血清BNP、cTnI及心肌酶谱水平检测在慢性心力衰竭患者中应用研究

Application of Serum BNP,cTnI and Myocardial Zymogram in Patients with Chronic Heart Failure

目的探讨血清脑钠肽(BNP)、心肌肌钙蛋白I(cTnI)、心肌酶谱水平检测在慢性心力衰竭(CHF)中的应用价值。方法选取2020年8月-2022年8月我院收治的CHF患者及健康体检者作为观察组(116例)及对照组(116例)。均于清晨采血开展BNP、cTnI、肌酸激酶同工酶(CK-MB)及肌酸激酶(CK)检测,比较两组血清BNP、cTnI、CK-MB、CK水平差异,并依据心功能分级分为Ⅱ级、Ⅲ级、Ⅳ级组,比较不同心功能分级血清BNP、cTnI、CK-MB、CK水平差异;所有CHF患者均常规治疗,3个月后复查,比较治疗前后血清BNP、cTnI、CK-MB、CK水平差异;绘制ROC曲线,分析血清BNP、cTnI、CK-MB、CK及联合检测诊断CHF的临床价值。结果观察组血清BNP、cTnI、CK、CK-MB水平为(624.82±52.41)ng/mL、(0.15±0.03)ng/mL、(243.63±20.41)U/L、(48.52±4.23)U/L,高于对照组的(62.41±5.27)ng/mL、(0.02±0.01)ng/mL、(79.85±6.38)U/L、(19.85±2.14)U/L,差异有统计学意义(P<0.05);心功能Ⅳ级CHF患者血清BNP、cTnI、CK、CK-MB水平为(1053.24±86.34)ng/mL、(0.23±0.05)ng/mL、(345.62±31.45)U/L、(76.35±5.39)U/L,高于Ⅲ级[(602.51±65.18)n g/mL、(0.14±0.03)n g/mL、(249.85±22.65)U/L、(50.41±4.63)U/L]、Ⅱ级[(324.41±36.89)n g/mL、(0.07±0.02)n g/m L、(143.25±18.52)U/L、(33.21±3.42)U/L]患者,差异有统计学意义(P<0.05);116例CHF患者治疗后血清BNP、cTnI、CK、CK-MB水平为(92.63±8.14)n g/mL、(0.03±0.01)n g/mL、(102.32±10.35)U/L、(25.63±2.84)U/L,低于治疗前的(624.82±52.41)ng/mL、(0.15±0.03)n g/mL、(243.63±20.41)U/L、(48.52±4.23)U/L,差异有统计学意义(P<0.05);绘制ROC曲线显示,血清各指标及联合检测诊断CHF的曲线下面积分别为:0.815、0.768、0.835、0.776、0.972,联合检测价值最高。结论血清BNP、cTnI、CK-MB、CK检查在CHF患者病情诊断及严重程度评估中均具有较高价值,且联合检测可进一步提高诊断效能,有助于疾病早期诊疗方案的制定。

Objective To explore the application value of serum brain natriuretic peptide(BNP),cardiac troponin I(cTnI),and myocardial enzyme spectrum levels in chronic heart failure(CHF).Method CHF patients and healthy individuals admitted to our hospital from August 2020 to August 2022 were selected as the observation group(116 cases)and the control group(116 cases).Blood samples were collected in the early morning for BNP,cTnI,creatine kinase isoenzyme(CK-MB),and creatine kinase(CK)testing.The serum BNP,cTnI,CK-MB,and CK levels were compared between the two groups,and they were divided into grade II,III,and IV groups based on heart function grading.Differences in serum BNP,cTnI,CK-MB,and CK levels were compared between different heart function grading groups;All CHF patients were treated with routine anti heart failure therapy,and a follow-up examination was conducted 3 months later to compare the differences in serum BNP,cTnI,CK-MB,and CK levels before and after treatment;Draw ROC curves to analyze the clinical value of serum BNP,cTnI,CK-MB,CK,and combined detection in the diagnosis of CHF.Results The serum BNP,cTnI,CK,and CK-MB levels in the observation group were(624.82±52.41)ng/mL,(0.15±0.03)ng/mL,(243.63±20.41)U/L,and(48.52±4.23)U/L,which were higher than those in the control group(62.41±5.27)ng/mL,(0.02±0.01)ng/mL,(79.85±6.38)U/L,and(19.85±2.14)U/L,with statistical significance(P<0.05);The serum levels of BNP,cTnI,CK,and CK-MB in patients with Grade IV CHF were(1053.24±86.34)ng/mL,(0.23±0.05)ng/mL,(345.62±31.45)U/L,and(76.35±5.39)U/L,which were higher than those in Grade III[(602.51±65.18)ng/mL,(0.14±0.03)ng/mL,(249.85±22.65)U/L,(50.41±4.63)U/L],Grade II[(324.41±36.89)ng/mL,(0.07±0.02)ng/mL],and(143.25±18.52)U/L,(33.21±3.42)U/L patients,The difference was statistically significant(P<0.05);After treatment,the serum levels of BNP,cTnI,CK,and CK-MB in 116 CHF patients were(92.63±8.14)ng/mL,(0.03±0.01)ng/mL,(102.32±10.35)U/L,and(25.63±2.84)U/L,which were lower than those before treatment(624.82±52.41)ng/mL,(0.15±0.03)ng/mL,(243.63±20.41)U/L,and(48.52±4.23)U/L,with statistical significance(P<0.05);The ROC curve analysis showed that the areas under the curves for serum BNP,cTnI,CK,CK-MB,and combined detection for diagnosing CHF were 0.815,0.768,0.835,0.776,and 0.972,respectively.Combined detection had higher diagnostic value.Conclusion Serum BNP,cTnI,CK-MB,and CK tests have high value in the diagnosis and severity assessment of CHF patients,and combined testing can further improve diagnostic efficiency and help formulate early diagnosis and treatment plans for the disease.