher than the control group [ （ 55 ±12） mm vs （46 ±11 ） mm; t = 2. 58, P 〈 0. 01 ]. （3） The differences of BNP levels in patients with coronary heart disease, dilated cardiomyopathy, rheumatic heart disease, hypertensive heart disease and valvular heart disease were no significant （P 〉 0. 01 ）. （4）BNP levels in patients with chronic heart failure were significantly correlated with cTnI （ r = 0. 29, P 〈 0.01 ）. Conclusion BNP levels were significantly correlated with NYHA grades, cardiac structure. BNP has important reference value in the diagnosis of chronic heart failure.