CAJ | 학술논문

目的：观察老年冠心病慢性心力衰竭( chronic heart failure, CHF)患者N末端B型利钠肽原( N-termi-nal-pro-B-type natriuretic peptide, NT-proBNP)和血清半胱氨酸蛋白酶抑制素C(Cystain C, Cys-C)的水平变化,探讨NT-proBNP和血清Cys-C相关性及临床意义。方法选取2012年10月—2013年9月在我院老年病科住院治疗的老年冠心病CHF 54例作为冠心病CHF组,选择同期住院的老年冠心病无心力衰竭30例作为对照组；根据美国纽约心脏病学会( NYHA)制定的心功能分级标准将冠心病CHF组54例分为NYHAⅡ级组和NYHA Ⅲ~Ⅳ级组。比较冠心病CHF组与对照组、NYHAⅡ级组与NYHAⅢ~Ⅳ级组NT-proBNP和血清Cys-C水平,并对NT-proBNP的影响因素进行分析。结果冠心病CHF组左室舒张末期内径、肌酐、尿素、NT-proBNP、血清Cys-C值高于对照组,左室射血分数及白蛋白值低于对照组,两组比较差异均有统计学意义(P<0.05或P <0.01)。 NYHAⅡ级组NT-proBNP及血清Cys-C水平均低于NYHA Ⅲ~Ⅳ级组,差异有统计学意义(P<0.05或P <0.01)。 Pearson相关分析结果显示NT-proBNP与年龄、血清Cys-C、左室舒张末期内径、肌酐、尿素呈正相关,与体重指数、左室射血分数、估计肾小球滤过率呈负相关。多元线性逐步回归分析结果显示体重指数、血清Cys-C、估计肾小球滤过率与NT-proBNP独立相关。结论老年冠心病CHF 患者NT-proBNP 和血清Cys-C 明显相关,NT-proBNP 和血清Cys-C 可作为评价CHF 严重程度及反映心功能状态的指标。
목적：관찰노년관심병만성심력쇠갈( chronic heart failure, CHF)환자N말단B형리납태원( N-termi-nal-pro-B-type natriuretic peptide, NT-proBNP)화혈청반광안산단백매억제소C(Cystain C, Cys-C)적수평변화,탐토NT-proBNP화혈청Cys-C상관성급림상의의。방법선취2012년10월—2013년9월재아원노년병과주원치료적노년관심병CHF 54례작위관심병CHF조,선택동기주원적노년관심병무심력쇠갈30례작위대조조；근거미국뉴약심장병학회( NYHA)제정적심공능분급표준장관심병CHF조54례분위NYHAⅡ급조화NYHA Ⅲ~Ⅳ급조。비교관심병CHF조여대조조、NYHAⅡ급조여NYHAⅢ~Ⅳ급조NT-proBNP화혈청Cys-C수평,병대NT-proBNP적영향인소진행분석。결과관심병CHF조좌실서장말기내경、기항、뇨소、NT-proBNP、혈청Cys-C치고우대조조,좌실사혈분수급백단백치저우대조조,량조비교차이균유통계학의의(P<0.05혹P <0.01)。 NYHAⅡ급조NT-proBNP급혈청Cys-C수평균저우NYHA Ⅲ~Ⅳ급조,차이유통계학의의(P<0.05혹P <0.01)。 Pearson상관분석결과현시NT-proBNP여년령、혈청Cys-C、좌실서장말기내경、기항、뇨소정정상관,여체중지수、좌실사혈분수、고계신소구려과솔정부상관。다원선성축보회귀분석결과현시체중지수、혈청Cys-C、고계신소구려과솔여NT-proBNP독립상관。결론노년관심병CHF 환자NT-proBNP 화혈청Cys-C 명현상관,NT-proBNP 화혈청Cys-C 가작위평개CHF 엄중정도급반영심공능상태적지표。
Objective To evaluate changes of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and serum cystain C( Cys-C) in elderly patients with chronic heart failure( CHF) and coronary artery disease, and explore their correla-tion and clinical significance. Methods A total of 54 elderly CHF patients with coronary artery disease who were treated in Department of Geratology from October 2012 to September 2013 were selected as CHF group. And 30 elderly patients with cor-onary artery disease and compensated heart function were selected as control group. According to the New York Heart Associa-tion ( NYHA) cardiac functional standard, 54 patients in CHF group were divided into NYHA Ⅱ group and NYHA Ⅲ-Ⅳgroup. NT-proBNP as well as serum Cys-C level in CHF group and control group was compared. Those between NYHAⅡand NYHA Ⅲ-IV group were also compared. NT-proBNP influence factors were analyzed. Results Left ventricular end-diastolic dimension( LVEDD) , serum creatinine, blood urea nitrogen, serum NT-proBNP and Cys-C level in CHF group were signifi-cantly higher than those in control group (P<0. 05 or P<0. 01), but left ventricular ejection fraction (LVEF) and albumin were significantly lower than those in control group (P<0. 05 or P<0. 01). Serum NT-proBNP and Cys-C level in NYHAⅡgroup were significantly lower than those in NYHAⅢ-Ⅳgroup (P<0. 05 or P<0. 01). Pearson correlation analysis showed that NT-proBNP was positively correlated with age, serum Cys-C, serum creatinine, blood urea nitrogen and LVEDD;but NT-proBNP was negatively correlated with BMI, LVEF and eGFR. Multiple linear regression analysis showed that BMI, Cys-C and eGFR were independently correlated with NT-proBNP. Conclusion NT-proBNP and serum Cys-C level have obvious correlation in elderly CHF patients with coronary artery disease. Both are good indicators in evaluating the severity of CHF and reflecting the heart function.