B型钠尿肽前体和D-二聚体在老年慢性心力衰竭患者中的应用价值及相关性

Application value and relevance of B-type natriuretic peptide precursor and D-dimer in senior patients with chronic heart failure

目的 分析B型钠尿肽前体和D-二聚体在老年慢性心力衰竭（CHF）患者中的应用价值及相关性.方法 选取河北北方学院附属第一医院（以下简称“我院”）2012年1月～2013年6月收治的CHF患者140例,根据美国纽约心脏病协会（NYHA）心功能分级标准,其中无临床症状患者37例（Ⅰ级组）,心功能Ⅱ级CHF患者36例（Ⅱ级组）,Ⅲ级CHF患者34例（Ⅲ级组）,Ⅳ级CHF患者33例（Ⅳ级组）,另外选取同时期我院健康体检者35例为健康对照组.采用免疫比浊法检测血D-二聚体水平,免疫荧光法检测血中B型钠尿肽前体水平.比较不同心功能分级患者血D-二聚体及B型钠尿肽前体水平,比较各组治疗前后D-二聚体及B型钠尿肽前体水平变化情况并进行相关性分析.结果 ①各组D-二聚体水平比较：Ⅰ级组高于健康对照组,Ⅱ级组高于Ⅰ级组,Ⅲ级组高于Ⅱ级组,Ⅳ级组高于Ⅲ级组,差异均有统计学意义（P＜0.05）;各组B型钠尿肽前体水平比较：Ⅰ级组高于健康对照组,Ⅱ级组高于Ⅰ级组,Ⅲ级组高于Ⅱ级组,Ⅳ级组高于Ⅲ级组,差异均有统计学意义（P＜0.05）.②Ⅱ、Ⅲ、Ⅳ级组患者治疗后D-二聚体水平[（1.04±0.34）、（1.43±0.39）、（1.51±0.42）μg/mL]均明显低于同组治疗前[（2.80±1.21）、（4.76±2.09）、（6.43±2.58） μg/mL],差异有统计学意义（P＜0.05）;Ⅱ、Ⅲ、Ⅳ级组患者治疗后B型钠尿肽前体水平[（47.8±13.5）、（75.4±28.1）、（86.6±31.7）pg/mL]均明显低于同组治疗前[（334.4±79.5）、（494.6±134.6）、（1535.2±723.5）pg/mL],差异均有统计学意义（P＜0.05）.③血中B型钠尿肽前体水平与D-二聚体呈正相关（r=0.64,P＜0.05）.结论 D-二聚体及B型钠尿肽前体水平随心功能分级增加而升高,可作为判断患者心功能的客观检查指标.

Objective To analyze the application value and relevance of B-type natriuretic peptide precursor and Ddimer in senior patients with chronic heart failure（CHF）. Methods 140 cases of CHF from January 2012 to June 2013 in the First Affiliated Hospital of Hebei North University（＂our hospital＂ for short） were selected. According to the NYHA Cardiac function classification standard, 37 cases without clinical symptom were chose as Ⅰ grade group, 36 cases with Ⅱ grade cardiac function were chose as Ⅱ grade group, 34 cases with Ⅲ grade cardiac function were chose as Ⅲgrade group, 33 cases with Ⅳ grade cardiac function were chose as Ⅳ grade group; 35 cases of health examination in the same term in our hospital were chose as healthy control group. The D-dimer level was detected by immunoturbidimetry method, the B-type natriuretic peptide precursor was detected by immumofluorescence method. The D-dimer and B-type natriuretic peptide precursor level in patients with different heart function classification were compared; the changes of D-dimer and B-type natriuretic peptide precursor level before and after the treatment in each group were compared; the correlation analysis was carried out. Results 1 The D-dimer level in Ⅰ grade group was higher than that in healthy control group, this in Ⅱ grade group was higher than that in Ⅰ grade group, the D-dimer level in Ⅲgrade group was higher than that in Ⅱ grade group, the D-dimer level in Ⅳ grade group was higher than that in Ⅲgrade group, the differences were statistically significant（P 〈0.05）; the B-type natriuretic peptide precursor level in Ⅰgrade group was higher than that in healthy control group, this in Ⅱ grade group was higher than that in Ⅰ grade group, the B-type natriuretic peptide precursor level inⅢ grade group was higher than that in Ⅱ grade group,the B-type natriuretic peptide precursor level in Ⅳ grade group was higher than that in Ⅲ grade group, the differences were statistically significant（P 〈0.05）. 2The D-dimer level in Ⅱ grade group, Ⅲ grade group, Ⅳ grade group after the treatment [（1.04±0.34）,（1.43±0.39）,（1.51±0.42） μg/m L] were all lower than those before the treatment [（2.80±1.21）,（4.76±2.09）,（6.43±2.58） μg/m L], the differences were statistically significant（P 〈0.05）. The B-type natriuretic peptide precursor level in Ⅱ grade group, Ⅲ grade group, Ⅳ grade group after the treatment [（47.8±13.5）,（75.4±28.1）,（86.6±31.7） pg/m L] were all lower than those before the treatment [（334.4 ±79.5）,（494.6±134.6）,（1535.2 ±723.5） pg/m L], the differences were statistically significant（P 〈0.05）. 3The positive correlation relationship was found between B-type natriuretic peptide precursor level and D-dimer level（r = 0.64, P 〈0.05）. Conclusion The D-dimer and B-type natriuretic peptide precursor level rise along with heart function classification, it is right to use them as the objective indicators in the judgment of heart function.