慢性心力衰竭患者血浆利钠肽水平的变化

The changes of plasma levels of natriuretic peptides in patients with chronic heart failure

目的 :研究慢性心力衰竭 (CHF)患者血浆利钠肽 (ANP、BNP、CNP)水平的变化及其与心功能状态、心脏结构的关系 ,探讨其用于CHF诊断的价值。方法 :4 8例CHF患者为心力衰竭组 ,心功能按HYHA标准分级 :Ⅱ级 15例 ,Ⅲ级 2 4例 ,Ⅳ级 9例 ,基本病因为冠心病、扩张型心肌病、高血压性心脏病 ;对照组 10例 ,为健康体检者。用同位素放射免疫法和免疫放射法测定血浆ANP、BNP、CNP水平 ,心脏彩色多普勒超声诊断仪测量左室结构和功能。结果 :心力衰竭组血浆ANP、BNP水平均较对照组显著增高(P均 <0 0 1) ,并与心功能严重程度有关 ,但不同病因的CHF患者之间血浆ANP、BNP、CNP水平均无明显差异 (P均 >0 0 5 )。其中LVEF <4 5 %的患者 4 1例 ,其血浆BNP水平和LVEF负相关 (r=- 0 37,P <0 0 5 ) ,和左室舒张末期内径 (LVEDD)、左室心肌重量指数 (LVMI)呈正相关 (r均为 0 36 ,P均 <0 0 5 ) ,血浆ANP、BNP水平和肺动脉收缩压正相关 (P <0 0 5或P <0 0 1)。血浆CNP水平在CHF患者无明显升高 (P >0 0 5 )。结论 :血浆ANP、BNP水平可作为反映心功能状态的指标 ,其中血浆BNP水平更为敏感、特异并且和心脏结构相关 。

Objective:This study was performed to explore the correlation among plasma levels of natriuretic peptides and the left ventricular function and structure in patients with chronic heart failure(CHF),and to evaluate the value of plasma levels of natriuretic petides in the CHF diagnosis.Method:We enrolled 48 patients with CHF,among them,10 with coronary artery disease,22 with dilated cardiomyopathy,16 with hypertensive heart disease.Accoriding to the New York Heart Association(NYHA) class,15 patients were classified NYHA Ⅱ,24 NYHA Ⅲ,9 NYHA Ⅳ.Plasma levels of atrial and brain and C\|type natriuretic peptides (ANP,BNP,CNP) were measured by radioimmunoassay and immunoradiometric assay in these patients and 10 age and gender\|matched healthy controls.Doppler echocardiography was performed to measure left ventricular function and structure.Result:Plasma levels of ANP and BNP were significantly eleyated in CHF pATIENTS ( P all <0\^01),and levels increased in proportion to the severity of left ventricular dysfunction.In patients with LVEF<45%,plasma level of BNP had a negative correlation with LVEF( P <0\^05),both ANP and BNP levels has positive correlations with pulmonary artery systolic pressure ( P <0\^05 or 0\^01),and BNP plasma level had a positive correlation with left ventricular end\|diastolic diameter and left ventricular mass index ( P all <0\^05). However,the CNP plasma level was not significantly elevzted in CHF patients ( P >0\^05).Conclusion:ANP and BNP plasma levels were good markers used to reflect left ventricular function,whereas BNP level was more sensitive and specific and had close relationship with left ventricular structure.Measurement of BNP plasma level was useful to reflect the immediate change of left ventricular function.