慢性心力衰竭患者血浆NT-proBNP的变化及临床意义

Change of plasma NT-proBNP in patients with chronic heart failure and its application value

目的探讨慢性心力衰竭（CHF）患者血浆N末端B型利钠肽原（NT-proBNP）的变化及其临床意义。方法选择2014年2月至2015年8月佛山市第二人民医院急诊科收治的CHF患者86例，将86例患者按不同年龄段分为3组：A组（45～54岁，12例）、B组（55～64岁，31例）、C组（≥65岁，43例）。治疗前后分别测定血浆NT-proBNP水平，并对患者随访12个月，观察记录心血管事件。结果在常规抗心衰治疗症状显著改善后，NT-proBNP水平较治疗前明显下降（t＝－443．002，P＜0．05）。各组治疗后血浆中NT-proBNP水平A组＜B组＜C组，与治疗前比较，差异具有统计学意义（t＝－177．487，－251．517，－269．607，P＜0．05）。发生心血管事件患者24例（27．907％），血浆NT-ProBNP水平为（5536．25±1581．36）pg／mL，显著高于未发生心血管事件组患者的（3239．47±1501．58）pg／mL （t＝244．77，P＜0．05）。未发生心血管事件组患者血浆NT-ProBNP水平下降，与发生心血管事件组比较，下降更为显著，差异具有统计学意义（t＝－88．22，P＜0．05）。结论血浆NT-proBNP是评价心功能紊乱的指标之一，采用NT-proBNP可诊断心衰和评估心功能状态，同时还可在一定程度上判断患者预后和指导治疗。

Objective To investigate the changes of N terminal plasma b-type natriuretic peptide (NT-proBNP)and its application value in patients with chronic heart failure (CHF).Methods Eighty-six cases of CHF were selected and divided into three groups according to different ages,including A group (12 cases,45 -54 years old)and group B (31 cases,55 -64 years old),group C (43 cases,at the age of 65 or higher).The plasma NT-proBNP levels were determined in the patients before and after treatment and followed up for 12 months,and the observation of cardiovascular events was recorded.Results Heart failure symptoms were significantly improved after conventional treatment,the NT-proBNP level was significantly lowered (t=443.002,P<0.05):t value of plasma NT-proBNP levels in different age group after treatment was -177.487,-251.517 and -269.607 pg/ml in groups A,B and C,respectively,(P<0.05).A total of 24 patients with cardiovascular events accounted for 27.91% (24/86)including 13 men and 11 women;their plasma level of NT-proBNP pg/ml (5536.25 ±1581.36)was significantly higher than the group of patients without cardiovascular events (3239.47 ±1501.58)pg/ml (t =244.77,P<0.05). Plasma NT-proBNP levels were significantly decreased in patients without cardiovascular events as compared with patients with cardiovascular events (t=88.22,P<0.05).Conclusion Plasma NT-proBNP is one of indicators of cardiac function disorder and it can be used in the diagnosis of heart failure and evaluation of heart function;at the same time it can also be used to judge prognosis and guide therapy in some degree.