老年心力衰竭患者测定脑利钠肽的临床意义

目的探讨老年舒张性心力衰竭（DHF）与收缩性心力衰竭（SHF）中脑利钠肽（BNP）的变化及诊断早期DHF的临界值。方法对老年DHF64例患者及34例SHF患者检测BNP,81例无心衰患者作对照。结果1NYHA心功能~级患者BNP水平分别为（281.47±247.60）pg/ml、（1235.60±926.79）pg/ml、（2838.75±1193.80）pg/ml,P=0.001;2BNP水平在SHF和DHF中分别为（746.3±823.0）pg/ml、（2468.9±1288.9）,P=0.000;3在SHF、DHF,BNP与左心室射血分数均呈负相关,r值分别为-0.595（P=0.001）、-0.333（P=0.016）;4在SHF,BNP与左心室大小呈正相关（r=0.435,P=0.026）;在DHF,BNP与左心房大小呈正相关,（r=0.359,P=0.01）。5排除SHF后,以78.50 pg/ml为临界值诊断DHF的曲线下面积为0.995,其敏感性96.8%,特异性为97.5%。结论BNP能反映心力衰竭的严重程度,可作为诊断早期DHF的有效指标。

The clinical significance of the concentration of brain natriuretic peptide in elderly patients with heart failure

Objective To investigate the differences of BNP level between diastolic heart failure （DHF） and systolic heart failure （SHF） in the aged patients,and to identify the diagnostic threshold value of early DHF. Methods The plasma levels of BNP were measured in 64 aged patients with DHF and 34 aged patients with SHF. 81 patients with normal heart function were used. as control group. Results （1）The plasma levels of BNP in patients with heart function rated NYHA Class Ⅱ-Ⅳ were 281.47±247. 60, 1235. 60±926. 79 and 2838. 75±1193. 80 （pg/ml） respectively （P = 0. 001）. （2）The levels of BNP in SHF and DHF were 746.3±823.0 and 2468. 9±1288. 9 （pg/ml）respectively （P= 0. 000）. （3）There was a negative correlation between LVEF and BNP in both SHF and DHF （r = -- 0. 595, P = 0. 001 ; r = -- 0. 333, P = 0. 016） ; （4）There was a positive correlation between LVD and BNP in SHF （r= 0. 435,P = 0. 026）,while in DHF patients, LAD is positively related to BNP（r=0. 359,P=0. 001）; （5）Excluding SHF,when 78.50pg/ml used as the threshold value to diagnose DHF,the area under the curve （AUC）was 0. 995, the sensibility was 96.8% ,and the specificity was 97.5%. Conclusion The levels of BNP could reflect the severity of heart failure and it was a valuable laboratory marker to diagnose early DHF .