cTnI、hs-CRP和BNP在心力衰竭患者治疗前后的变化及其对诊断和预后判断的价值

目的探讨心肌肌钙蛋白I（cTnI）、高敏C反应蛋白（hs—CRP）和B型钠尿肽（BNP）联合检测对心力衰竭（HF）诊断和预后判断的价值。方法测定128例明确诊断为HF的不同病因、不同心功能分级的患者人院时、治疗开始后48h及出院时血清cTnI、hs—CRP和血浆BNP水平，进行治疗前后对比观察，并与50名健康对照组比较，随访观察患者心脏事件的再发生。结果血清cTnI、hs—CRP和血浆BNP水平在HF患者不同心功能分级组和对照组之间差异均有统计学意义，且心功能越差，其浓度越高（P均〈0．01）；三者在HF患者不同时期治疗前后比较，差异均有统计学意义（P均〈0．01）；三者联合检测在HF患者早期敏感性为94．5％，明显优于单项检测（P均〈0．01）；随访患者发生心脏事件组血清cTnI、hs—CRP和血浆BNP出院时浓度明显高于未发生心脏事件组（P均〈0．01）。结论血清cTnI、hs—CRP和血浆BNP在HF患者中明显升高，三者联合检测对HF临床诊断和预后判断有重要意义。

The change and the diagnostic and prognostic values of measurements of cardiac troponin I, high sensitive C reactive protein and B-type natriuretic peptide before or after treatment in patients with heart failure

Objective To explore the diagnostic and prognostic values of measurements of cardiac troponin I (cTnI), high sensitive C reactive protein(hs-CRP) and B-type natriuretic peptide(BNP) in patients with heart failure(HF). Methods 128 clearly diagnosed HF patients of different etiology and different classification of cardiac function were determined on admission to hospital, 48 hours after treatment and at hospital discharge. Their serum cTnI, hs-CRP and plasma BNP levels on pre-treatment and after treatment were determined and compared to observe, with 50 healthy subjects as controls. The patients were followed up to be observed the recurrence of cardiac events. Results In the HF patients with different classification of cardiac function and the controls, serum cTnI, hs-CRP and plasma BNP levels were compared, and the differences were statistically significant. The worse the heart function was, the higher the concentration was (P<0.01). They were compared in the three different periods of treatment in HF patients, and there was a substantially difference (P<0.01). The joint measurement of serum cTnI, hs-CRP and plasma BNP levels in HF patients had an early sensitivity of 94.5%, and it was obviously better than a single measurement (P<0.01). In the follow-up patients of the cardiac events group, serum cTnI, hs-CRP and plasma BNP concentrations at hospital discharge were markedly higher than those in the non-cardiac events group (P<0.01). Conclusions Serum cTnI, hs-CRP and plasma BNP concentrations in patients with HF significantly increase, and the clinical diagnosis and prognosis of the three combined measurements in patients with HF have important significance.