脑钠肽在慢性心力衰竭中应用价值探讨

目的:研究脑钠肽(BNP)在慢性心力衰竭(CHF)患者的诊断、病情评估、治疗疗效评价方面的临床价值.方法:采用电化学发光免疫分析法测定102例CHF患者(CHF组)和同期住院以呼吸困难为主诉并排除心脏疾病的患者30例(对照组)的血液BNP浓度,彩色超声心动图测定左心室射血分数、心脏指数,CHF组31例患者随机做核素心血池显像,测定安静状态的左心室射血分数.结果:CHF组的血液BNP浓度显著高于对照组(P＜0.001),BNP水平与NYHA心功能分级呈良好正相关,与左心室射血分数、心脏指数呈良好负相关.核素心血池显像的左心室射血分数和血液BNP浓度的关系与彩色超声心动图左心室射血分数和血液BNP浓度关系呈一致性.CHF患者经治疗后,随着NYHA心功能分级的改善,血液BNP明显下降(P＜0.001).血液BNP浓度≥10 720 pg/ml或BNP浓度呈进行性升高患者近期病死率高.结论:BNP的检测有利于CHF患者的早期诊断、病情评估、疗效评价,因此具有广泛的临床应用价值.

Application of Brain Natriuretic Peptide in Chronic Heart Failure

Objective: To investigate the value of brain natriuretic peptide(BNP) in the diagnosis,illness evaluation,and effect on chronic heart failure(CHF). Methods: The serum BNP concentration of 102 CHF patients and 30 controls were measured by electrochemiluminoimmunoassay(ECLA),and left ventricular ejection fraction(LVEF) and cardiac index(CI) were detected by color Doppler.Thirty-one randomized patients in CHF group were examined by nuclide gated cardiac blood pool imaging in order to determine LVEF at rest. Results: The serum BNP concentration in CHF group was much higher than in the controls( p <0.001),which was positively correlated with NYHA class,and negatively with LVEF and CI.The levels of LVEF and BNP by nuclide gated cardiac blood pool imaging were consistent with those by color Doppler.With the improving of heart function,the level of BNP declined obviously ( p <0.001). The patients with a BNP level above 10 720 pg/ml or increasing rapidly had a high short-term mortality. Conclusions: BNP is a useful marker for diagnosis,illness evaluation and therapeutic effect of CHF.