N末端B型利钠肽在治疗心力衰竭患者中的应用分析

Application of N-terminal B-type Natriuretic Peptide in the Treatment of Patients with Heart Failure

目的集中探讨N末端B型利钠肽在治疗心力衰竭患者中的临床效果。方法纳入2016年4月—2017年5月因心力衰竭于该院心内科进行治疗的患者200例,按照NYHA心功能分级,其中心力衰竭Ⅰ组患者共18例,心力衰竭Ⅱ组患者共46例,心力衰竭Ⅲ组患者共85例,剩余51例患者为心力衰竭Ⅳ组患者。另外,取同时期于该院进行体格检查的60名老人为对照组,比较两组患者的NT-ProBNP、cTnI、LVEF和LVEDD。结果心力衰竭Ⅰ的患者NT-proBNP和cTnI分别为(89.3±37.6)pg/mL、(0.22±0.13)ng/mL,心力衰竭Ⅱ的患者NT-proBNP和cTnI分别为(366.8±124.9)pg/mL、(0.24±0.17)ng/mL,心力衰竭的患者ⅢNTproBNP和cTnI分别为(1 789.3±173.6)pg/mL、(0.48±0.26)ng/mL,心力衰竭Ⅳ的患者NT-proBNP和cTnI分别为(4021.3±401.2)pg/mL、(0.95±0.55)ng/mL,增高程度均明显高于对照组患者(69.6±29.1)pg/mL、(0.16±0.12)ng/mL,差异有统计学意义(P<0.01)。心力衰竭Ⅱ~Ⅳ组患者的NT-proBNP升高程度较对照组明显,差异有统计学意义(P<0.05);各组心力衰竭患者的比较中,差异有统计学意义(P<0.05)。心力衰竭Ⅲ和Ⅳ两组患者的cTnI较对照组升高明显,差异有统计学意义,除心力衰竭Ⅰ和Ⅱ组之外,其余心力衰竭的组间比较,差异有统计学意义(P<0.05)。收缩性心力衰竭患者的NT-proBNP、LVEF、LVEDD三项指标均明显高于舒张性心力衰竭的患者,差异有统计学意义(P<0.01)。另外将NT-proBNP和LVEF、LVEDD的相关性进行比较,结果显示,NT-proBNP与LVEF呈负相关(r=-0.685,P<0.05);NT-proBNP与LVEDD呈正相关(r=0.738,P<0.05),差异有统计学意义。结论 NT-proBNP在评估心力衰竭患者心脏器质性及其功能性的变化方面具有积极的意义,同时具有易于操作的优势,可在临床工作中推广使用。

Objective This paper tries to investigate the clinical effect of N-terminal B-type natriuretic peptide in the treatment of pa-tients with heart failure. Methods 200 patients with heart failure from April 2016 to May 2017 in this hospital were selected, accord-ing to NYHA heart function classification, there were 18 patients with heart failure group Ⅰ and 46 patients with heart failure groupⅡ, 85 cases of heart failure Ⅲ group, the remaining 51 patients with heart failure group Ⅳ. In addition, 60 patients with physical examination of the same period were enrolled in this study. NT-ProBNP, cTnI, LVEF and LVEDD were compared between the two groups. Results NT-proBNP and cTnI were（89.3±37.6）pg/mL,（0.22±0.13）ng/mL in groupⅠ, and NT-proBNP and cTnI in patients with heart failure were（366.8±124.9）pg/mL,（0.24±0.17）ng/mL in groupⅡ, and those of（1789.3±173.6）pg/mL and（0.48±0.26）ng/mL in groupⅢ; and those of（4021.3±401.2）pg/mL,（0.95±0.55）ng/mL in group IV, significantly higher than those in patients with heart failure in the control group of（69.6 ±29.1）pg/mL,（0.16±0.12）ng/mL, with significant statistical difference（P〈0.01）. The level of NT-proBNP in patients with heart failure Ⅱ~Ⅳ was significantly higher than that in the control group（P〈0.05）. The difference was significant in the patients with heart failure（P〈0.05）. The levels of cTnI in patients with heart failure Ⅲ and Ⅳ were significantly higher than those in the control group, the difference was statistically significant, except for heart failure Ⅰ and Ⅱ group, the difference was significant between other groups, with statistically significant difference（P〈0.05）. The levels of NT-proBNP, LVEF and LVEDD in patients with systolic heart failure were significantly higher than those in patients with diastolic heart failure, and the difference was statistically significant（P〈0.01）. NT-proBNP was negatively correlated with LVEF（r=-0.685, P〈0.05）. NT-proBNP was positively correlated with LVEDD（r=0.738, P〈0.05）, the differences were statistically significant（P〈0.05）. Conclusion NT-proBNP has a positive effect in assessing the changes of heart organism and its function in patients with heart failure,with easy operation and can be applied in clinical work.