根据肾功能分层界定N端脑钠肽诊断心力衰竭时的临界值

目的:调查肾功能不全患者在应用N端脑钠肽(NT-ProBNP)诊断心力衰竭时的准确性;评价根据肾功能分层界定NT-ProBNP诊断心力衰竭临界值的必要性。方法:选取50～70岁心力衰竭伴肾功能不全患者107例,计算肌酐清除率(eGFR)值并分组,eGFR值60～90ml/min为实验Ⅰ组,eGFR值在30～60ml/min为实验Ⅱ组,eGFR值<30ml/min为实验Ⅲ组,分别各组测定血浆NT-ProBNP水平。对照组为50～70岁无心力衰竭、肾功能正常老人100例,来自我院体检科健康体检人群。应用ROC软件计算曲线下面积,评价不同程度肾功能不全患者在应用NT-ProBNP诊断心力衰竭时的准确性。结果:三组病例所得到的ROC曲线下面积分别是0.884,0.824,0.798,3组间差异有统计学意义(P<0.05)。结论:50～70岁老年人应根据eGFR值分层界定NT-proBNP临界值,可提高NT-proBNP在诊断心力衰竭伴肾功能不全时的诊断准确性。     

慢性心力衰竭患者血浆NT-proBNP的变化及其意义

目的:探讨慢性心力衰竭患者血浆N末端B型利钠肽原( NT - proBNP)的变化及其临床意义.方法:选取CHF患者60例,于治疗前后分别测定血浆NT- proBNP水平,并对其进行为期1年的随访,记录心血管事件.结果:在正规抗心衰治疗症状明显改善后,NT-proBNP水平较治疗前明显下降(P＜0.05);发生心血管事件的患者(18例)血浆NT - proBNP( 5548.11±1575.17) pg/ml,明显高于未发生心血管事件组(42例)(3245.26±1502.45) pg/ml(P＜ 0.05);未发生心血管事件组的患者较发生心血管事件组的患者在心衰症状明显改善后的血浆NT - ProBNP水平下降更明显(3030.38±1390.86,2221.89±1471.31)pg/ml(P＜0.05).结论:血浆NT-proBNP是心功能紊乱时最敏感和特异的指标之一,我们用NT - proBNP来诊断心衰和评估心功能状态的同时还可以用它来判断预后和指导治疗.     

血脂康胶囊联合普伐他汀治疗慢性心力衰竭的临床研究

目的 探讨血脂康胶囊联合普伐他汀钠片治疗慢性心力衰竭的临床疗效。方法 选取2020年6月—2022年2月在天津市第三中心医院分院就诊的78例慢性心力衰竭患者,根据随机数字表法将78例患者分为对照组和治疗组,每组各39例。对照组口服普伐他汀钠片,20 mg/次,1次/d。治疗组在对照组基础上口服血脂康胶囊,2粒/次,2次/d。两组患者连续治疗1个月。观察两组的临床疗效,比较两组心功能指标、生活质量和血清N末端B型利钠肽原（NT-ProBNP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平。结果 治疗后,治疗组的总有效率为92.31%,显著高于对照组的总有效率74.36%,差异有显著性（P＜0.05）。治疗后,两组的左室射血分数（LVEF）、心输出量（CO）明显增加,左心室收缩末期内径（LVESD）明显减少（P＜0.05）;治疗后治疗组的LVEF、CO比对照组高,LVESD比对照组低（P＜0.05）。治疗后,两组的明尼苏达生活质量量表（MLHFQ）评分较治疗前明显降低（P＜0.05）,并且治疗组患者MLHFQ评分明显低于对照组（P＜0.05）。治疗后,两组的血清NT-ProBNP、IL-6、TNF-α水平较治疗前降低（P＜0.05）,且治疗组的血清NT-ProBNP、IL-6、TNF-α水平均低于对照组（P＜0.05）。结论 血脂康胶囊联合普伐他汀钠片治疗慢性心力衰竭的疗效确切,能改善患者心功能和生活质量,降低炎症反应,降低心肌损伤,并且药物安全性较好。     

红细胞分布宽度水平与急性心力衰竭的相关性研究

目的探讨急性心力衰竭(AHF)与红细胞分布宽度(RDW)水平的相关性。方法研究对象为广州市第一人民医院近1年来临床表现为气促、呼吸困难的急诊患者154例,就诊后行全血细胞计数检测和N端脑钠脲肽前体(NT-ProBNP)检测。分为AHF患者组[87例,按心功能分级分为Ⅰ级(n=8)、Ⅱ级(n=10)、Ⅲ级(n=36)、Ⅳ级(n=33)]和非AHF组(67例,排除心源性疾病)。结果 (1)AHF组和非AHF组RDW水平比较差异有统计学意义(P0.05),且随NYHA心功能分级级数的增高而增高。(2)RDW与NT-ProBNP的水平具有相关性,呈正相关。结论 AHF患者升高的NT-ProBNP与RDW是正相关的,RDW与急性心力衰竭严重程度密切相关,RDW结合NT-ProBNP可作为急性心力衰竭低廉、简易的辅助预测因子,也可用于临床心力衰竭分级。     

超声心动图在评估心力衰竭等级中的应用价值

目的探讨综合超声心动图多项参数的心力衰竭超声指数在评估慢性心力衰竭等级中的应用价值。方法选取2010年9月至2011年9月在我院接受治疗或查体的慢性心力衰竭患者87例和健康人员32例,设为观察组和对照组。所有患者均行超声心动图检查,进行心力衰竭超声指数(HFEI)的评分,并将该评分与同期血浆氨基末端脑钠肽前体(NT-ProBNP)水平和纽约心功能分级(NYHA)进行比较。结果观察组HFEI明显高于对照组(P<0.05),相关性分析显示HFEI与血浆NT-ProBNP水平高度相关(r=0.86)。结论应用HFEI联合临床表现来诊断心力衰竭分级的方法是可行的,HFEI作为评价慢性心力衰竭患者心功能的一项新指标,值得在临床推广应用。     

红细胞体积分布宽度与慢性心力衰竭的相关性

目的研究红细胞体积分布宽度（RDW）与慢性心力衰竭（CHF）患者心功能之间的相关性,并探讨其可能的机制和意义。方法收集220例CHF患者住院病历资料,根据其左室射血分数（LVEF）分为A组（n=114）,LVEF≥50%;B组（n=60）,50%〉LVEF〉35%;C组（n=46）,LVEF≤35%组。另选60例同期住院无CHF患者作为对照组,比较RDW,血N-末端脑钠肽前体（NT-ProBNP）和Hb等相关因素在各组间的变化差异,分析RDW与NT-ProBNP和LVEF二者之间的相关性,并采用多元线性逐步回归法分析各因素与RDW的相关性。结果随着LVEF的逐渐下降,RDW和NT-ProBNP皆逐渐升高,并且二者在各组间两两比较均具有显著性差异（P〈0.05）。经相关性分析,RDW与年龄,血清Fe和Hb等因素之间均不存在直线相关关系（P〉0.05）,而与NT-ProBNP,LVEF和BUN之间存在直线相关,其相关系数r分别为0.595,-0.485和0.185,经多元线性逐步回归分析可得出回归方程：RDW=13.793＋1.421（LgNT-ProBNP）＋0.074（BUN）-0.116（LVEF）。结论 CHF患者RDW较正常对照组明显升高,且与心功能成负相关。     

NT-ProBNP和QRS积分对急性心肌梗死近期心功能判断价值比较

目的比较N末端脑钠素原（NT—ProBNP）与QRS积分对急性心肌梗死（AMI）患者近期心功能判定价值。方法应用酶联免疫法测定49例患者AMI后5～7d血浆NT—ProBNP水平，同期应用12导联-心电图QRS积分评价梗死范围。随访AMI后第7d、1个月、3个月时超声心动图。结果AMI患者NT—ProBNP较正常对照组升高（P〈0．01）；前壁组和下壁＋正后壁（＋右室）组NT—ProBNP均高于下壁组（P〈0．05），前壁组与下壁＋正后壁（＋右室）组之间差异无统计学意义。前壁组QRS积分高于下壁组和下壁＋正后壁（＋右室）组，差异有统计学意义（P〈0．05）；下壁组与下壁＋正后壁（＋右室）组之间差异无统计学意义（P〉0．05）。下壁AMI心功能2级者血浆NT—ProBNP高于1级者，而两者QRS积分差异无统计学意义。AMI后5～7d的NT—ProBNP和QRS积分与心梗后第7d、1个月、3个月时左室射血分数（LVEF）、室壁运动积分（WMS）相关。结论血浆NT-ProBNP及QRS积分与AMI范围密切相关，是反映心室重构的较敏感指标；与QRS积分相比，血浆NT-ProBNP还可反映心功能状态，故更为优越。     

左西孟旦在射血分数中间值心力衰竭患者中的应用

目的观察左西孟旦对射血分数中间值的心力衰竭患者临床治疗效果。方法选取我院2016年1月至2017年8月收治的左室射血分数在40%~49%之间的心力衰竭患者66例,随机分为左西孟旦组33例及对照组33例,测定NT-ProBNP水平,并行心脏彩超检查测定左室射血分数,治疗组予以左西孟旦静脉泵入,观察1周后两组患者活动耐量提高程度(6min步行距离)、NT-ProBNP水平及心脏彩超测定左室射血分数。结果治疗组活动耐量、NT-ProBNP水平及左心室射血分数均较对照组明显改善,且两组之间具有统计学意义(P<0.01)。结论射血分数中间值的心力衰竭患者应用左西孟旦可以改善临床症状,增加活动耐量,并提高心功能。     

Emergency Thoracic Ultrasound in the Differentiation of the Etiology of Shortness of Breath (ETUDES): Sonographic B-lines and N-terminal Pro-brain-type Natriuretic Peptide in Diagnosing Congestive Heart Failure

Objectives: Sonographic thoracic B‐lines and N‐terminal pro‐brain‐type natriuretic peptide (NT‐ProBNP) have been shown to help differentiate between congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). The authors hypothesized that ultrasound (US) could be used to predict CHF and that it would provide additional predictive information when combined with NT‐ProBNP. They also sought to determine optimal two‐ and eight‐zone scanning protocols when different thresholds for a positive scan were used. Methods: This was a prospective, observational study of a convenience sample of adult patients presenting to the emergency department (ED) with shortness of breath. Each patient had an eight‐zone thoracic US performed by one of five sonographers, and serum NT‐ProBNP levels were measured. Chart review by two physicians blinded to the US results served as the criterion standard. The operating characteristics of two‐ and eight‐zone thoracic US alone, compared to, and combined with NT‐ProBNP test results for predicting CHF were calculated using both dichotomous and interval likelihood ratios (LRs). Results: One‐hundred patients were enrolled. Six were excluded because of incomplete data. Results of 94 patients were analyzed. A positive eight‐zone US, defined as at least two positive zones on each side, had a positive likelihood ratio (LR+) of 3.88 (99% confidence interval [CI] = 1.55 to 9.73) and a negative likelihood ratio (LR?) of 0.5 (95% CI = 0.30 to 0.82), while the NT‐ProBNP demonstrated a LR+ of 2.3 (95% CI = 1.41 to 3.76) and LR? of 0.24 (95% CI = 0.09 to 0.66). Using interval LRs for the eight‐zone US test alone, the LR for a totally positive test (all eight zones positive) was infinite and for a totally negative test (no zones positive) was 0.22 (95% CI = 0.06 to 0.80). For two‐zone US, interval LRs were 4.73 (95% CI = 2.10 to 10.63) when inferior lateral zones were positive bilaterally and 0.3 (95% CI = 0.13 to 0.71) when these were negative. These changed to 8.04 (95% CI = 1.76 to 37.33) and 0.11 (95% CI = 0.02 to 0.69), respectively, when congruent with NT‐ProBNP. Conclusions: Bedside thoracic US for B‐lines can be a useful test for diagnosing CHF. Predictive accuracy is greatly improved when studies are totally positive or totally negative. A two‐zone protocol performs similarly to an eight‐zone protocol. Thoracic US can be used alone or can provide additional predictive power to NT‐ProBNP in the immediate evaluation of dyspneic patients presenting to the ED.