脑钠肽与N端前体脑钠肽对心功能不全患者的诊断价值

目的对比脑钠肽(BNP)与N端前体脑钠肽(NT-ProBNP)对于心功能不全患者的诊断价值及血肌酐水平对于BNP与NT-ProBNP的影响。方法 54例心功能不全患者按NYHA分级,Ⅰ级组9例,Ⅱ级组16例,Ⅲ级组15例,Ⅳ级组14例,分别检测其BNP与NT-ProBNP,并根据其肌酐是否>104μmol/L分为肾功能正常组与肾功能不全组。比较NYHA分级与BNP、NT-ProBNP、EF、6min步行试验关系及相关性。利用ROC(receiver operating characteristic,ROC)曲线比较BNP、NT-ProBNP对于心功能不全的诊断价值。结果①不同NYHA心功能分级患者的血浆BNP、NT-ProBNP水平不同,随心功能分级的增加而增高(P<0.05)。②血浆BNP、NT-ProBNP水平与EF、6min步行试验呈负相关(P<0.05)。③肾功能正常组与肾功能不全组其BNP水平分布差异无统计学意义,而NT-proBNP水平分布差异具有统计学意义。结论在肾功能正常的患者,由于NT-proBNP稳定,半衰期长,可为评价心功能的很好指标。但对于肾功能不全患者,BNP是较NT-proBNP更能反映心功能的指标。

THE DIAGNOSTIC VALUE OF BNP AND NT-PROBNP FOR PATIENTS WITH HEART FAILURE

Objective To compare the diagnostic value of BNP and NT-ProBNP for patients of heart failure,and assess the impact of serum creatinine on BNP and NT-ProBNP.Methods According to the NYHA cardiac functional grading,54 patients with heart failure were divided into four grades that was grade Ⅰ(9 cases),grade Ⅱ(16 cases),grade Ⅲ(15 cases) and grade Ⅳ(14 cases).Serum concentration of BNP and NT-ProBNP were detected.The patients were devided into two groups according to whether the serum creatinine more than 104 umol/L or not.The correlation among NYHA cardiac functional grading、BNP 、NT-ProBNP、LVEF and six-minute walk test were analyzed.Results ①Plasma level of BNP and NT-ProBNP were different from the level of the diagnoses criterion of NYHA;the more advanced level of the NYHA,the higher were the plasma level of BNP and NT-ProBNP accordingly.②The plasma level of BNP and NT-ProBNP were negative correlation with LVEF and six-minute walk test.③Plasma level of NT-ProBNP was significantly different between the kidney disease or not,but plasma level of BNP was not.Conclusion NT-ProBNP may be a discerning marker for the detection and evaluation of heart failure for patients no kidney disease,but BNP is better for the patients with heart failure accompanied by kidney disease.