尿脑钠肽和β2-微球蛋白与慢性心力衰竭的关系研究

Relationship between Levels of Urinary Brain Natriuretic Peptide and Beta 2-microglobulin and Chronic Heart Failure

背景由于慢性心力衰竭(CHF)诊断尚无统一的金标准,且缺乏客观准确的诊断标准,而找到一种无创的、客观的诊断手段和指标是目前面临的主要问题。目的分析尿脑钠肽(BNP)和β2-微球蛋白(β2-MG)与CHF的关系。方法选取2017年1月—2018年6月西安交通大学第一附属医院心内科收治的CHF患者133例作为观察组,选取同时期于本院体检健康者100例作为对照组,比较两组受试者尿BNP、β2-MG,不同纽约心脏病协会(NYHA)分级CHF患者尿BNP、β2-MG。对CHF患者进行至少1年的随访,记录患者一般资料及尿BNP、β2-MG、生存情况,并根据生存情况将所有CHF患者分为预后良好组(n=104)和预后不良组(n=29)。尿BNP、β2-MG与CHF患者NYHA分级的相关性分析采用Spearman秩相关分析;CHF患者预后的影响因素分析采用多因素Logistic回归分析。结果观察组患者尿BNP、β2-MG高于对照组(P<0.05)。NYHA分级Ⅱ、Ⅲ、Ⅳ级患者尿BNP、β2-MG高于Ⅰ级(P<0.05),NYHA分级Ⅲ、Ⅳ级患者尿BNP、β2-MG高于Ⅱ级(P<0.05),NYHA分级Ⅳ级患者尿BNP、β2-MG高于Ⅲ级(P<0.05)。Spearman秩相关分析结果显示,CHF患者的尿BNP、β2-MG与NYHA分级呈正相关(rs值分别为0.705、0.437,P<0.05)。预后不良组与预后良好组患者年龄、心力衰竭部位、NYHA分级、左心室射血分数、尿BNP及β2-MG比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NYHA分级Ⅲ级~Ⅳ级〔OR=5.249,95%CI(2.771,9.944)〕、左心室射血分数<40%〔OR=3.916,95%CI(1.618,9.478)〕、尿BNP≥100 ng/L〔OR=5.286,95%CI(2.490,11.219)〕、β2-MG≥3.0 mg/L〔OR=2.901,95%CI(1.555,5.410)〕是CHF患者预后的危险因素(P<0.05)。结论CHF患者尿BNP和β2-MG升高,并与患者心功能分级呈正相关,且尿BNP≥100 ng/L、β2-MG≥3.0 mg/L是CHF患者预后的危险因素。

Background At present,there is no unified gold standard for chronic heart failure(CHF)diagnosis,and there is a lack of objective and accurate diagnostic standard,therefore finding a noninvasive and objective diagnostic method and indicators is the main problem now.Objective To investigate the relationship between levels of urinary brain natriuretic peptide(BNP)and beta 2-microglobulin(β2-MG)and CHF.Methods A total of 133 CHF patients were selected from the Department of Cardiology,First Affiliated Hospital of Xi'an Jiaotong University as observation group from January 2017 to June 2018,and 100 normal people who underwent physical examination at the same time in this hospital were selected as control group.Urine BNP,β2-MG levels were compared between the observation group and control group and patients with different NYHA grades.CHF patients were followed up for at least one year.General data,levels of urine BNP,β2-MG and survival condition were recorded.All CHF patients were divided into good prognosis group(n=104)and poor prognosis group(n=29).Correlation of levels of urine BNP,β2-MG and NYHA grades of CHF patients was analyzed by Spearman rank correlation analysis;multivariate Logistic regression analysis was used to analyze the influence factors of prognosis of CHF patients.Results Urine BNP andβ2-MG levels in observation group were statistically significantly higher than those in control group(P<0.05).Urine BNP andβ2-MG levels in patients with NYHA grade-Ⅱ,-Ⅲ and-Ⅳ were statistically significantly higher than those in patients with NYHA grade-Ⅰ(P<0.05);levels of urine BNP andβ2-MG in patients with NYHA grade-Ⅲ and-Ⅳ were statistically significantly higher than those in patients with NYHA grade-Ⅱ(P<0.05);levels of urine BNP andβ2-MG in patients with NYHA grade-IV were statistically significantly higher than those in patients with grade-Ⅲ(P<0.05).Spearman rank correlation analysis result showed that,levels of urine BNP andβ2-MG in CHF patients were positively correlated with NYHA classification(rs values were 0.705,0.437,respectively,P<0.05).There were statistically significantly differences in age,heart failure site,NYHA grade,left ventricular ejection fraction,levels of urine BNP andβ2-MG between poor prognosis group and good prognosis group(P<0.05).Multivariate Logistic regression analysis results showed that,NYHA grade-Ⅲ-Ⅳ〔OR=5.249。95%CI(2.771,9.944)〕,LVEF<40%〔OR=3.916,95%CI(1.618,9.478)〕,urine BNP≥100 ng/L〔OR=5.286,95%CI(2.490,11.219)〕andβ2-MG≥3.0 mg/L〔OR=2.901,95%CI(1.555,5.410)〕were the risk factors for prognosis of CHF patients(P<0.05).Conclusion Urine BNP andβ2-MG levels increased in CHF patients,and are positively correlated with the cardiac function grading.Urine BNP≥100 ng/L and β2-MG≥3.0 mg/L are the risk factors for prognosis of CHF patients.