慢性心衰患者NT-proBNP、血浆肌钙蛋白I、hsCRP检测的意义

目的：探讨检测慢性心力衰竭（CHF）患者氨基末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）、高敏C反应蛋白（hsCRP）的诊断、预后意义。方法：83例临床诊断为CHF的患者,根据NYHA心功能级别分为Ⅱ级组（27例）,Ⅲ级组（29例）,Ⅳ级组（27例）,各组又根据NT-proBNP下降是否〉30%分为NT-proB-NP下降〉30%组和NT-proBNP下降≤30%组,分别在入院时及入院7d后测定患者的左心室射血分数（LVEF）,左室舒张末期内径（LVEDd）,NT-proBNP、cTnI、hsCRP水平。其中75例随访9～12个月以了解心脏事件发生与NT-proBNP,cTnI,hsCRP关系。结果：随着CHF程度加重,NT-proBNP及cTnI,hsCRP水平均明显升高,LVEDd明显增大,LVEF明显减小（P均〈0.01）;在心功能Ⅳ级组中,与NT-proBNP下降≤30%比较,NT-proBNP下降〉30%患者cTnI,hsCRP水平明显降低（P〈0.01）。随访患者入院7d时与未发生心脏事件组比较,发生心脏事件患者cTnI（0.17±0.03）ng/ml比（0.965±0.24）ng/ml],hsCRP（1.07±0.05）mg/L比（6.97±0.12）mg/L]、NT-proBNP（253.54±57.40）pg/ml比（4358.70±543.22）pg/ml]水平明显升高（P〈0.01）。结论：氨基末端脑钠肽前体,心肌肌钙蛋白I,高敏C反应蛋白在诊断心衰和评估预后方面有临床意义。

Clinical significance detecting NT-proBNP,plasma cTnI and hsCRP in patients with chronic heart failure

Objective:To explore diagnostic and prognostic significance detecting N terminal pro brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI) and high sensitive C-reactive protein(hsCRP) in patients with chronic heart failure(CHF).Methods:According to New York heart association(NYHA) cardiac classification,a total of 83 CHF patients were divided into NYHA class Ⅱ group(n=27),NYHA class Ⅲ group(n=29) and NYHA class Ⅳ group(n=27);according to NT-proBNP decreased >30% or not after treatment,each group was further divided into NT-proBNP decreasing >30% group and NT-proBNP decreasing ≤30% group.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic dimension(LVEDd),levels of NT-proBNP,cTnI and hsCRP were measured in all patients at the beginning and 7d after admission.A total of 75 cases were followed up for 9～12 months to study relationship among NT-proBNP,cTnI,hsCRP and incidence of cardiac events.Results: As CHF was more severe,there were significant increase in levels of NT-proBNP,cTnI,hsCRP and LVEDd,and significant decrease in LVEF,P<0.01 all;in NYHA class Ⅳ group,compared with NT-proBNP decreasing ≤30% group,there were significant decrease in levels of cTnI and hsCRP in NT-proBNP decreasing >30% group(P<0.01).Compared with no cardiac events group on seventh day after admission,there were significant increase in levels of cTnI (0.17±0.03) ng ml vs.(0.965±0.24) ng ml],hsCRP (1.07±0.05) mg L vs.(6.97±0.12) mg L]and NT-proBNP (253.54±57.40) pg ml vs.(4358.70±543.22) pg ml]in group with cardiac events(P<0.01).Conclusion: NT-proBNP,cTnI and hsCRP possess important significance in diagnosis and evaluation of prognosis of chronic heart failure.