检测血清脑钠肽前体在肺心病诊疗中的意义

目的探讨血浆脑钠肽前体（NT-pro BNP）在肺心病的诊断和治疗中的作用。方法分析90例肺心病患者的NT-pro BNP与一般情况、检验结果、心脏彩超结果的相关性;比较不同程度的肺动脉收缩压（PASP,对照组22例,轻度肺动脉高压38例,中重度肺动脉高压30例）、心功能状态（NYHA心功能分级为Ⅱ级22例,Ⅲ级47例,Ⅳ组21例）和治疗前后NT-pro BNP水平。结果肺心病患者NT-pro BNP与体温、血白细胞（WBC）、肌钙蛋白-I（Tn-I）呈正相关（P〈0.05或0.01）,与体重指数（BMI）、红细胞压积（Hct）、肌酐清除率（CCr）呈负相关（P〈0.05）,与心脏左心室舒张末期内径（LVDd）、室间隔厚度（IVS）、PASP呈正相关（P〈0.01）,与左室射血分数（LVEF）呈负相关（P〈0.01）;肺心病患者PASP越高NT-pro BNP水平越高,对照组、轻度肺动脉高压（PH）组、中重度PH组的NT-pro BNP水平分别为（568.5±64.6）μg/L、（1726.5±157.4）μg/L、（2796.6±264.8）μg/L;NT-pro BNP水平随着心功能分级的增加而升高,NYHA心功能分级为Ⅱ级、Ⅲ级、Ⅳ级肺心病患者治疗前NT-pro BNP分别为（526.7±57.2）μg/L、（1528.5±159.6）μg/L、（3024.5±258.4）μg/L;治疗后的NT-pro BNP水平较治疗前明显下降（P〈0.01）。结论NT-pro BNP可作为肺心病诊断和判断预后的一个参考指标,对评估病情及疗效判断起一定指导作用。

Significance of detecting serum brain natriuretic peptide in the diagnosis and treatment of pulmonary heart disease

Objective To investigate effect of N-terminal pro-brain natriuretic peptide（ NT-pro BNP） in the diagnosis and treatment of pulmonary heart disease. Methods Correlation of NT-pro BNP and general condition,results of laboratory tests and heart doppler ultrasound in 90 cases of pulmonary heart disease was analyzed. Different levels of pulmonary artery systolic pressure（ PASP,22 cases in control group,38 cases in mild pulmonary hypertension group,30 cases in moderate-tosevere pulmonary hypertension group）,heart function（ NYHA function classification was as follows： 22 cases in gradeⅡ,47 cases in grade Ⅲ,21 cases in grade Ⅳ） and NT-pro BNP levels before and after treatment were compared. Results NT-pro BNP level had a positive correlation with body temperature,white blood cell（ WBC） and troponin-I（ Tn-I）（ P〈0. 05 or 0. 01）,but it had negative correlation with body mass index（ BMI）,hematocrit（ Hct） and creatinine clearance（ CCr）（ P〈0. 05）. It was also positively correlated with heart left ventricular end diastolic dimension（ LVDd）,interventricular septum dimension（ IVS） and PASP（ P〈0. 01）,but negatively correlated with left ventricular ejection fraction（ LVEF）（ P〈0. 01）.The higher the PASP was,the higher levels of NT-pro BNP might be. NT-pro BNP levels of the control group,the mild PH group,and the moderate-to-severe PH group were（ 568. 5 ± 64. 6） μg / L,（ 1726. 5 ± 157. 4） μg / L and（ 2796. 6 ± 264. 8）μg /L,respectively. NT-pro BNP levels increased with the increase of cardiac function. NT-pro BNP levels of pulmonary heart disease patients of grade Ⅱ,grade Ⅲ,grade Ⅳ（ NYHA heart function classification） before treatment were（ 526. 7 ± 57. 2）μg /L,（ 1528. 5 ± 159. 6） μg /L and（ 3024. 5 ± 258. 4） μg /L,respectively; and their NT-pro BNP levels significantly decreased after treatment（ P〈0. 01）. Conclusion NT-pro BNP can be used as a diagnostic reference index of pulmonary heart disease and play a