慢性心力衰竭患者心功能及血浆copeptin和NT-proBNP检测及临床意义

Detection of plasma copeptin and NT-proBNP in patients with chronic heart failure and their clinical significance in evaluation of cardiac function

目的探讨慢性心力衰竭患者心功能及血浆和肽素(copeptin)和末端脑钠肽前体(NT-proBNP)水平及临床意义,为临床诊疗提供参考。方法选择2017年8月至2019年8月于西安市中医医院接受诊治的慢性心力衰竭患者65例为心衰组,根据NYHA分级分为Ⅱ级(23例)、Ⅲ级(22例)、Ⅳ级(20例),选择同一时期25例健康体检者作为对照组,检测并比较各组受检者的左心射血分数(LVEF)、左室舒张末期内径(LVDD)、左室收缩末期内径(LVSD)、左室的舒张末期容积(LVEDV)、左室的收缩末期容积(LVESV),以及血浆copeptin和NT-proBNP水平。结果心衰组患者的LVEF为(43.16±2.79)%,明显低于对照组的(58.72±3.46)%,LVDD、LVSD、EDV、ESV分别为(56.28±4.12) mm、(44.39±3.64) mm、(156.84±13.63) m L、(64.25±5.14) mL,明显高于对照组的(48.51±3.24) mm、(29.52±2.47) mm、(108.41±10.22) m L、(35.13±3.40) m L,差异均有统计学意义(P<0.05);LVEF随慢性心力衰竭患者NYHA分级增加而明显下降,LVDD、LVSD、LVEDV、LVESV随慢性心力衰竭患者NYHA分级增加而明显上升,且各分级之间比较,差异均有统计学意义(P<0.05);心衰组患者copeptin和NT-proBNP水平分别为(10.85±3.19) ng/mL、(2508.41±681.52) ng/L,明显高于对照组的(2.42±0.77) ng/mL、(158.29±48.26) ng/L,差异均有统计学意义(P<0.05);copeptin和NT-proBNP水平均随着慢性心力衰竭患者NYHA分级增加而明显上升,且各分级之间比较,差异均有统计学意义(P<0.05)。结论慢性心力衰竭患者NYHA分级越高,心功能越差,且copeptin和NT-proBNP水平随NYHA分级增加而升高,可作为诊断、评估病情严重程度的指标应用于临床慢性心力衰竭诊疗中。

Objective To explore the cardiac function, the levels of plasma and peptide(copeptin) and N-Terminal pro-brain natriuretic peptide(NT-proBNP) in patients with chronic heart failure and their clinical significance, so as to provide reference for clinical diagnosis and treatment. Methods A total of 65 patients with chronic heart failure whowere treated in Xi’an Hospital of Traditional Chinese Medicine from August 2017 to August 2019 were selected as the heart failure group. According to the New York Heart Association(NYHA) functional classification system, the patients were divided into grade Ⅱ(23 cases), grade Ⅲ(22 cases) and grade Ⅳ(20 cases). Twenty-five healthy people in the same period were selected as the control group. The left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVDD), left ventricular end systolic diameter(LVSD), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV), plasma copeptin, and NT-proB NP levels were measured and compared. Results The LVEF of heart failure group was(43.16 ± 2.79)%, which was significantly lower than(58.72 ± 3.46)% of control group(P<0.05);LVDD, LVSD, LVEDV, LVESV of the heart failure group were(56.28±4.12) mm,(44.39±3.64) mm,(156.84±13.63) mL,(64.25±5.14) mL, respectively, which were significantly higher than corresponding(48.51±3.24) mm,(29.52±2.47) mm,(108.41 ± 10.22) mL,(35.13 ± 3.40) mL of the control group(all P<0.05). The LVEF decreased significantly with the increase of NYHA grade in patients with chronic heart failure, LVDD, LVSD, LVEDV, LVESV increased significantly with the increase of NYHA grade in patients with chronic heart failure, and the differences between the grades were statistically significant(all P<0.05);the levels of copeptin and NT-pro BNP in the heart failure group were(10.85±3.19) ng/m L,(2 508.41 ± 681.52) ng/L, respectively, which were significantly higher than corresponding(2.42 ± 0.77) ng/m L and(158.29±48.26) ng/L in the control group(P<0.05);the water content of copeptin and NT-pro BNP increased significantly with the increase of NYHA grade in patients with chronic heart failure(P<0.05). Conclusion The higher the NYHA grade, the worse the cardiac function, and the levels of copeptin and NT-pro BNP increased with the increase of NYHA grade, which could be used as an index for diagnosis and evaluation of the severity of chronic heart failure.