不同心功能分级心力衰竭心力衰竭患者BNP和IL-33水平变化情况及其临床诊断价值

Investigate the changes of BNP and IL-33 levels and their clinical diagnostic values in different heart function classification of patients with heart failure.

目的 探究B型钠尿肽（B type natriuretic peptide,BNP）和白细胞介素（interleukin,IL）-33水平在心力衰竭患者不同心功能分级中的变化情况以及临床诊断价值.方法 选择2016年1月-2017年1月在温岭市第一人民医院治疗的286例心力衰竭心力衰竭患者作为心力衰竭心力衰竭组,另选择同期106例健康者作为对照组,心力衰竭心力衰竭组依据纽约心脏病协会（New York Heart Association,NYHA）的心功能分级标准又分为心功能Ⅰ级76例、Ⅱ级129例、Ⅲ级61例、Ⅳ级20例,比较心力衰竭心力衰竭组与对照组间以及不同心功能分级组间BNP和IL-33水平差异,使用单因素及多因素Logistic回归方法分析心力衰竭的相关因素,采用受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）分析BNP和IL-33对心力衰竭的诊断价值.结果心力衰竭 心力衰竭组BNP水平显著高于对照组（P〈0.05）,而IL-33水平显著低于对照组（P〈0.05）.不同心功能分级组间BNP水平的差异均有统计学意义（P〈0.05）,且随心功能分级增高而升高,而IL-33水平的差异无统计学意义.单因素分析显示：BNP和IL-33均为心力衰竭的相关因素,而多因素Logistic分析显示：仅BNP为心力衰竭的独立因素.ROC曲线结果提示：BNP诊断心力衰竭的曲线下面积大于IL-33,差异有统计学意义（P〈0.05）.结论 BNP和IL-33均可有效辅助诊断心力衰竭,但BNP更具诊断价值,且BNP可有效反映心功能情况、病情程度及预后情况,更科学指导临床治疗.

Objective To investigate the changes of B type natriuretic peptide（BNP） and interleukin（IL）-33 levels and their clinical diagnostic values in different heart function classification of patients with heart failure.MethodsFrom January 2016 to January 2017,286 patients with heart failure in our hospital were selected as the heart failure group,while 106 healthy people were selected as the control group.The heart failure group was divided into New York Heart Association（NYHA）Ⅰ（n=76）, NYHA Ⅱ（n=129）, NYHA Ⅲ（n=61） and NYHA Ⅳ（n=20） according to the NYHA heart function classification criteria.The BNP and IL-33 levels were compared between heart failure group and control group,as so as the different heart function classification groups.And analyzed the factors related to heart failure by single factor and multivariate logistic regression.The diagnostic value of BNP and IL-33 in heart failure were analyzed by receiver operating characteristic（ROC） curve.ResultsThe level of BNP in heart failure group was significantly higher than that in control group（P〈0.05）,while IL-33 level was significantly lower than that in control group （P〈0.05）.The BNP levels in heart function classification groups had significant difference（P〈0.05）,but there was no significant difference in IL-33 level among them.Univariate analysis showed that both BNP and IL-33 were associated factors of heart failure, but multivariate logistic analysis showed that only BNP was an independent factor of heart failure.ROC curve showed that the area under the curve（AUC） of heart failure diagnosed of BNP was bigger than that of IL-33,the difference was statistically significant （P〈0.05）.ConclusionBNP and IL-33 can both effectively diagnose heart failure, but BNP is more diagnostic value.Besides, BNP can effectively reflect the cardiac function, the degree of disease and prognosis, witch can more scientifically guide the clinical treatment.