B型利钠肽与急性呼吸困难心力衰竭患者分级的关系及其与超声心动图的优势比较

Relationship of B type natriuretic peptide(BNP) and classification of acute respiratory CHF patients and its advantages over echocardiography(UCG)

目的探讨B型利钠肽(BNP)与急性呼吸困难心力衰竭(CHF)患者分级及其与超声心动图(UCG)的关系,并且与UCG比较,探讨BNP在测定CHF方面的优势。方法比较观察组和对照组的超敏C-反应蛋白(hs-CRP)、BNP、脂蛋白磷脂酶A2(Lp-PLA2)、糖链抗原125(CA-125)、左心功能指标值,分析CHF患者BNP和其他指标的关系。结果 (1)和对照组对比,观察组各组hs-CRP、BNP、Lp-PLA2、CA-125水平明显更高,差异有统计学意义(P<0.05)。和心功能Ⅱ级对比,心功能Ⅲ级和Ⅳ级hs-CRP、Ig NT-pro BNP、Lp-PLA2、CA-125水平明显更高,差异有统计学意义(P<0.05)。和心功能Ⅲ级对比,心功能Ⅳ级hsCRP、BNP、Lp-PLA2、CA-125水平明显更高,差异有统计学意义(P<0.05)。(2)对照组和心功能Ⅰ级组、Ⅱ级组间的左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左心室射血分数(LVEF)差异无统计学意义(P>0.05)。心功能Ⅲ级和Ⅳ级组间的LVEDV、LVESV、LVEF差异无统计学意义(P>0.05)。心功能Ⅱ级和Ⅲ级组间的LVEDV、LVESV、LVEF差异有统计学意义,和Ⅱ级组对比,Ⅲ级和Ⅳ级组LVEDV、LVESV明显更高,LVEF明显更低,差异有统计学意义(P<0.05)。(3)根据Pearson相关分析结果,BNP和心功能分级(r=0.299,P<0.05)、hs-CRP(r=0.515,P<0.05)、血浆Lp-PLA2(r=0.745,P<0.05)均为显著正相关关系,和LVEDV(r=0.050,P>0.05)、LVESV(r=0.100,P>0.05)、LVEF(r=-0.009,P>0.05)差异无统计学意义。(4)BNP和LVEF的阳性预测率方面差异无统计学意义(P>0.05);BNP敏感度、阴性预测率、准确度明显高于LVEF,特异度明显低于LVEF,差异有统计学意义(P<0.05)。结论 BNP能快速而有效地诊断心源性呼吸困难,能为心功能不全提供量化数据,对CHF患者有重要的预后判断意义。BNP和UCG测定左心室功能方面相比,优势更为明显。

Objective To investigate the effect of B type natriuretic peptide （BNP） in the classification of acute respiratory congestive heart failure （CHF） patients and to compare BNP with echocardiography （UCG） for its advantages in diagnosing CHF.Methods We compared the hs-CRP,BNP,Lp-PLA2,CA-125 and left cardiac function index of the observation group and control group,analyzed the relationship between BNP and other indicators of CHF patients.Results （1） Compared with the control group,the levels of hs-CRP,BNP,Lp-PLA2 and CA-125 were significantly higher in the observation group,and the differences between the two groups were statistically significant （P〈0.05）.Compared with the group of grade Ⅱ cardiac function,hs-CRP,IgNT-proBNP,Lp-PLA2 and CA-125 were significantly higher in groups of grades Ⅲ,Ⅳ cardiac function,and the differences were statistically significant （P〈0.05）.Compared with the group of grade Ⅲ cardiac function,hs-CRP,BNP,Lp-PLA2,CA-125 levels were significantly higher than those in group of grade Ⅳ cardiac function and the differences were statistically significant （P〈0.05）.（2） There were no significant differences in LVEDV,LVESV and LVEF between the control group and the grade I cardiac function group and the grade Ⅱ cardiac function group （P〉0.05）.There were no significant differences in LVEDV,LVESV and LVEF between the groups of grades Ⅲ and Ⅳ cardiac function （P〉0.05）.There were significant differences between grades Ⅱ and Ⅲ cardiac function groups in LVEDV,LVESV and LVEF,and compared with grade Ⅱ cardiac function group,the levels of LVEDV and LVESV were significantly higher while LVEF level was significantly lower in grades Ⅲ and Ⅳ cardiac function groups.The difference was statistically significant （P〈0.05）.（3） According to the results of Pearson correlation analysis,BNP and heart function classification （r=0.299,P 〈0.05）,hs-CRP （r=0.515,P〈0.05） and plasma Lp-PLA2 （r=0.745,P〈0.05） were positively correlated,while BNP had no significant relationships with left ventricular end diastolic volume （r=0.050,P〉0.05）,left ventricular end systolic volume （r=0.100,P〉0.05） and left ventricular ejection fraction （r=-0.009,P〉0.05）.（4） The positive predictive rates of BNP and LVEF had no significant differences （P〉0.05）.BNP sensitivity,negative predictive rate and accuracy were significantly higher than LVEF,while BNP specificity was significantly lower than LVEF.The difference was statistically significant （P〈0.05）.Conclusions BNP can be used to diagnose cardiac dyspnea quickly and effectively.It can provide quantitative data for cardiac insufficiency,and has important prognostic significance in patients with CHF.BNP content was measured and compared with echocardiography （UCG） in terms of left ventricular function,and the superiority was more obvious.