BNP/NT-proBNP在老年心力衰竭患者心功能评估中的应用价值

Application value of BNP/NT-proBNP in evaluation of cardiac function in elderly patients with heart failure

目的通过检测老年心力衰竭患者血清中的BNP/NT-proBNP,探讨其在心力衰竭中的诊断价值。方法2017年1月至2019年12月中国人民解放军联勤保障部队第九〇〇医院干部一科收治的169例老年慢性病患者,按照美国纽约心脏病协会(NYHA)心功能分级,将患者分为A组(无心力衰竭者)、B组(NYHAⅠ+Ⅱ级)和C组(NYHAⅢ+Ⅳ级),使用多普勒超声检测患者左心室射血分数(LVEF)。入院时测定患者6 min步行试验(6MWT),并检测患者血清BNP、NTproBNP、C反应蛋白(CRP)、降钙素原、肌酐、尿素氮、球蛋白、白蛋白、胱抑素C,采用方差分析比较不同心功能分级的患者血清BNP/NT-proBNP是否具有差异性,采用Pearson相关分析法分析BNP/NT-proBNP与上述指标间的相关性。另外,在各组内按不同肾功能或是否合并感染分出亚组,进一步分析在心力衰竭合并肾功能不全或感染时BNP/NT-proBNP是否具有差异性。结果随着心功能的下降,3组BNP/NT-proBNP逐渐降低(0.252±0.065,0.221±0.062,0.195±0.071,F=9.807,P<0.001),该比值与LVEF、6MWT具有显著正相关性(r=0.300,P<0.001;r=0.230,P=0.003)。3组中,未合并感染者BNP/NT-proBN与合并感染患者差异均无统计学意义(P均>0.05)。在B组和C组内,GFR<30 ml/(min·1.73 m^2)的患者BNP/NT-proBNP较GFR≥30 ml/(min·1.73 m^2)的患者低[B组:(0.128±0.110)vs(0.225±0.056),C组:(0.135±0.046)vs(0.199±0.077)],差异具有统计学意义(B组:t=6.578,P<0.001,C组:t=2.819,P=0.007),而当排除GFR<30 ml/(min·1.73 m^2)的患者进行进一步研究发现,在3组内,GFR<60 ml/(min·1.73 m^2)的患者BNP/NT-proBNP与GFR≥60 ml/(min·1.73 m^2)的患者比较,差异均无统计学意义(P均>0.05)。结论BNP/NTproBNP在老年心力衰竭患者心功能诊断及判断预后中具有重要价值。

Objective To investigate the diagnostic value of serum brain natriuretic peptide(BNP)/N terminal pro-BNP(NT-proBNP)in elderly patients with heart failure(HF).Methods A total of 169 elderly patients with chronic diseases admitted to our department from January 2017 to December 2019 were selected.According to New York Heart Association(NYHA)cardiac function classification,the patients were divided into Group A(No HF),Group B(NYHAⅠ+Ⅱ),and Group C(NYHAⅢ+Ⅳ).Left ventricular ejection fraction(LVEF)was detected by Doppler ultrasound.The 6-minute walking distance(6MWT),serum BNP,NT-proBNP,C-reactive protein(CRP),calcitonin,creatinine,urea nitrogen,globulin,albumin,and cystatin C were measured on admission.The differences of serum BNP/NT-proBNP were compared by ANOVA in patients with different cardiac function grades and the relationship between BNP/NT-proBNP and the above indexes was analyzed with Pearson′s correlation analysis.Each group was divided into sub-groups according to different renal functions or whether or not they were combined with infections,and the differences of BNP/NT-proBNP in HF combined with renal insufficiency or infection were further compared.Results With the decrease of cardiac function,BNP/NT-proBNP decreased gradually(0.252±0.065,0.221±0.062,and 0.195±0.071,F=9.807,P<0.001),and the ratio was significantly correlated with LVEF and 6MWT(r=0.300,P<0.001;r=0.230,P=0.003).In the three groups,the BNP/NT-proBNP level did not differ significantly between the uninfected patients and those with combined infection( P>0.05).In group B and C,patients with a glomerular filtration rate(GFR)<30 ml/(min·1.73 m2)had significantly lower BNP/NT-proBNP than those with a GFR≥30 ml/(min•1.73 m2)(Group B:0.128±0.110 vs 0.255±0.056,t=6.578,P<0.001;Group C:0.135±0.046 vs 0.199±0.077,t=2.819,P=0.007).However,when the patients with a GFR<30 ml/(min·1.73 m2)were excluded for further study,it was found that in the three groups,the differences of BNP/NT-proBNP in patients with a GFR<60 ml/(min·1.73 m2)were not statistically significant compared with those with a GFR≥60 ml/(min·1.73 m2)(P>0.05).Conclusion BNP/NT-proBNP plays an important role in the diagnosis and prognosis of HF in elderly patients.