CAJ | 학술논문

目的探讨床边快速测定B型尿钠肽(Brain Natriuretic Peptide,BNP)对心力衰竭早期诊断和疗效评估的应用价值.方法对2008年-2012年于本院就诊,疑似心衰的384例患者进行X线胸片、心电图以及心脏超声测定,根据测定结果分为心衰组(HF组)89例和非心衰组(非HF组)295例,对HF组患者进行常规西药治疗,分别在用药前,用药24h、48h、72h采取静脉血测定血浆BNP水平,并与非HF组比较差异;将295例HF组患者按心功能(NYHA分级)分为Ⅱ级121例,Ⅲ级101例,和Ⅳ级73例,分别在治疗前后采取静脉血测定并比较各组患者血浆BNP水平.结果 HF组与非HF组比较:用药前,HF组患者血浆BNP水平显著高于非HF组(P<0.05);用药后,HF组患者血浆BNP水平持续下降,且用药前、用药24h、48h、72h相比,差异均有显著性(P<0.05);用药72h后基本降至正常水平,与非HF组无显著性差异(P>0.05).HF组内部分级比较:治疗前,Ⅱ、Ⅲ、Ⅳ患者血浆BNP水平依次升高,且组间有统计学差异(P<0.05);治疗后,各级患者血浆BNP水平均显著下降(P<0.05),其下降后依然呈Ⅱ、Ⅲ、Ⅳ依次升高趋势,且组间差异显著(P<0.05).结论床边快速测定BNP对心力衰竭的早期诊断、病情评估及疗效的实时监测均有一定价值,在心力衰竭临床诊治工作中的应用具有更深层次的挖掘潜力.
목적탐토상변쾌속측정B형뇨납태(Brain Natriuretic Peptide,BNP)대심력쇠갈조기진단화료효평고적응용개치.방법대2008년-2012년우본원취진,의사심쇠적384례환자진행X선흉편、심전도이급심장초성측정,근거측정결과분위심쇠조(HF조)89례화비심쇠조(비HF조)295례,대HF조환자진행상규서약치료,분별재용약전,용약24h、48h、72h채취정맥혈측정혈장BNP수평,병여비HF조비교차이;장295례HF조환자안심공능(NYHA분급)분위Ⅱ급121례,Ⅲ급101례,화Ⅳ급73례,분별재치료전후채취정맥혈측정병비교각조환자혈장BNP수평.결과 HF조여비HF조비교:용약전,HF조환자혈장BNP수평현저고우비HF조(P<0.05);용약후,HF조환자혈장BNP수평지속하강,차용약전、용약24h、48h、72h상비,차이균유현저성(P<0.05);용약72h후기본강지정상수평,여비HF조무현저성차이(P>0.05).HF조내부분급비교:치료전,Ⅱ、Ⅲ、Ⅳ환자혈장BNP수평의차승고,차조간유통계학차이(P<0.05);치료후,각급환자혈장BNP수평균현저하강(P<0.05),기하강후의연정Ⅱ、Ⅲ、Ⅳ의차승고추세,차조간차이현저(P<0.05).결론상변쾌속측정BNP대심력쇠갈적조기진단、병정평고급료효적실시감측균유일정개치,재심력쇠갈림상진치공작중적응용구유경심층차적알굴잠력.
@@@@Objective To investigate the bedside rapid determination of type B urine sodium Peptide(Brain Natriuretic Peptide, BNP) on heart failure in the early diagnosis and curative effect evaluation of application value. Methods For 2008 to 2012 in our hospital, 384 cases of suspected heart failure patients with ecg, X-ray chest radiograph, and cardiac ultrasound measurement, according to the measurement results are divided into heart failure(HF) group 89 cases and the heart failure group(not a HF group) 295 cases, conventional western medicine therapy in patients with HF group, respectively, before the medication, medication for 24 h, 48 h, 72 h to determination of venous blood plasma BNP level, and compared with the HF group differences; To 295 patients with HF group according to the cardiac function(NYHA grading) is divided into Ⅱ level of 121 cases Ⅲ level of 101 cases and Ⅳ 73 cases, respectively, in the treatment of venous blood was taken before and after the determination of plasma BNP levels and compare groups of patients. Results HF group and HF group comparison: before medication, HF plasma BNP levels were significantly higher than in patients with HF group(P<0.05); After medication, plasma BNP levels in patients with HF group continues to decline, and medication, medication before 24h, 48h, 72h, all have significant difference(P<0.05); Use basic dropped to normal level after 72h, and the HF group no significant difference(P>0.05). HF group internal grading comparison: before the treatment, Ⅱ, Ⅲ, Ⅳ plasma BNP levels in patients with elevated, and between different groups had significant difference(P<0.05); After treatment, patients with all levels of plasma BNP levels were significantly decreased(P<0.05), after the fall of water still showed a trend of increase Ⅱ, Ⅲ, Ⅳ, and significant difference between group and group(P<0.05). Conclusion Bedside rapid determination of BNP on heart failure of early diagnosis, illness evaluation and treatment efficacy of real-time monitoring has a certain value, the application in the diagnosis and treatment of heart failure in clinical work with deeper mining potential.