脑钠肽、尿微量白蛋白在心力衰竭患者中的临床诊断价值

Diagnostic value of brain natriuretic peptide and urine microalbuminuria for patients with heart failure

目的:观察不同心力衰竭患者血浆脑钠肽(BNP)和尿微量白蛋白(UMA)水平及其相关性。方法:选择180例心内科住院病人为研究对象,根据NYHA心功能分级和左室功能,患者被分为无心衰对照组(32例)、舒张性心力衰竭(DHF)组(72例)和收缩性心力衰竭(SHF)组(76例)。测定比较以上三组心功能组的血浆BNP和尿UMA水平,并分析二者的相关性。结果:与无心衰对照组比较,DHF组和SHF组的血浆BNP[(15.42±8.04)pg/ml比(69.48±55.16)pg/ml比(456.23±386.19)pg/ml]和尿UMA水平[(27.92±6.51)mg/L比(72.19±26.35)mg/L比(142.39±35.41)mg/L]均显著升高;且SHF组血浆BNP和尿UMA水平显著高于DHF组,P均<0.01。随着NYHA心功能等级的升高(Ⅰ,Ⅱ,Ⅲ,Ⅳ),血浆BNP[(45.42±8.04)pg/ml比(127.23±79.64)pg/ml比(418.35±187.36)pg/ml比(1257.62±454.26)pg/ml]和尿UMA水平[(47.92±16.51)mg/L比(74.68±27.02)mg/L比(131.05±33.68)mg/L比(263.14±104.69)mg/L]也逐渐升高,各组间比较均有显著差异,P<0.05或<0.01。简单线性回归分析显示血浆BNP与尿UMA水平呈显著正相关(r=0.544,P=0.001)。结论:血浆脑钠肽和尿微量白蛋白浓度随心衰的程度的加重而升高,且呈正相关关系,对诊断、评估严重程度、预后等均有较高价值。

Objective： To observe plasma level of brain natriuretic peptide （BNP） and urine microalbuminuria （UMA） level and their correlation in patients with different heart failure （HF）. Methods： A total of 180 patients hospital- ized in our department were selected. According to NYHA heart function classification and left ventricular function, patients were divided into no HF control group （n = 32）, diastolic HF （DHF） group （n = 72） and systolic HF （SHF） group （n= 76）. Plasma BNP and UMA levels were measured and compared among above three groups and groups with different NYHA classes, and correlation between BNP and UMA was analyzed. Results; Compared with no HF control group, there were significant rise in plasma BNP level [ （15. 42 ± 8. 04） pg/ml vs. （69. 48 ± 55. 16） pg/ml vs. （456. 23 ± 386.19） pg/ml] and UMA level [ （27.92 ± 6. 51） mg/L vs. （72.19 ± 26.35） mg/L vs. （142.39 ± 35.41） mg/L] in DHF group and SHF group; and those of SHF group were significantly higher than those of DHF group, P〈0.01 all. Along with NYHA class increased （ Ⅰ , Ⅱ, Ⅲ, Ⅳ）, there were significant rise in plasma BNP level [- （45.42 ± 8.04） pg/ml vs. （127. 23 ± 79.64） pg/ml vs. （418.35 ± 187. 36） pg/ml vs. （1257. 62 ± 454. 26） pg/ml] and UMA level [- （47.92± 16.51） mg/L vs. （74.68 ± 27.02） mg/L vs. （131.05 ± 33.68） mg/L vs. （263.14 ± 104.69） mg/L], and there existed significant difference between any two groups, P〈0.05 or 〈0.01. Simple linear regression analysis indicated that plasma BNP level was significant positively correlated with UMA level （ r = 0. 544, P = 0. 001）. Conclusion： Plasma brain natriuretic peptide level is significantly positively correlated with urine mi- croalbuminuria concentrations along with heart failure aggravating, and they possess high value for diagnosis, assessment of severity and prognosis etc.