CAJ | 학술논문

目的：探讨慢性心力衰竭（心衰，CHF）患者N端脑钠肽前体（NT-proBNP）、内皮素（ET）水平与心功能的关系。方法入选56例CHF患者作为研究对象，29例心功能正常者作为对照组。心衰患者按照NYHA分级分为心功能Ⅱ级、Ⅲ级、Ⅳ级3个亚组，分别测定患者NT-proBNP、ET水平，同时用心脏彩色多普勒超声心动仪测定左室射血分数（LVEF）和左室舒张末期内径（LVDD）并进行组间比较及相关性分析。结果对照组及CHF心功能Ⅱ级、Ⅲ级、Ⅳ级亚组的患者NT-proBNP水平分别为（336.24±41.25）ng/ml、(1761.35±21.43) ng/ml、（2693.45±41.54）ng/ml、（3161.26±67.56） ng/ml，ET水平分别为（19.89±11.35）ng/L、（48.60±21.25）ng/L、（61.56±31.68）ng/L、（161.67±46.56）ng/L。对照组患者及CHF心功能Ⅱ级组、Ⅲ级组、Ⅳ级组患者血浆NT-proBNP、ET水平呈逐渐增高趋势，差异具有显著统计学意义（P＜0.01）。除心功能Ⅱ级组与心功能Ⅲ级组间ET与LVEF水平比较无统计学差异（P＞0.051），其余各组间NT-proBNP、ET水平及LVEF、LVDD水平比较，均有显著统计学差异（P均＜0.01）。NT-proBNP与心功能分级呈正相关（r=0.769，P＜0.05），与LVDD呈正相关（r=0.606，P＜0.05），与LVEF呈负相关（r=-0.656，P＜0.05）。ET水平与心功能分级呈正相关（r=0.357，P＜0.05），与LVDD呈正相关（r=0.265，P＜0.05），与LVEF呈负相关（r=-0.274，P＜0.05）。结论CHF患者NT-proBNP与ET水平随心力衰竭程度的加重而相应升高，与心功能分级有良好的相关性，对心力衰竭患者心力衰竭严重程度及预后的评价有意义。
목적：탐토만성심력쇠갈（심쇠，CHF）환자N단뇌납태전체（NT-proBNP）、내피소（ET）수평여심공능적관계。방법입선56례CHF환자작위연구대상，29례심공능정상자작위대조조。심쇠환자안조NYHA분급분위심공능Ⅱ급、Ⅲ급、Ⅳ급3개아조，분별측정환자NT-proBNP、ET수평，동시용심장채색다보륵초성심동의측정좌실사혈분수（LVEF）화좌실서장말기내경（LVDD）병진행조간비교급상관성분석。결과대조조급CHF심공능Ⅱ급、Ⅲ급、Ⅳ급아조적환자NT-proBNP수평분별위（336.24±41.25）ng/ml、(1761.35±21.43) ng/ml、（2693.45±41.54）ng/ml、（3161.26±67.56） ng/ml，ET수평분별위（19.89±11.35）ng/L、（48.60±21.25）ng/L、（61.56±31.68）ng/L、（161.67±46.56）ng/L。대조조환자급CHF심공능Ⅱ급조、Ⅲ급조、Ⅳ급조환자혈장NT-proBNP、ET수평정축점증고추세，차이구유현저통계학의의（P＜0.01）。제심공능Ⅱ급조여심공능Ⅲ급조간ET여LVEF수평비교무통계학차이（P＞0.051），기여각조간NT-proBNP、ET수평급LVEF、LVDD수평비교，균유현저통계학차이（P균＜0.01）。NT-proBNP여심공능분급정정상관（r=0.769，P＜0.05），여LVDD정정상관（r=0.606，P＜0.05），여LVEF정부상관（r=-0.656，P＜0.05）。ET수평여심공능분급정정상관（r=0.357，P＜0.05），여LVDD정정상관（r=0.265，P＜0.05），여LVEF정부상관（r=-0.274，P＜0.05）。결론CHF환자NT-proBNP여ET수평수심력쇠갈정도적가중이상응승고，여심공능분급유량호적상관성，대심력쇠갈환자심력쇠갈엄중정도급예후적평개유의의。
Objective To investigate the relationship between N-terminal pro brain natriuretic peptide (NT-proBNP) or endothelin (ET) and heart function in the patients with chronic heart failure (CHF). Methods The CHF patients (n=56) were chosen as subjects and 20 volunteers with normal heart function were chosen as control group, and CHF patients were divided into grade II sub-group, grade III sub-group and grade IV sub-group according to NYHA grading. The levels of NT-proBNP and ET were detected respectively, changes of LVEF and LVDD were detected by using color Doppler echocardiography, and all outcomes were compared and analyzed among groups. Results The level of NT-proBNP was, respectively, (336.24±41.25) ng/mL, (1761.35±21.43) ng/mL, (2693.45± 41.54) ng/mL and (3161.26±67.56) ng/mL, and level of ET was, respectively, (19.89±11.35) ng/L, (48.60±21.25) ng/L, (61.56±31.68) ng/L and (161.67±46.56) ng/L in control group, grade II sub-group, grade III sub-group and grade IV sub-group. The levels of NT-proBNP and ET showed an ascending trend in control group, grade II sub-group, grade III sub-group and grade IV sub-group and difference had statistical significance (P<001). The comparisons in ET level and LVEF change had no statistical difference between grade II sub-group and grade III sub-group (P>0.05), and comparisons in levels of NT-proBNP and ET, and changes of LVEF and LVDD among other groups had statistical difference significantly (all P<0.01). The level of NT-proBNP was positively correlated to heart function grading (r=0.769, P<0.05), and was negatively correlated to LVDD (r=0.606, P<0.05) and LVEF (r=-0.656, P<0.05). The level of ET was positively correlated to heart function grading (r=0.357, P<0.05), and was negatively correlated to LVDD (r=0.265, P<0.05) and LVEF (r=-0.274, P<0.05). Conclusion The levels of NT-proBNP and ET will increase when CHF exacerbates, and they are correlated to heart function grading in the patients with CHF, which are significant to reviewing the severity and prognosis of CHF.