慢性心力衰竭患者血浆脑钠肽水平变化及其对预后的影响研究

Plasma BNP Level Changes and Its Impact on Prognosis of Patients with Chronic Heart Failure

目的探讨慢性心力衰竭患者血浆脑钠肽水平变化及其对预后的影响。方法选取海南省农垦那大医院2010年2月—2011年2月收治的慢性心力衰竭患者120例，参照纽约心脏病协会（NYHA）心功能分级标准分为心功能Ⅱ级组、心功能Ⅲ级组和心功能Ⅳ级组，每组40例。观察各组患者血浆脑钠肽水平、左心室舒张末期内径、左心室射血分数；患者出院后随访1—3年，观察血浆脑钠肽水平升高者与正常者死亡情况、年平均住院次数及年平均住院时间。结果心功能Ⅳ级组患者血浆脑钠肽水平、左心室舒张末期内径高于心功能Ⅲ级组和心功能Ⅱ级组，左心室射血分数低于心功能Ⅲ级组和心功能Ⅱ级组，心功能Ⅲ级组患者血浆脑钠肽水平、左心室舒张末期内径高于心功能Ⅱ级组，左心室射血分数低于心功能Ⅱ级组（p〈0．05）。心功能Ⅲ级组、心功能Ⅳ级组患者血浆脑钠肽水平升高率高于心功能Ⅱ级组（P〈O．05），而心功能Ⅲ级组与心功能Ⅳ级组患者血浆脑钠肽水平升高率比较，差异无统计学意义（P〉0．05）。血浆脑钠肽水平升高组患者病死率高于血浆脑钠肽水平正常组，年平均住院次数多于血浆脑钠肽水平正常组，年平均住院时间长于血浆脑钠肽水平正常组（P〈0．05）。结论血浆脑钠肽水平可反映慢性心力衰竭患者心功能，对判断患者病情严重程度及预测患者预后有一定的参考价值。

Objective To investigate the plasma BNP level changes and its impact on prognosis of patients with chronic heart failure. Methods A total of 120 patients with chronic heart failure were selected in Hainan Agricultural Reclamation Nada Hospital from February 2010 to February 2011, and they were divided into A group （with Ⅱ grade cardiac function）, B group （with Ⅲ grade cardiac function） and C group （with 1V grade cardiac function） according to NYHA cardiac functional grading standard, each of 40 cases. Plasma BNP level, LVEDD and LVEF were compared among the three groups; all of the patients were fellowed up for 1 to 3 years, the fatality rate, annual average hospitalization times, annual average hospital stays were compared between patients with increased and with normal plasma BNP level. Results Plasma BNP level and LVEDD of C group were statistically significantly higher than those of A group and B group, while LVEF of C group was statistically significantly lower than that of A group and B group, respectively （ P 〈 0. 05 ） ; plasma BNP level and LVEDD of B group were statistically significantly higher than those of A group, while LVEF of B group was statistically significantly lower than that of A group （P 〈0. 05 ）. The increased rate of plasma BNP level of B group and C group was statistically significantly higher than that of A group, respectively （ P 〉 0.05 ） ; while no statistically significant difference of increased rate of plasma BNP level was found between B group and C group （ P 〉 0. 05 ）. The fatality rate of patients with increased plasma BNP level was statistically significantly higher than that of patients with normal plasma BNP level, annual average hospitalization times of patients with increased plasma BNP level was statistically significantly more than that of patients with normal plasma BNP level, and annual average hospital stays of patients with increased plasma BNP level was statistically significantly longer than that of patients with normal plasma BNP level （ P 〈 0.05 ）. Conclusion Plasma BNP level can reflect the cardiac function of patients with chronic heart failure has certain value on evaluation of disease severity and prediction of prognosis.