脑利钠肽对男性退行性心脏瓣膜病合并心衰患者病情的判断价值

Judging value of brain natriuretic peptide on patient′s condition of male patients with senile degenerative heart valvular disease complicated heart failure

目的:探讨脑利钠肽(BNP)对男性老年退行性心脏瓣膜病(SDHVD)合并心力衰竭者的病情判断价值。方法:选择67例老年心力衰竭合并SDHVD男性患者作为SDHVD组,同期收治的43例年龄相匹配的无瓣膜病的心力衰竭男性患者作为单纯心衰组。测定并比较两组心功能指标,血浆BNP水平,并分析BNP与左室舒张末内径(LVEDd)间的相关性,以及判断SDHVD合并心衰严重程度的BNP水平界值。结果:与单纯心衰组对比,SDHVD组LVEDd[(49.79±4.31)mm比(53.04±7.10)mm]显著增大,血浆BNP水平[(214.43±237.71)pg/ml比(682.06±981.15)pg/ml]显著升高,而左室射血分数[LVEF,(64.84±5.83)%比(58.24±7.99)%]显著降低,P<0.05或<0.01;SDHVD组中重度心功能不全(NYHAⅢ+Ⅳ级)比例显著高于单纯心衰组(56.72%比37.21%),χ2=3.988,P=0.046。Spearman相关分析显示BNP水平与LVEDd呈显著正相关(r=0.588,P=0.001)。BNP的ROC曲线下面积(AUC)为0.975,BNP水平判断男性SDHVD合并心力衰竭严重程度的临界点为312pg/ml,其敏感性和特异性分别为86.8%、96.6%。结论:老年退行性心脏瓣膜病合并心力衰竭者的病情较无心脏瓣膜病者更严重,BNP水平有助于对其病情严重程度的判断。

Objective： To explore the judging value of brain natriuretic peptide （BNP） on patient＇s condition of malepatients with senile degenerated heart valvular disease （SDHVD） complicated heart failure （HF）. Methods： A total of 67 SDHVD ＋ HF male patients were regarded as SHDVD group, another 43 male HF patients, who accepted treatment during the same period with corresponding age and without valvular heart disease, were enrolled as pure HF group. Cardiac function indexes and plasma BNP level were measured and compared between two groups, the correlation between BNP and left ventricular end- diastolic dimension （LVEDd） was analyzed, and the cutoff point of BNP level for judging severity of SDHVD ＋ HF was also calculated. Results： Compared with pure HF group, there were significant rise in LVEDd [ （49.79 ± 4.31） mm vs. （53.04± 7.10） mm] and plasma BNP level [ （214. 43±237.71） pg/ml vs. （682.06±981.15） pg/ml], and significant reduction in left ventricular ejection fraction [LVEF, （64.84±5.83） % vs. （58.24±7.99） %], P〈0.05 or 〈0.01; percentage of moderate - severe heart dys- function （NYHA class HI ＋ IV） in SDHVD group was significantly higher than that of pure HF group （56.72% vs. 37. 21%）, ;X2 = 3. 988, P = 0. 046. Spearman correlation analysis indicated that BNP level was positively correlated with LVEDd （r=0. 588, P = 0. 001）. The area under ROC （AUC） of BNP was 0. 975, and the critical point of BNP level judging severity of male SDHVD complicated HF was 312 pg/ml, and its sensitivity and specificity was 86. 8% and 96.6% respectively. Conclusion.. The SDHVD patient＇s condition is more severe compared with patients without valvular heart disease, and BNP level is help to judging patient＇s condition.