N 末端脑钠肽在心力衰竭病情及预后评估中的临床价值研究简

目的研究不同类型心力衰竭N末端脑钠肽（NT—ProBNP）变化情况及N末端脑钠肽与心力衰竭患者病情严重程度、预后评估的关系。方法89例心力衰竭患者分为舒张性心力衰竭组（DHF组）26例，收缩性心力衰竭组（SHF组）63例，并以52例健康体检人员为对照组，观察各组NT—ProBNP浓度及超声心动图指标变化，研究心衰患者NT—ProBNP浓度与NYHA心功能分级关系，比较治疗前后心衰患者NT—ProBNP变化，探讨NT—ProBNP作为心衰预后指标的临床应用价值。结果对照组、DHF组及SHF组中NT—ProBNP对数值依次升高，组间比较有统计学差异（P〈0．05），DHF组NT—ProBNP对数值对数值与左室舒张末期内径（LVEDD）（r=0．426，P〉0．05）、左室射血分数（LVEF）（r=-0．554，P〉0．05）均无相关性；SHF组NT—ProBNP对数值对数值与左室舒张末期内径（r=0．569，P〈0．05）呈正相关，NT—ProBNP对数值对数值与左室射血分数（r=-0．621，P〈0．05）呈负相关；不同NYHA心功能分级心力衰竭各组的NT—ProBNP对数值组间均有统计学差异（P〈0．05），NT—ProBNP对数值与NYHA心功能分级呈正相关（r=0．663，P=0．000，P〈0．05）；心衰Ⅲ、IV级组治疗前后NT-ProBNP对数值出现下降，LVEF出现上升，LVEDD出现下降，组间比较有统计学差异（P〈0．05）。结论NT—ProBNP在心力衰竭早期诊断中具有较高的灵敏性，其升高程度与病情严重程度关系密切，对病情的预判、预后评估均有重要的临床意义。

Study on the clinical significance of N - terminal pro - brain natriuretic pepfide in assessment of severity and prognosis of heart failure.

Objective To study the change in N - terminal pro brain natriuretic peptide （ NT - ProBNP） in different types of heart fail- ure, and to evaluate the relationship between changes of NT - ProBNP and the severity, prognosis of patients with heart failure. Methods A total of 89 patients with heart failure were divided into diastolic heart failure group （ DHF group, n = 26 eases）, systolic heart failure group （ SHF group, n =63 eases）, and 52 healthy persons as control group. The concentration of plasma NT - ProBNP and changes in ultrasound Beckoning figure index were studied. The relationship between concentration of NT - ProBNP in patients with heart failure and NYHA classification for heart function also has been studied. The changes in NT - ProBNP of patients with heart failure before and after treatment were studied. The significance of NT - ProBNP as evaluation of the prognosis of patients with heart failure has been evaluated. Results The concentration of NT - ProBNP incontrol group, DHF group and SHF group increased successively. There was statistically significant difference between these groups （ P 〈 O. 05 ）. There was no correlation in NT - ProBNP Log Koc and left ventricular end diastolic dimension （LVEDD） （ r = O. 426, P 〉 O. 05 ）, left ventricular ejection fraction （LVEF） （ r = -0.554, P 〉0.05） in DHF group. No correlation was found in SHF group. NT- ProBNP on numerical end di- astolic diameter on the numerical and left ventricular （ r = 0. 569, P 〈 O. 05 ） were positively correlated. NT - ProBNP on the numerical value and left ventricular ejection fraction （ r = - O. 621, P 〈 O. 05 ） was negatively correlated. Different NYHA classification of cardiac function of heart failure in each group of NT - ProBNP on numerical significantly （ P 〈 O. 05 ）. NT - ProBNP on the cardiac function of numerical and NYHA clas- sification were positively correlated （ r = 0.663, P = 0.000, P 〈 O. 05 ）. Heart failure before and after treatment, IV level of NT - ProBNP on the numerical decline, LVEF rise, left ventricular end diastolic diameter decreased, inter group were statistically significant （ P 〈0.05 ）. Conclu- sion NT -ProBNP has higher sensitivity in the early diagnosis of heart failure, the close relationship between the increased with the severity, clinical significance for prognosis, prognostic evaluation are important.