急性充血性心力衰竭治疗后脑利钠肽的恢复情况的研究

目的 评价急性充血性心力衰竭（CHF）患者标准化抗心衰治疗中血浆脑利钠肽（BNP）水平、心功能各参数的动态变化，探讨心衰治疗过程中心脏内分泌的病理生理变化及临床意义。方法 急性CHF组54例，健康对照组52例。分别于心衰治疗前、治疗后1个月、3个月时以放射免疫法（IRMA）测定血浆BNP，行6min步行试验（6MWT）及超声测量心功能参数。结果 治疗前心衰组BNP显著增高；治疗1个月后BNP明显降低，各项心功能参数无显著变化；康复治疗3个月后血浆BNP进一步下降，6MWT、CO、CI、EF显著增加，患者症状、运动耐量明显改善。结论 急性CHF患者治疗后，血浆BNP的下降先于心脏功能指标的恢复，这种心脏内分泌变化可能有助于心衰预后。     

运动康复护理对冠心病慢性心衰患者心功能分级及ALD水平的影响

目的探讨运动康复护理对冠心病慢性心衰(CHF)患者心功能分级及醛固酮(ALD)水平的影响。方法选取2017年1月至2019年1月某院收治的冠心病CHF患者72例,按照年龄、心功能分级、合并症等可对比原则分为两组,每组各36例。对照组给予常规护理,观察组在常规护理基础上联合运动康复护理干预,对比两组心功能分级、血浆脑钠肽(BNP)和ALD水平以及运动耐力。结果观察组治疗后心功能分级优于对照组,差异有统计学意义(P0.05);随访6个月,两组血浆BNP、ALD水平低于干预前,6 min步行试验(6MWT)水平高于干预前,且观察组优于对照组,差异有统计学意义(P0.05)。结论冠心病CHF患者采用运动康复护理,可有效改善心功能,改善BNP、ALD水平,提高运动耐力。     

不同心脏康复运动强度对慢性心力衰竭患者生活质量及心功能的影响

目的探讨不同运动强度对慢性心力衰竭(CHF)患者心功能和生活质量的影响。方法将90例CHF患者按随机数字表法分为对照组、观察A组和观察B组,每组30例。对照组采用常规治疗;观察A组在常规治疗基础上给予中等强度心脏康复运动治疗;观察B组在常规治疗基础上给予高等强度心脏康复运动治疗。3个月为1个疗程,共治疗2个疗程。观察3组治疗前后左室射血分数(LVEF)与6分钟步行试验(6MWT)的变化情况,比较3组治疗后生活质量评分。结果 3组治疗后LVEF和6MWT均较治疗前显著增加,且观察B组治疗后增加较观察A组和对照组更为显著,差异均有统计学意义(P<0.05);观察B组治疗后生活质量评分显著低于观察A组和对照组(P<0.05)。结论选用高强度心脏康复运动能显著改善CHF患者心功能,提高生活质量,在患者耐受和安全措施到位的情况下,适当增强运动强度在临床具有可行性。     

步行试验评价阿托伐他汀钙改善心功能衰竭转归初步观察

目的:以6 min步行试验评价阿托伐他汀钙治疗慢性充血性心力衰竭(CHF)患者后血浆脑利钠肽(BNP)水平的动态变化,探讨阿托伐他汀钙对患者运动耐量及心脏内分泌的病理生理影响.方法:随机入选116例扩张性心肌病伴CHF患者,其中阿托伐他汀钙组59例,另57例为对照组.Bittner方案行6 min步行试验.放射免疫法测定BNP.结果:阿托伐他汀钙治疗6个月后,患者症状、运动耐量明显改善,同时血浆BNP水平明显降低.结论:CHF患者接受阿托伐他汀钙治疗后能缓解心衰症状、提高运动耐量,而且显著改善心脏内分泌功能,这种心脏内分泌变化可能有助于心衰预后.     

β受体阻滞剂对慢性充血性心力衰竭病人心功能和血B型钠尿肽的影响

目的探讨β受体阻滞剂美多洛尔对慢性心力衰竭(CHF)病人心功能和B型钠尿肽(BNP)的影响。方法CHF患者59例,分别予常规治疗(常规治疗组,27例)或加用美多洛尔(美多洛尔组,32例)治疗3个月。治疗前后用心脏彩色多普勒超声诊断仪测量心功能,用快速荧光免疫法测定BNP;观察治疗前后两组心功能和血BNP的变化及组间差异。结果NYHA心功能分级:常规治疗组治疗前后无明显变化(P>0.05),美多洛尔组治疗前后心功能改善明显(P<0.05);血BNP水平都显著下降(P均<0.05),但两组间有显著差异(P<0.05)。结论CHF病人在常规治疗基础上加用β受体阻滞剂治疗3个月,可进一步改善心功能,降低血BNP水平。     

贝那普利联合美托洛尔治疗慢性心力衰竭患者的临床疗效评价

目的探讨贝那普利联合美托洛尔治疗慢性心力衰竭(CHF)患者的临床疗效。方法将122例CHF患者随机分为治疗组及对照组,每组61例。2组均给予常规治疗,治疗组在此基础上加用贝那普利及美托洛尔。比较2组患者心率变异性(HRV)、肱动脉血管内皮舒张功能、血浆脑钠肽(BNP)、6 min步行试验(6MWT)距离及不良反应。结果 2组治疗后HRV各指标均较同组治疗前显著升高,且治疗组升高幅度显著大于对照组;2组治疗后反应性充血期间肱动脉内径(D1)及肱动脉内径扩张百分比(△)均显著增大,且治疗组增大幅度显著大于对照组;2组治疗后BNP显著下降,6MWT距离显著延长,治疗组BNP下降及6MWT距离延长幅度均大于对照组。治疗组不良反应均较轻微。结论应用贝那普利联合美托洛尔治疗CHF患者可显著升高HRV指标,改善血管内皮舒张功能,降低血浆BNP水平,延长6MWT距离,且不良反应轻微,患者可耐受,值得临床推广应用。     

贝那普利联合美托洛尔治疗慢性心力衰竭患者的临床疗效分析

目的探讨贝那普利联合美托洛尔治疗慢性心力衰竭(CHF)患者的临床疗效。方法将122例CHF患者随机分为治疗组及对照组,每组61例。2组均给予常规治疗,治疗组在此基础上加用贝那普利及美托洛尔。比较2组患者心率变异性(HRV)、肱动脉血管内皮舒张功能、血浆脑钠肽(BNP)、6 min步行试验(6MWT)距离及不良反应。结果 2组治疗后HRV各指标均较治疗前显著升高,治疗组升高幅度显著大于对照组;2组治疗后反应性充血期间肱动脉内径及肱动脉内径扩张百分比均显著增大,治疗组增大幅度显著大于对照组;2组治疗后BNP显著下降,6MWT距离显著延长,治疗组BNP下降及6MWT距离延长幅度均大于对照组。治疗组不良反应均较轻微。结论在常规治疗基础上,应用贝那普利联合美托洛尔治疗CHF患者可显著升高HRV指标,改善血管内皮舒张功能,降低血浆BNP水平,延长6MWT距离,且不良反应轻微,患者可耐受,值得推广和进一步研究。     

超声心动图多参数评分在慢性心力衰竭患者治疗随访中的应用

目的 应用心功能超声多参数评分(HF-EMPS)评价慢性心力衰竭患者(CHF)治疗前后的整体心功能状态,并分析其与BNP的关系.方法 选慢性心力衰竭患者(CHF)53例,分别于初诊及药物治疗6个月后行BNP及超声心动图检查.分析治疗前后HF-EMPS及各参数与血浆BNP的变化.结果 (1)治疗前后lgBNP、HF-EMPS、肺动脉压力参数及瓣膜参数有所下降,差异有统计学意义(P<0.05);(2)相关性分析表明lgBNP与HF-EMPS呈正相关,相关系数(r)等于0.43,(P<0.05),Logistic回归统计分析表明瓣膜参数及肺动脉压参数为BNP高于400pg/ml的强危险因素.结论 HF-EMPS可用于慢性心衰患者的整体心功能的评估,指导慢性心衰患者的治疗.     

心脉隆对老年充血性心力衰竭心脏结构和功能的影响

目的：探讨心脉隆对老年充血性心力衰竭（CHF）心脏结构和功能的影响。方法：145例老年CHF患者随机分为心脉隆组和常规组,治疗前、治疗后1个月和6个月时分别测定脑钠肽（BNP）水平、评价心脏结构和功能及主要心脏不良事件（MACE）发生情况。结果：治疗后1个月和6个月时两组左心室射血分数（LVEF）较治疗前增加,BNP明显下降;心脉隆组较常规组LVEF值高,BNP下降明显,MACE发生率低。心脉隆组左心室舒张末内径（LVEDD）较治疗前缩小。结论：心脉隆能改善老年CHF心室重构和心功能,降低MACE发生率。     

中老年冠心病患者经皮冠状动脉介入治疗术后开展心脏运动训练的康复效果

目的:探讨中老年冠心病(coronar y heart disease,CHD)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)出院后开展心脏运动训练的康复效果。方法:前瞻性选取2017年6月至2019年6月期间在中国人民解放军陆军第七十三集团军医院接受PCI术的80例CHD患者,纽约心脏病协会(New York Heart Association,NYHA)心功能分级I~II级,患者均对研究知情同意。采用计算机随机分组法分为常规组(n=40)和康复组(n=40),常规组患者PCI术后给予常规心内科治疗和护理,康复组在对照组基础上开展心脏运动训练,由专业康复医护人员负责指导和跟踪,均持续随访观察3个月,比较2组治疗前后超声心动图心功能指标、血清N端B型脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、6 min步行试验(6 min walking test,6MWT)、心肺运动试验中峰值摄氧量(peak or maximum oxygen uptake,VO2peak)和西雅图心绞痛调查量表(Seattle Angina Questionnaire,SAQ)变化情况。结果:2组治疗3个月后LVEF、6MWT、VO2peak较治疗前均明显提高,LVEDD均显著下降,差异有统计学意义(P<0.05),2组治疗前后血清NT-proBNP水平无明显变化(P>0.05),康复组治疗3个月后LVEF、6MWT、VO2peak明显高于常规组,LVEDD显著低于常规组,差异有统计学意义(P<0.05)。2组治疗3个月后SAQ量表“躯体活动受限程度”“心绞痛稳定程度”“心绞痛发作频率”“治疗满意程度”和“疾病认知程度”评分均较治疗前显著升高,差异有统计学意义(P<0.05),且康复组治疗3个月SAQ量表上述5个维度评分均显著高于常规组,差异有统计学意义(P<0.05)。结论:中老年CHD患者PCI术后开展心脏运动训练康复效果显著,能有效改善心功能和提高运动耐力,改善患者术后生活质量,值得推广应用。     

充血性心力衰竭患者血浆脑钠素浓度与心功能的关系

目的 探讨充血性心力衰竭(CHF)患者血浆脑钠素(BNP)浓度变化及与心功能级别和30天再住院率的关系。方法 随机选择78例CHF患者进行心功能分级(NYHA分级),并测定其入院及出院当天血浆BNP浓度,选择20例健康中老年健康体检者作为对照组。结果 CHF组较对照组血浆BNP浓度明显升高,476.9±243.6pmol/L对184.3±54.2pmol/L(P<0.01);不同心功能分级之间均有显著差异,NYHAⅡ～Ⅳ级血浆BNP浓度分别为263.4±56.3pmol/L、412.1±163.6pmol/L、769.7±141.7pmol/L(各组间P<0.01);33例CHF患者出院时血浆BNP浓度小于300pmol/L,30天再住院率6％,45例CHP患者出院时血浆BNP浓度大于300pmol/L,30天再住院率27％(P<0.05)。结论 血浆BNP浓度可作为诊断CHF的参考指标,随着心衰的加重,血浆BNP浓度逐渐升高,当血浆BNP浓度降至300pmol/L以下时,患者30天再住院率明显下降。     

Association of coronary artery calcium and congestive heart failure in the general population: results of the Heinz Nixdorf Recall Study

Background

The main causes of congestive heart failure (CHF) are coronary artery disease (CAD) and arterial hypertension. Coronary artery calcification (CAC) evidencing coronary atherosclerosis may occur prior to clinical CAD. The aim of our study was to assess the association between CAC as a sign of subclinical CAD and CHF in a general unselected population.

Methods

Participants of the Heinz Nixdorf Recall Study without known CAD but with known CHF as defined by a physicians’ diagnosis of CHF and dyspnea were identified. B-natriuretic peptide was measured and an exercise stress test was performed as possible. Cardiovascular risk factors and the EBCT-based CAC Agatston score were determined.

Results

Those 105/4,230 subjects (2.5%) with CHF (age 65 ± 7 years, 44% males), had higher brain natriuretic peptide (BNP) levels (median BNP 36.8 [16.5–70.1] vs. 17.6 [9.5–31.7] pg/ml, p < 0.01) and lower exercise capacity (108.7 ± 39.4 vs. 130.0 ± 40.7 W, p < 0.01) than those without. CAC in subjects with CHF was significantly higher than in those without (median CAC 64.7 [8.5–312.3] vs. 11.6 [0–109.8], p < 0.01). In univariate analysis, CAC-burden after logarithmic transformation according to log₂(CAC + 1) showed a significant association with the presence of CHF (odds ratio (OR) (95% CI): 1.16 (1.1–1.23), p < 0.0001). Adjustment for age and sex (OR 1.11 (1.04–1.18), p < 0.001), additional Framingham risk score (OR 1.09 (1.02–1.16), p = 0.015), and additional cardiovascular medication (OR 1.07 (0.998–1.14), p = 0.058) attenuated this association. Age, systolic blood pressure, antihypertensive medication and increased body mass index also remained significantly associated with presence of CHF in the full multivariate model.

Conclusion

The observed association between CAC and CHF in persons without clinically overt CAD is partly determined by risk factors that are involved in the natural history of both CAC and CHF. Whether CAC has a role to identify subjects at risk of future CHF remains to be determined using follow-up analyses.     

无创通气对高龄心力衰竭患者血浆脑钠肽水平的影响

【目的】探讨无创通气（NPPV）对高龄慢性心力衰竭（CHF）患者血浆脑钠肽（BNP）水平的影响。【方法】连续入选2007年6月至2008年6月在本院住院的高龄CHF患者60例,随机分为NPPV组（A组）和基础治疗组（B组）,入选患者均行超声心动图检查和血浆BNP的测定。【结果】高龄CHF患者治疗前的血浆BNP水平明显升高,A组以及B组血浆BNP较治疗前显著下降（P〈0．05）,且治疗后,A组较B组下降程度更大。A组治疗后心功能Ⅳ级者下降较Ⅲ级下降更为显著（P〈0．05）。【结论】在基础治疗基础上辅以NPPV治疗高龄CHF患者,改善心功能作用更显著,对于心功能Ⅳ级CHF患者较Ⅲ级效果更为显著。     

慢性心力衰竭患者甲状腺激素水平变化的相关研究

【目的】探讨慢性心力衰竭（CHF）患者血清甲状腺激素水平的变化特点,以及合并正常甲状腺功能病态综合征（ESS）患者的血浆脑钠肽（BNP）水平变化。【方法】选取CHF患者104例（NYHAⅡ级38例,Ⅲ级40例,Ⅳ级26例）,对照组（NYHAⅠ级）23例,分别测定血清T3、FT3、T4、FT4、TSH、BNP、左室射血分数（LVEF）,比较ESS组和非ESS组之间BNP、LVEF等指标变化。【结果】①不同心功能组T3、FT3、T4、FT4水平随心功能不全的加重而下降,ESS发生率依次升高;②CHF合并ESS患者BNP明显升高,LVEF下降、LVEDD扩大、心率增快。【结论】CHF合并ESS患者,心肌结构和神经内分泌系统改变更严重。     

Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure

BACKGROUND: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. METHODS: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). RESULTS: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) micro g/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 micro g/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 micro g/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. CONCLUSION: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.     

血清尾加压素Ⅱ的水平与慢性充血性心力衰竭的关系研究

[目的]检测心力衰竭患者血清尾加压素Ⅱ（UⅡ）的水平,探讨其在慢性充血性心力衰竭（CHF）中的意义及与B型钠尿肽（BNP）的关系。[方法]采用酶联免疫法及荧光免疫法测定20例CHF患者及24名正常对照者的血清UⅡ及全血BNP浓度,并作统计学分析。[结果]CHF组血清UⅡ及全血BNP水平增高于正常对照组（P〈0．001）,BNP〉590pg／mL的CHF患者的血清UⅡ水平明显高于BNP〈590的pg／mL的CHF患者（P〈0．05）。[结论]CHF患者血清uⅡ显著增高,有可能在CHF的发生发展的病理过程中起一定的作用。     

促红细胞生成素对慢性心力衰竭伴贫血患者脑钠肽和心功能的影响

【目的】探讨促红细胞生成素（EPO）对慢性心力衰竭（CHF）4#贫血患者脑钠肽（BNP）和心功能的影响。【方法】176例CHF伴贫血患者,随机分为治疗组和对照组,两组患者均给予常规抗心衰治疗,治疗组加用EPO注射及铁剂口服治疗,随访6个月,比较两组在BNP及心功能等指标上的差别。【结果】治疗组治疗前后BNP、运动耐力、贫血指标及心功能指标的改善均优于对照组（P〈0．05）。【结论】使用EPO治疗CHF伴贫血,可显著改善患者的临床症状及心功能。     

B型利钠肽在慢性心力衰竭中的诊断价值

【目的】探讨血浆B型利钠肽（BNP）在慢性心力衰竭（CHF）中的诊断价值。【方法】随机选择74例住院CHF和46例无器质性心脏病患者作为研究对象。入院当日利用雅培Axsym免疫分析仪检测血浆BNP,并采用日本Alokaa5超声心动仪检查心功能。【结果】与对照组比较,心衰纽血浆BNP水平显著升高（P〈0．01）。随着心衰程度的加重,血浆BNP逐渐增高,患者血浆BNP水平与NYHA心功能分级和左心室舒张末期内径（LVEDD）呈正相关,与左室射血分数（LVEF）呈负相关（P均〈0．01）。【结论]BNP对CHF诊断和心功能分级具有重要的临床参考价值。     

肺炎并心力衰竭患儿血浆脑钠肽变化及其与心功能的关系

目的探讨肺炎并心力衰竭患儿血浆脑钠肽（BNP）变化及其与心功能的关系。方法选取4年住院肺炎并心力衰竭患儿（肺炎心衰组）40例,男26例,女14例;年龄3个月-2岁。一般肺炎患儿（一般肺炎组）40例,男25例,女15例;年龄3个月-3岁。健康对照组为本院同期体检健康儿童共40例,男25例,女15例;年龄5个月-3岁。抽取各组患儿静脉血2-3 mL,采用酶联免疫吸附法（ELISA）测定血清BNP水平;同时均行心脏超声测定其左室射血分数（LVEF）和左室短轴缩短（LVFS）。比较各组BNP水平;以及BNP与LVEF、FS的相关性。结果肺炎心衰组较健康对照组和一般肺炎组血清BNP水平显著升高,[（579.0±90.0）ng·L^-1]vs[（108.6±15.0）ng·L^-1],[（579.0±90.0）ng·L^-1]vs[（121.5±10.1）ng·L^-1];LVEF和LVFS水平降低;有统计学差（P〈0.05）。肺炎心衰组血清BNP与LVEF、LVFS均呈负相关（r=-0.89,-0.78,P〈0.05）。结论肺炎心衰患儿血浆BNP水平显著升高,与左室功能呈负相关。血浆BNP水平可作为判断肺炎并心力衰竭患儿的心衰程度的指标。     

Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?

The aim of the present study was to evaluate the effects of a normal-sodium (120 mmol sodium) diet compared with a low-sodium diet (80 mmol sodium) on readmissions for CHF (congestive heart failure) during 180 days of follow-up in compensated patients with CHF. A total of 232 compensated CHF patients (88 female and 144 male; New York Heart Association class II-IV; 55-83 years of age, ejection fraction <35% and serum creatinine <2 mg/dl) were randomized into two groups: group 1 contained 118 patients (45 females and 73 males) receiving a normal-sodium diet plus oral furosemide [250-500 mg, b.i.d. (twice a day)]; and group 2 contained 114 patients (43 females and 71 males) receiving a low-sodium diet plus oral furosemide (250-500 mg, b.i.d.). The treatment was given at 30 days after discharge and for 180 days, in association with a fluid intake of 1000 ml per day. Signs of CHF, body weight, blood pressure, heart rate, laboratory parameters, ECG, echocardiogram, levels of BNP (brain natriuretic peptide) and aldosterone levels, and PRA (plasma renin activity) were examined at baseline (30 days after discharge) and after 180 days. The normal-sodium group had a significant reduction (P<0.05) in readmissions. BNP values were lower in the normal-sodium group compared with the low sodium group (685+/-255 compared with 425+/-125 pg/ml respectively; P<0.0001). Significant (P<0.0001) increases in aldosterone and PRA were observed in the low-sodium group during follow-up, whereas the normal-sodium group had a small significant reduction (P=0.039) in aldosterone levels and no significant difference in PRA. After 180 days of follow-up, aldosterone levels and PRA were significantly (P<0.0001) higher in the low-sodium group. The normal-sodium group had a lower incidence of rehospitalization during follow-up and a significant decrease in plasma BNP and aldosterone levels, and PRA. The results of the present study show that a normal-sodium diet improves outcome, and sodium depletion has detrimental renal and neurohormonal effects with worse clinical outcome in compensated CHF patients. Further studies are required to determine if this is due to a high dose of diuretic or the low-sodium diet.