BNP与pro—BNP对心力衰竭合并肾功能不全患者的诊断价值

目的探讨NT—proBNP、BNP、cTnI及CK—MB与心力衰竭患者肾功能的关系。方法序贯入选临床诊断心力衰竭患者194例，根据GFR水平分为2组（A组GFR≥60ml／min／1．73m^2，B组GFR〈60ml／min／1．73m^2）．比较两组间的NT—proBNP、BNP、cTnI及CK—MB水平，结合超声心动图对心力衰竭合并有肾功能不全患者进行评价。结果GFR〈60ml／min／1．73m。组的心力衰竭患者相较于GFR≥60ml／min／1．73m。组患者，NT—proBNP、NT—proBNP／BNP、cTnl水平显著增高（P〈0．01），Spearman相关分析显示cTnI与GFR相关（r=-0．411，P〈0．001）；log（NT—proBNP／BNP）与GFR显著相关（r=-0．776，P〈0．001），BNP及CK—MB水平两组间无明显差异.结论心力衰竭患者NT—proBNP／BNP及cTnI数值与GFR密切相关，心力衰竭患者合并肾功能不全时血浆BNP水平受受肾功能影响较小，是理想评价心功能状态的指标。

Plasma BNP and NT-proBNP levels in heart failure patients with renal dysfunction

Objective To investigate plasma levels of N-terminal pro-brain natriuretic peptide （NT- proBNP）, brain natriuretic peptide（ BNP）, cardiac troponin I（ cTnI）, creatine kinase isoenzyme（ CK- MB） and renal function in patients with heart failure. Methods One hundred and ninety-four patients with heart failure were enrolled consecutively, including 96 cases with GFR ≥ 60 mL/（ min · 1.73 m ^-2）as group A and 98 cases with GFR 〈60 ml/（min·1.73 m^-2） as group B. The plasma levels of NT-proBNP, BNP, cTnI and CK-MB were measured and compared between two groups. Results Compared to group A, the plasma levels of cTnI, NT-proBNP and NT-proBNP/BNP were significantly higher in group B （ P 〈 0.01 ）. Spearman correlation analysis showed that cTnI and log （ NT-proBNP/ BNP） were negatively correlated with isotope GFR （ r = - 0.411 and r = - 0. 776, respectively and P 〈 0. 001 ）. But there were no significant difference in BNP and CK-MB levels between two groups. Conclusion Plasma NT-proBNP/BNP and cTnI are decreased with decreasing of GFR, while BNP level is less affected by renal function, indicating BNP is an ideal indicator for cardiac function in heart failure patients with renal insufficiency.