不同NYHA心功能分级慢性心力衰竭患者心脏标志物四项、PCT、BNP水平变化及临床意义

Changes and clinical significance of four cardiac markers, procalcitonin, and B-type brain natriuretic peptide levels in patients with chronic heart failure with different NYHA cardiac function grades

目的分析不同美国纽约心脏病学会(NYHA)分级慢性心力衰竭患者心脏标志物四项、降钙素原(PCT)、B型脑钠肽(BNP)水平变化及临床意义。方法选取2019年1月至2020年1月泾阳县医院心血管内一科收治的124例慢性心力衰竭患者进行研究(慢性心力衰竭组),参照NYHA心功能分级标准分为心功能Ⅱ级35例、Ⅲ级48例及Ⅳ级41例,同期入选106例健康体检者作为对照组。对慢性心力衰竭患者进行1年随访,按照有无心血管事件分组。比较各组氨基末端脑钠肽前体(NT-proBNP)、肌酸磷酸激酶同工酶(CK-MB)、超敏-C反应蛋白(hs-CRP),肌钙蛋白Ⅰ(cTnⅠ)、PCT、BNP水平。结果慢性心力衰竭组患者的NT-proBNP、cTnⅠ、CK-MB、hs-CRP、PCT、BNP水平明显高于对照组,差异均有统计学意义(P<0.05);NT-proBNP、cTnⅠ、CK-MB、hs-CRP、PCT、BNP水平随着心功能分级的不断增加而逐渐升高,差异均有统计学意义(P<0.05);慢性心力衰竭患者治疗后心脏标志物、PCT、BNP水平明显低于治疗前,差异均有统计学意义(P<0.05);治疗后心血管不良事件发生组患者的四项心脏标志物、PCT、BNP水平明显高于无心血管不良事件发生组,差异均有统计学意义(P<0.05)。结论慢性心力衰竭患者随着NYHA心功能分级的不断增加,四项心脏标志物和PCT、BNP水平相应上升,可作为心功能、病情程度和预后的评估指标。

Objective To analyze the changes and clinical significance of four cardiac markers, procalcitonin(PCT), and B-type brain natriuretic peptide(BNP) in patients with chronic heart failure of different cardiac function classification grades of New York Heart Association(NYHA). Methods A total of 124 patients of chronic heart failure(chronic heart failure group) admitted to Jingyang County Hospital from January 2019 to January 2020 were selected for this study. According to NYHA heart function classification standard, 35 cases, 48 cases, and 41 cases were classified into heart function grade Ⅱ, grade Ⅲ, and grade Ⅳ, respectively. A total of 106 healthy subjects were selected as the control group during the same period. Patients with chronic heart failure were followed up for one year and divided into groups according to whether there were cardiovascular events. The levels of amino-terminal pro-brain natriuretic peptide(NT-proBNP), creatine phosphokinase isoenzyme(CK-MB), high sensitivity C-reactive protein(hs-CRP), troponin I(cTn Ⅰ), PCT, and BNP in each group were compared. Results The levels of NT-proBNP, cTnI, CK-MB, hs-CRP,PCT, and BNP in patients with chronic heart failure were significantly higher than those in the control group(P<0.05);the levels of NT-proBNP, cTnⅠ, CK-MB, hs-CRP, PCT, and BNP gradually increased with the continuous increase of cardiac function classification(P<0.05);the levels of cardiac markers, PCT, and BNP in patients with chronic heart failure after treatment were significantly lower than those before treatment(P<0.05);after treatment, the levels of four cardiac markers, PCT, and BNP in patients with cardiovascular adverse events were significantly higher than those in patients without cardiovascular adverse events(P<0.05). Conclusion With the increase of NYHA cardiac function classification, the levels of four cardiac markers, PCT, and BNP increase correspondingly in patients with chronic heart failure,which can be used as evaluation indexes of cardiac function, disease degree and prognosis.