老年心力衰竭患者BNP、甲状腺激素水平变化对心功能及预后的影响

Effects of BNP and thyroid hormone levels on cardiac function and prognosis in elderly patients with congestive heart failure

目的分析老年心力衰竭患者脑钠肽(BNP)、甲状腺激素水平变化对心功能及预后的影响,以探讨测定BNP和甲状腺激素用于指导临床治疗的价值。方法选取老年心力衰竭患者88例为观察组,根据患者心功能情况分为Ⅰ~Ⅳ级4组,另外选取同期健康体检老年患者30例为对照组,测定所有入选者BNP和甲状腺激素水平。结果观察组BNP水平(694±128)pg/ml,高于对照组(32±14)pg/ml,FT3水平(3.16±0.85)pg/ml,低于对照组(5.63±0.81)pg/ml(均P<0.01),FT4和促甲状腺激素(TSH)水平与对照组差异均无统计学意义(均P>0.05)。随着心力衰竭程度的加重,FT3水平降低,BNP水平升高,不同程度心力衰竭患者FT3水平和BNP水平差异均有统计学意义(均P<0.05);存活者BNP水平(916.25±452.37)pg/ml,低于死亡者(2 367.82±1 002.24)pg/m(l P<0.05),FT3水平(3.89±1.24)pmol/L,高于死亡者(2.67±0.85)pmol/L(P<0.05)。患者BNP水平越高、FT3水平越低,死亡发生率越高。结论老年心力衰竭患者心力衰竭严重程度可以采用测定BNP和甲状腺激素水平来评价,BNP降低、FT3升高可以作为预后良好的指标。

Objective To investigate the effect of brain natriuretic peptide（BNP） and thyroid hormone levels on cardiac function and prognosis in elderly patients with congestive heart failure.Methods Eighty eight elderly patients with heart failure admitted in our hospital from March 2015 to July 2013（study group）,and 30 healthy aged subjects undergoing health check-up at the same period（control group） were enrolled in the study.The BNP and thyroid hormone levels were measured in two groups.Results BNP level in study group was significantly higher than that in control group（694±128pg/ml vs.32±14pg/ml,P〈0.01）;the level of FT3 in study group was significantly lower than that in control group（3.16±0.85pg/ml vs.5.63±0.81pg/ml,P〈0.01）;there was no significant difference in FT4 and TSH2 levels between two groups（P〉0.05）.With the aggravation of heart failure,the level of FT3 was significantly decreased,and the level of BNP was gradually increased;there was a significant difference in FT3 and BNP levels among patients with different cardiac functions（grades I-IV,P〈0.05）.The BNP level in survival patients was significantly lower than that in fatal patients（916.25±452.37pg/ml vs.2367.82±1002.24pg/ml,P〈0.05）,while the FT3 level in survival group was significantly higher than that in fatal group（3.89±1.24pmol/L vs.2.67±0.85pmol/L,P〈0.05）.The incidence of mortality was positively associated with BNP level and negatively associated with FT3 level in elderly patients with heart failure.Conclusion The BNP and thyroid hormones levels are associated with the severity of heart failure in the elderly patients,indicating that BNP and FT3 may be used to evaluate the prognosis of patients.