慢性心力衰竭合并房颤患者血浆BNP水平的变化

Changes of plasma brain natriuretic peptide in patients with chronic heart failure(CHF) complicated by atrial fibrillation

目的 观察慢性心力衰竭合并心房纤颤（房颤，AF）患者血浆脑钠肽（BNP）水平的变化。方法 选取2009年4月~2013年4月四川省广元市第二人民医院心内科收治的325例慢性心力衰竭（心衰）患者，其中男性193例，女性132例，年龄34~86岁。按照其是否发生AF分为AF组（117例）及窦性心律组（208例）。按照AF患者疾病类型进行再次分组，分为A组（65例）及B组（52例），分别为阵发性房颤及持续性房颤。检测所有入选者血浆BNP水平以及心房内径（LAD）、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）、左室后壁厚度（LVPWT）。结果 三组患者随着纽约心脏协会心功能分级的升高，其血浆BNP水平也随之显著升高，差异有统计学意义（P均＜0.05）。与窦性心律组比较，A组和B组患者血浆BNP水平显著升高，同时B组患者血浆BNP水平显著高于A组，差异有统计学意义（P均＜0.05）。B组患者LVEDD、LAD显著高于A组和窦性心律组，A组和B组患者LVPWT显著高于窦性心律组，差异有统计学意义（P均＜0.05）。血浆BNP水平与LVEDD、LVPWT呈显著正相关，相关系数分别为0.427、0.585（P均＜0.05）。结论 慢性心力衰竭合并AF患者血浆BNP水平显著升高，心功能越差其水平升高越明显，且血浆BNP水平越高左室结构改变越明显。

Objective To observe the changes of plasma brain natriuretic peptide (BNP) in patients withchronic heart failure (CHF) complicated by atrial fibrillation (AF). Methods CHF patients (n=325, male 193,female 132 and aged from 34 to 86) were chosen from the Department of Cardiovasology of the Second People’sHospital of Guangyuan City in Sichuan Province from Apr. 2009 to Apr. 2013. All patients were divided, accordingto whether or not they had atrial fibrillation (AF), into AF group (n=117) and normal sinus rhythm group (NSR group,n=208). AF group was divided again, according to the types of AF, into group A (with paroxysmal AF, n=65) andgroup B (with sustained AF, n=52). The levels of BNP, left atrial diameter (LAD), left ventricular end-diastolicinner diameter (LVEDd), left ventricular ejection fraction (LVEF) and left ventricular posterior wall thickness(LVPWT) were detected in all groups. Results The level of plasma BNP increased as NYHA class increased in3 groups (all P<0.05). Compared with NSR group, the level of plasma BNP increased significantly in group A andgroup B, and that was significantly higher in group B than that in group A (all P<0.05). LVEDD and LAD weresignificantly higher in group B than those in group A and NSR group, and LVPWT was significantly higher in groupA and group B than that in NSR group (all P<0.05). The level of plasma BNP was positively correlated to LVEDD (r=0.427) and LVPWT (r=0.585, all P<0.05). Conclusion The level of plasma BNP increases significantly inpatients with CHF complicated by AF, and the poorer the heart function, the higher the BNP level. The changes ofleft ventricular structure will be more significant as level of plasma BNP increases.