N末端脑钠肽前体与心肌酶谱联合检测在心力衰竭诊断及预后分析中的应用

Application of N-terminal pro-brain natriuretic peptide and myocardial enzyme spectrum combined detection in diagnosis and prognosis analysis of heart failure

目的探讨N末端脑钠肽前体(NT-proBNP)与心肌酶谱联合检测在心力衰竭(HF)诊断中的应用价值。方法选择2019年5月-2020年1月徐州医科大学附属第三医院收治的76例HF患者作为HF组,另外选择同期76例健康体检者作为健康对照组。比较两组的血清NT-proBNP、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBD)、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平。根据美国纽约心脏病学会(NYHA)心功能分级划分HF患者的病情严重程度等级,并对患者进行随访,观察预后,比较不同NYHA分级和不同预后患者的血清NT-proBNP、LDH、HBD、CK、CK-MB水平,分析上述指标与HF患者NYHA分级和不良预后的相关性。结果 HF组NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于健康对照组〔NT-proBNP(ng/L):534.02±73.24比68.91±8.29,LDH(μmol·s^-1·L^-1):5.81±0.79比2.67±0.53,HBD(U/L):319.82±41.08比95.31±13.29,CK(U/L):286.61±57.18比90.34±15.07,CK-MB(U/L):58.82±6.05比12.06±3.04,均P<0.05〕;NYHA分级≥Ⅲ级患者的NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于NYHA分级<Ⅲ级的患者〔NT-proBNP(ng/L):718.04±74.52比345.39±61.05,LDH(μmol·s^-1·L^-1):7.52±1.03比4.15±0.76,HBD(U/L):398.35±48.67比224.08±26.71,CK(U/L):388.26±61.08比179.74±30.43,CK-MB(U/L):78.61±9.07比39.34±5.82,均P<0.05〕;预后不良患者的NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于预后良好患者〔NT-proBNP(ng/L):759.35±79.17比291.24±56.82,LDH(μmol·s^-1·L^-1):8.04±1.12比3.79±0.67,HBD(U/L):410.04±51.81比209.18±24.86,CK(U/L):411.95±63.72比158.63±28.54,CK-MB(U/L):86.05±10.82比35.08±5.29,均P<0.05〕。Pearson相关性分析显示,NT-proBNP、LDH、HBD、CK、CK-MB与HF患者NYHA分级和不良预后均呈正相关(均P<0.05)。结论 NT-proBNP、LDH、HBD、CK、CK-MB联合检测在HF诊断中具有较高的应用价值,并能为患者病情及预后分析提供指导。

Objective To explore the application value of N-terminal pro-brain natriuretic peptide(NT-proBNP) and myocardial enzyme spectrum combined detection in diagnosis of heart failure (HF).Methods The 76 HF patients in the Third Affiliated Hospital of Xuzhou Medical University from May 2019 to January 2020 were selected as HF group,and 76 healthy medical examiners were selected as healthy control group,the serum NT-proBNP,lactate dehydrogenase (LDH),α-hydroxybutyrate dehydrogenase (HBD),creatine kinase (CK) and creatine kinase-MB(CK-MB) were compared between the two groups.According to heart function classification of New York Heart Association (NYHA),the HF degree was determined,the patients were followed up,the prognosis was observed,and the serum NT-proBNP,LDH,HBD,CK and CK-MB were compared in patients with different conditions and prognosis.The correlation between above indexes and NYHA grade and poor prognosis were analyzed.Results The NT-proBNP,LDH,HBD,CK and CK-MB in HF group were significantly higher than those in healthy control group [NT-proBNP (ng/L):534.02±73.24 vs.68.91±8.29,LDH (μmol·s^-1·L^-1):5.81±0.79 vs.2.67±0.53,HBD (U/L):319.82±41.08 vs.95.31±13.29,CK (U/L):286.61±57.18 vs.90.34±15.07,CK-MB (U/L):58.82±6.05 vs.12.06±3.04,all P < 0.05].The NT-proBNP,LDH,HBD,CK and CK-MB in patients with NYHA grade≥Ⅲwere significantly higher than those in patients with NYHA grade <Ⅲ[NT-proBNP (ng/L):718.04±74.52 vs.345.39±61.05,LDH (μmol·s^-1·L^-1):7.52±1.03 vs.4.15±0.76,HBD (U/L):398.35±48.67 vs.224.08±26.71,CK (U/L):388.26±61.08 vs.179.74±30.43,CK-MB (U/L):78.61±9.07 vs.39.34±5.82,all P < 0.05].The NT-proBNP,LDH,HBD,CK and CK-MB in patients with poor prognosis were significantly higher than those in the patients with good prognosis [NT-proBNP (ng/L):759.35±79.17 vs.291.24±56.82,LDH (μmol·s^-1·L^-1):8.04±1.12 vs.3.79±0.67,HBD (U/L):410.04±51.81 vs.209.18±24.86,CK (U/L):411.95±63.72 vs.158.63±28.54,CK-MB (U/L):86.05±10.82 vs.35.08±5.29,all P < 0.05].Pearson correlation analysis showed that NT-proBNP,LDH,HBD,CK and CK-MB were positively correlated with NYHA grade and poor prognosis in HF patients (all P > 0.05).Conclusion The combined detection of NT-proBNP,LDH,HBD,CK and CK-MB has exact value in diagnosis of HF,and can provide guidance for patients’ disease and prognosis analysis.