摘要
目的探讨B型钠尿肽(BNP)对慢性心力衰竭(CHF)患者的临床诊断价值、心功能评价及危险分层的意义。方法入选CHF患者208例,参照美国纽约心功能分级,心功能Ⅰ级50例(1组);心功能Ⅱ级51例(2组);心功能Ⅲ级55例(3组);心功能Ⅳ级52例(4组)。血浆BNP水平测定用放射免疫法;LVEF用彩色多普勒超声心动诊断仪测定。结果 1～4组患者血浆BNP水平分别为(78.05±1 2.86)ng/L、(235.38±36.65)ng/L、(587.98±75.78)ng/L、(1203.87±189.96)ng/L,与1组比较,2、3、4组患者BNP水平随着心功能级别的递增而显著增加,差异有统计学意义(P<0.01);2、3、4组患者随着BNP水平的升高,LVEF、6 min步行距离逐渐下降,随着CHF程度的加重,年住院次数增加;随访2、3、4组患者5年病死率分别为0,18.18%,44.23%;5年死亡风险随BNP水平的升高或治疗后下降幅度不明显而增大(P<0.01);BNP对LVEF<50%的CHF患者诊断敏感性、特异性分别为82.35%、75.42%;ROC曲线下面积为0.90。结论血浆BNP对CHF患者有较好的临床诊断价值,是CHF患者死亡风险较准确的评价指标之一;CHF患者血浆BNP水平与LVEF、6 min步行距离呈负相关。
Objective To study the effect of B-type natriuretic peptide（BNP） on clinical diagnosis, cardiac function assessment and risk stratification of patients with congestive heart failure（CHF）. Methods Two hundred and eight CHF patients were divided into grade 1 cardiac function group （group 1 ,n= 50）,grade 2 cardiac function group（group 2 ,n= 51）,grade 3 cardiac function group （group 3,n=55） and grade 4 cardiac function group（group 4,n=52） according to the cardiac function grading recommended by NYHA. Their plasma BNP level was measured by radioimmunoassay and LVEF was detected by color Doppler echocardiography. Results The plasma BNP level was 78.05±12.86 ng/L,235. 38±36. 65 ng/L,587. 98±75. 78 ng/L and 1203.87±189.96 ng/L,respectively,in groups 1-4,which was significantly higher in groups 2-4 than in group 1 （P〈0.01）. The LVEF and 6-minute walk test（6MWT） distance decreased gradually with the in- creasing BNP level in CHF patients. The times of patients admitted to hospital increased with the severity of heart failure in groups 2-4. The 5-year death rate of groups 2-4 was 0% ,18. 18%,and 44.23% ,respectively,during the f011ow-up period and the 5-year death risk increased with the increased BNP level or the insignificantly deceased BNP level after treatment（P%0.01）. The sensitivity and specificity of BNP in CHF patients with their LVEF%50% were 82.35% and 75.42%, respectively. Conclusion Plasma BNP level is a rather good indication for the diagnosis of CHF and negatively related with the LVEF and 6MWT distance in CHF patients.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2012年第4期343-346,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
利钠肽
脑
心力衰竭
每搏输出量
超声心动描记术
预后
natriuretic peptide, brain
heart failure
stroke volume
echocardiography
prognosis
