慢性心力衰竭患者心脏标志物水平及超声心动图特点

The levels of cardiac markers and echocardiographic features in patients with chronic heart failure

目的分析慢性心力衰竭(CHF)患者心脏标志物水平及超声心动图特点。方法选取2017年4月至2018年3月在泰兴市第二人民医院收治的82例CHF患者设为CHF组,选择同期24例健康体检者为对照组。将CHF患者根据心功能分级分为4个CHF亚组:CHF 1级23例、CHF 2级25例、CHF 3级21例和CHF 4级13例。检测外周血脑钠肽(BNP)和生长分化因子-15(GDF-15)水平,采用超声心动图测定室间隔舒张末期厚度(IVSTD)、左室后壁舒张期厚度(LVPWTD)、左心室舒张末期内径(LVDD)、左房收缩末期内径(LAD)。采用Simpson公式计算左室射血分数(EF)、心输出量(CO)、心脏指数(CI)。从心尖四腔切面获得二尖瓣血流频谱,收集舒张早期最大流速(E峰),舒张晚期最大速度(A峰),E/A、舒张早期快速充盈分数(RFF)、左心室重量指数(LVMI)、相对室壁厚度(RWT),并对两组结果进行比较。结果与对照组比,CHF组患者外周血BNP和GDF-15均明显增高(P <0. 05),在CHF组中,随着心功能降低,外周血BNP和GDF-15也增高(P <0. 05),与对照组比,CHF组的IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A明显增高(P <0. 05),CI、EF、E/A和RFF明显减少(P <0. 05),在CHF组中,随着心功能降低,IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A也明显增高(P <0. 05),CI、EF、E/A和RFF也明显减少(P <0. 05)。结论 CHF心脏标志物BNP和GDF-15明显增高,超声心动图各指标异常,异常集中表现为左心功能衰竭。

Objective To analyze the levels of cardiac markers and echocardiographic features in patients with chronic heart failure(CHF).Methods A total of 82 CHF patients admitted into the Second People’s Hospital of Taixing City from April 2017 to March 2018 were selected as CHF group,and 24 healthy volunteers were selected as control group.CHF patients were divided into four CHF subgroups according to cardiac function classification:23 cases of CHF grade 1,25 cases of CHF grade 2,21 cases of CHF grade 3 and 13 cases of CHF grade 4.The levels of brain natriuretic peptide(BNP)and growth differentiation factor-15(GDF-15)in peripheral blood were measured.The interventricular septal end-diastolic thickness(IVSTD),left ventricular posterior wall diastolic thickness(LVPWTD),left ventricular end-diastolic diameter(LVDD)and left atrial end-systolic diameter(LAD)were measured by echocardiography.Left ventricular ejection fraction(EF),cardiac output(CO)and cardiac index(CI)were calculated by Simpson formula.Mitral flow spectra were obtained from apical four-chamber section.The maximum early diastolic velocity(E peak),late diastolic maximum velocity(A peak),E/A,early diastolic rapid filling fraction(RFF),left ventricular mass index(LVMI),relative wall thickness(RWT)were collected and compared between the two groups.Results Compared with the control group,the levels of BNP and GDF-15 in peripheral blood of CHF group increased significantly(P<0.05).The levels of BNP and GDF-15 in peripheral blood increased with the decrease of cardiac function(P<0.05).Compared with the control group,IVSTD,LVPWTD,LVDD,LAD,LVMI,RWT,CO and A in CHF group increased significantly(P<0.05).CI,EF,E/A and RFF decreased significantly(P<0.05).IVSTD,LVPWTD,LVDD,LAD,LVMI,RWT,CO and A also increased significantly(P<0.05),CI,EF,E/A and RFF also decreased significantly(P<0.05).Conclusion The cardiac markers BNP and GDF-15 of CHF increased significantly,and the indexes of echocardiography were abnormal.The abnormal mainly manifestation was left ventricular failure.