CAJ | 학술논문

目的：探讨脑钠肽(BNP)在心力衰竭诊断和疗效监测中的价值。方法回顾性分析2009年6月至2013年6月在武汉大学人民医院住院治疗的100例老年心力衰竭患者的临床资料,其中纽约心脏病协会( NYHA)Ⅰ级患者32例、Ⅱ级27例、Ⅲ级23例、Ⅳ级18例,左心室射血分数( LVEF)>40%42例、LVEF≤40%58例,左心室舒张末期内径( LVEDD )≤55 mm 46例、LVEDD >55 mm 54例。另选择同期健康体检者50例作为对照组。观察不同心功能的患者和对照组血浆 BNP 和LVEF水平,不同心功能分级患者治疗前后血浆BNP水平变化,以及不同LVEF和LVEDD患者血浆BNP水平。结果 NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级组患者血浆BNP水平分别为(90±16) ng/L、(203±22) ng/L、(382±17) ng/L、(1088±30) ng/L,均高于对照组的(72±19) ng/L,且NYHAⅡ、Ⅲ以及Ⅳ级组BNP的水平均高于NYHAⅠ级组,差异有统计学意义(P<0．05)；NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级组患者的LVEF分别为(62±7)%、(48±5)%、(41±3)%和(34±3)%,对照组为(62±7)%,对照组与NYHAⅠ级组的LVEF均高于NYHAⅡ、Ⅲ、Ⅳ级组,差异有统计学意义( P<0．05)；LVEF>40%组患者血浆BNP水平低于LVEF≤40%组[(140±14) ng/L比(455±31) ng/L],LVEDD≤55 mm组高于LVEDD>55 mm 组[(515±45) ng/L比(158±19) ng/L],差异有统计学意义(P<0．05)；NYHA Ⅰ、Ⅱ、Ⅲ、Ⅳ级组患者治疗后血浆BNP分别为(59±6) ng/L、(66±5) ng/L、(71±6) ng/L及(79±4) ng/L,与治疗前比较差异均有统计学意义( P<0．01)。结论 BNP在心力衰竭患者的临床诊断中具有较高的诊断价值,且可为临床治疗心力衰竭提供一定的依据。
목적：탐토뇌납태(BNP)재심력쇠갈진단화료효감측중적개치。방법회고성분석2009년6월지2013년6월재무한대학인민의원주원치료적100례노년심력쇠갈환자적림상자료,기중뉴약심장병협회( NYHA)Ⅰ급환자32례、Ⅱ급27례、Ⅲ급23례、Ⅳ급18례,좌심실사혈분수( LVEF)>40%42례、LVEF≤40%58례,좌심실서장말기내경( LVEDD )≤55 mm 46례、LVEDD >55 mm 54례。령선택동기건강체검자50례작위대조조。관찰불동심공능적환자화대조조혈장 BNP 화LVEF수평,불동심공능분급환자치료전후혈장BNP수평변화,이급불동LVEF화LVEDD환자혈장BNP수평。결과 NYHAⅠ、Ⅱ、Ⅲ、Ⅳ급조환자혈장BNP수평분별위(90±16) ng/L、(203±22) ng/L、(382±17) ng/L、(1088±30) ng/L,균고우대조조적(72±19) ng/L,차NYHAⅡ、Ⅲ이급Ⅳ급조BNP적수평균고우NYHAⅠ급조,차이유통계학의의(P<0．05)；NYHAⅠ、Ⅱ、Ⅲ、Ⅳ급조환자적LVEF분별위(62±7)%、(48±5)%、(41±3)%화(34±3)%,대조조위(62±7)%,대조조여NYHAⅠ급조적LVEF균고우NYHAⅡ、Ⅲ、Ⅳ급조,차이유통계학의의( P<0．05)；LVEF>40%조환자혈장BNP수평저우LVEF≤40%조[(140±14) ng/L비(455±31) ng/L],LVEDD≤55 mm조고우LVEDD>55 mm 조[(515±45) ng/L비(158±19) ng/L],차이유통계학의의(P<0．05)；NYHA Ⅰ、Ⅱ、Ⅲ、Ⅳ급조환자치료후혈장BNP분별위(59±6) ng/L、(66±5) ng/L、(71±6) ng/L급(79±4) ng/L,여치료전비교차이균유통계학의의( P<0．01)。결론 BNP재심력쇠갈환자적림상진단중구유교고적진단개치,차가위림상치료심력쇠갈제공일정적의거。
Objective To explore the value brain natriuretic peptide ( BNP) in diagnosis of heart failure and the efficacy monitoring. Methods Retrospective analysis on the clinical data of 100 cases of senile heart failure during Jun. 2009 and Jun. 2013 in Wuhan University People′s Hospital was done,ng including New York heart association( NYHA) classⅠ32 cases,classⅡ27 cases,classⅢ23 cases,classⅣ18 cases;left ventricular ejection fraction (LVEF) >40% 42 cases,LVEF≤40% 58 cases;left ventricular end-diastolic diameter ( LVEDD) ≤55 mm 46 cases,LVEDD>55 mm 54 cases. Another 50 cases for physical examina-tion during the same period were included as control group. The BNP levels and LVEF among different heart function classification and control group,the BNP levels among patients with different LVEF and LVEDD, plasma BNP levels before and after treatment were observed and compared. Results Plasma BNP levels of NYHAⅠ,Ⅱ,Ⅲ,Ⅳ were (90 ± 16) ng/L,(203 ± 22) ng/L,(382 ± 17) ng/L and (1088 ± 30) ng/L, respectively,they were all higher than the control group′s (72 ± 19) ng/L,BNP levels of NYHAⅡ,ⅢandⅣ were higher than that of NYHAⅠ,and the differences had statistical significance(P<0. 05). The LVEF levels were (62 ± 7)%,(48 ± 5)%,(41 ± 3)% and (34 ± 3)% of the four groups,respectively,the con-trol group′s was (62 ± 7)%,the LVEF of control group and NYHAⅠwere higher than the NYHAⅡ,Ⅲ,Ⅳ(P<0.05). The plasma BNP level in LVEF >40%,was lower than LVEF ≤40% group[ (140 ± 14) ng/L vs (455 ±31) ng/L],LVEDD≤55 mm group was higher than LVEDD>55 mm group[(515 ± 45) ng/L vs (158 ± 19) ng/L],the differences were statistically significant. The levels of BNP of NYHAⅠ,Ⅱ,Ⅲ,Ⅳgroup after treatment were (59 ± 6) ng/L,(66 ± 5) ng/L,(71 ± 6) ng/L and (79 ± 4) ng/L,compared with before the treatment,there were statistically significant difference ( P<0. 05 ) . Conclusion BNP has high diagnostic value in clinical diagnosis,and can provide a certain basis for the clinical treatment for heart failure patients.