肺炎合并心力衰竭患者血浆脑钠肽和心肌肌钙蛋白Ⅰ的变化及临床意义

Changes and Clinical Significance of Plasma BNP and cTnI in Patients with Pneumonia and Congestive Heart Failure

目的探讨肺炎合并心力衰竭患者血浆脑钠肽(BNP)和心肌肌钙蛋白I(c Tn I)的变化及临床意义。方法选取于2013年7月至2015年2月北京市第六医院收治的55例肺炎合并心力衰竭患者作为观察组,另选取同时期来本院体检的正常健康志愿者30例作为对照组,比较其心率、左心室射血分数(LVEF)和左心室短轴缩短率(LVFS)值,以及BNP和c Tn I水平。结果观察组心功能Ⅲ级、Ⅳ级患者c Tn I和BNP水平[(0.26±0.05)μg/L、(1438±145)ng/L;(0.42±0.11)μg/L、(2093±257)ng/L]均显著高于心功能Ⅱ级[(0.14±0.03)μg/L、(519±126)ng/L],观察组心功能Ⅳ级c Tn I和BNP水平均显著高于心功能Ⅲ级(P<0.05)。观察组心力衰竭恢复期c Tn I和BNP低于心力衰竭期[(0.39±0.09)μg/L比(0.20±0.04)μg/L;(1290±431)ng/L比(652±138)ng/L],差异有统计学意义(P<0.01)。观察组患者心率显著高于对照组[(82±14)次/min比(70±8)次/min],LVEF和LVFS显著低于对照组[(48.4±2.5)%比(70.9±3.1)%,(29.2±1.4)%比(34.8±1.6)%],差异有统计学意义(P<0.01)。结论肺炎合并心力衰竭患者血浆内c Tn I和BNP均有显著升高,BNP可作为监测心力衰竭的一项指标,c Tn I则是诊断心肌梗死的标志物,便于医师早期进行风险评估,改善心脏功能,临床意义较高。

Objective To study the changes and clinical significance of plasma brain natriuretic peptide(BNP) and cardiac troponin(cTnI) in patients with pneumonia and heart failure.Methods Total of 55 cases of pneumonia complicated by heart failure in Beijing Sixth People’ s Hospital from Jul.2013 to Feb.2015 were included as an observation group,while 30 cases for health examination during the same period were included as a control group: the heart rate,left ventricular ejection fraction(LVEF) and left ventricular fractional shortening(LVFS) values,and BNP and c Tn I level were compared.Results cTnI and BNP levels of patients of cardiac function Ⅲ,Ⅳ in the observation group[(0.26±0.05) μg/L,(1438±145) ng/L;(0.42±0.11) μg/L,(2093±257) ng/L]were significantly higher than cardiac function Ⅱ in the observation group[(0.14±0.03) μg/L,(519±126) ng/L],the cTnI and BNP levels of patients of cardiac function Ⅳ in the observation group were significantly higher than patients of cardiac function Ⅲ(P <0.05).cTnI and BNP of the observation group during recovery stage were lower than the heart failure stage[(0.39±0.09) μg/L vs(0.20±0.04) μg/L;(1290±431) ng/L vs(652±138) ng/L],the differences were statistically significant(P < 0.05).Heart rate of the observation group was significantly higher than the control group,LVEF and LVFS were significantly lower than the control group[(82±14) times/min vs(70±8) times/min,(48.4±2.5)% vs(70.9±3.1)%,(29.2±1.4)% vs(34.8±1.6) %,P <0.01].Conclusion Plasma cTnI and BNP are significantly elevated in patients with pneumonia and heart failure,and BNP can be used as an indicator to monitor heart failure,cTnI is a marker for the diagnosis of myocardial infarction,which can be used to facilitate risk assessment in early stage to improve heart function,therefore has great clinical significance.