血清脑钠肽浓度与老年慢性心力衰竭严重程度的相关性

目的 研究慢性心力衰竭不同分级的血清脑钠肽（BNP）水平变化情况,探讨BNP浓度与慢性心力衰竭严重程度的相关性和预后评估关系.方法 选取老年慢性心力衰竭患者70例,用胶体金法测定BNP浓度,并与患者心电图QRS波时限、左室射血分数（LVEF）以及心功能分级相对应,观察其相关性;同时给予患者常规治疗,使用硝酸酯类血管扩张剂、利尿剂、洋地黄类以及血管紧张素转换酶抑制剂类（ACEI）药物等,所有患者随访两年,观察其间BNP浓度变化对慢性心衰预后的评估作用.结果 按纽约心脏病协会心功能分级标准,不同分级的患者BNP浓度与心电图QRS波时限、LVEF指标比较,差异有统计学意义（P＜ 0.05或P＜0.01）;心功能受损患者心功能分级与血清BNP水平对数值呈正相关（r=0.61,P＜0.05）;与LVEF呈负相关（r=-0.48,P＜0.05）;随访两年后血清BNP水平2次持续性升高者中重大心血管事件发生率为18.2％（2/11）,病死率为9.1％（1/11）;3～4次持续性升高者中重大心血管事件发生率为30.1％（7/23）,病死率为13.0％ （3/23）;与BNP水平平稳患者相比较,其重大心血管事件发生率存在明显差异（P＜0.05）;病死率亦有明显差异（P＜0.05）.结论 血清BNP水平监测心力衰竭程度的灵敏性高,二者呈成正相关,且BNP浓度对病情和预后的评估起到了指导作用.

Serum brain natriuretic peptide concentration and correlation between the severity of chronic heart failure of the elderly

Objective To study the changes of serum brain natriuretic peptide （BNP） level in chronic heart failure with different classification, and explore the correlation and prognosis evaluation between brain natriuretic peptide concen- tration and the severity of chronic heart failure. Methods 70 cases of elderly patients with chronic heart failure were selected, and colloidal gold method was used to determined the brain natriure~ic peptide concentration, and given corre- sponding to the patients＇electrocardi0gram QRS wave time, left ventricular ejection fraction （LVEF） and cardiac func- tion classification, the correlation were observed; the conventional treatment was given at the same time, the nitrate va- sodilator, diuretics, digitalis and ACEI drugs, etc., were used, all patients were followed up for two years, the changes in brain natriuretic peptide concentration for the evaluation of prognosis of chronic heart failure was observed. Results According to the NYHA classification standard, BNP concentration, time limit of electrocardiogram QRS wave and left ventricular ejection fraction （LVEF） index comparison in＇ patients with different classification, all had significant differ- ence （ P 〈 0.05 or P 〈 0.01）; serum BNP level of numerical value in patients with heart function damage was positively correlated with cardiac function classification （r=0.61, P 〈 0.05）; and left ventricular ejection fraction （LVEF） showed a negative correlation （r=-0.48, P 〈 0.05）; follow-up after two years of serum BNP level two continuous rised in the inci- dence of major cardiovascular events was 18.2% （2/11）, mortality was 9.1% （1/11）; 3-4 times increased sustainability in the incidence of major cardiovascular events was 30.1% （7/23）, mortality was 13.0% （3/23）; compared with the BNP levels in patients with stable, their major cardioascular eents had obvious difference （P 〈 0.05）; death rates also had obvious difference （P 〈 0.05）. Conclusion Levels of serum BNP level