老年慢性心力衰竭患者氨基末端脑钠肽前体、肌钙蛋白I、超敏C反应蛋白的变化及其意义

Changes and significance of N⁃terminal pro brain natriuretic peptide,Troponin I and hypersensitive C⁃reactive protein in elderly patients with chronic heart failure

目的 探讨老年慢性心力衰竭(CHF)患者氨基末端脑钠肽前体(NT-proBNP)、肌钙蛋白Ⅰ、超敏C反应蛋白(hs-CRP)对于心衰病情严重程度的判断价值。方法 选取安徽省阜南县人民医院2020年11月到2022年12月收治的老年CHF患者156例作为研究对象,根据纽约心脏病协会(NYHA)分级将患者分为轻度心衰组81例(NYHA分级为Ⅱ级)、重度心衰组75例(NYHA分级为Ⅲ~Ⅳ级);对比两组的左房内径(LA)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、二尖瓣舒张晚期血流峰值/二尖瓣舒张早期血流峰值(E/A);采用pearson法分析NT-proBNP、肌钙蛋白Ⅰ、hs-CRP与LVEF的关系,绘制受试者工作曲线(ROC)分析NT-proBNP、肌钙蛋白Ⅰ、hs-CRP判断心衰病情程度的价值。结果 轻度心衰组的NT-proBNP、肌钙蛋白Ⅰ、hs-CRP低于重度心衰组,而LVEF、E/A高于重度心衰组,差异均有统计学意义(t=-13.416、-11.836、-6.130、9.922、11.098,P<0.05);老年CHF患者LVEF与NT-proBNP、肌钙蛋白Ⅰ、hs-CRP均呈显著的负相关关系(r=0.721、-0.560、-0.614,P<0.05);NT-proBNP、hs-CRP、肌钙蛋白Ⅰ判断老年CHF患者心衰病情均具有较高价值(AUC>0.7),NT-proBNP判断老年CHF患者心衰病情灵敏度为0.840、特异度为0.951、准确度为89.74%、ROC曲线下面积AUC值为0.925;hs-CRP判断老年CHF患者心衰病情灵敏度为0.747、特异度为0.778、准确度为76.28%、ROC曲线下面积AUC值为0.884;肌钙蛋白Ⅰ的判断老年CHF患者心衰病情灵敏度为0.693、特异度为0.715、准确度为70.40%、ROC曲线下面积AUC值为0.775。结论 NT-proBNP、hs-CRP、肌钙蛋白Ⅰ随着老年CHF患者心衰程度的加重而升高,二者对于判断老年CHF病情具有一定的参考价值。

Objective To explore the value of N-terminal pro-brain natriuretic peptide(NT-proB-NP)、troponin I and hypersensitive C-reactive protein(hs-CRP)in judging the severity of heart failure in elder-ly patients with chronic heart failure(CHF).Methods 156 elderly patients with CHF admitted to Funan County Peoples Hospital from November 2020 to December 2022 were selected as the study subjects.Accord-ing to the classification of the New York Heart Association(NYHA),the patients were divided into 81 pa-tients with mild heart failure(NYHA gradeⅡ)and 75 patients with severe heart failure(NYHA gradeⅢto IV);The left atrial diameter(LA),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and peak value of late diastolic mitral flow/peak value of early diastolic mitral flow(E/A)were compared between the two groups;Linear correlation analysis was used to analyze the relationship be-tween NT-proBNP,troponin I and LVEF,and subject working curve(ROC)was drawn to analyze the value of NT-proBNP,troponin I and hs-CRP in judging the severity of heart failure.Results In the mild heart fail-ure group,LA,NT-proBNP,troponin I and hs-CRP were lower than those in the severe heart failure group,while LVEF and E/A were higher than those in the severe heart failure group,and the differences were statisti-cally significant(t=-13.416,-11.836,-6.130,9.922 and 11.098,respectively,P<0.05).In elderly CHF pa-tients,LVEF showed a significant negative correlation with NT-proBNP,troponin I and hs-CRP(r=0.721,-0.560 and-0.614,respectively,P<0.05).NT-proBNP,hs-CRP and troponin I were all highly valu-able in assessing the severity of heart failure in elderly CHF patients(AUC>0.7).NT-proBNP had a sensitivity of 0.840,specificity of 0.951,accuracy of 89.74%,and an AUC value of 0.925 in determining the severity of heart failure in elderly CHF patients.hs-CRP had a sensitivity of 0.747,specificity of 0.778,accuracy of 76.28%,and an AUC value of 0.884.Troponin I had a sensitivity of 0.693,specificity of 0.715,accuracy of 70.40%,and an AUC value of 0.775 in determining the severity of heart failure in elderly CHF patients.Conclusion NT proBNP,hs-CRP and troponin I increase with the severity of heart failure in elderly CHF pa-tients,and they have certain reference value for judging the condition of elderly CHF.