氨基末端脑钠素前体(NT-proBNP)在风心病合并心力衰竭患者中检测的临床意义

目的　观察在风心病合并心力衰竭患者中NT -proBNP的水平变化,探讨NT- proBNP用于评价风心病心功能异常的临床意义。方法　纳入风心病合并心力衰竭的患者42例以及正常对照17例,采用电化学发光法检测NT -proBNP浓度,同时采用超声心动图及彩色超声多普勒测定左室舒末内径、左房、右房和右室内径以及左室的射血分数,以单因素方差分析(ANOVA法)比较NT proBNP在风心病患者中不同NYHA分级间的差异,同时采用多因素相关分析寻找影响NT -proBNP水平的相关因素。结果　风心病患者中NT- proBNP浓度显著高于对照组(P <0 .0 1) ,在风心病患者中NT proBNP浓度随NYHA分级的升高而显著地升高(P <0 .0 5 ) ,但是多因素相关分析仅发现NT proBNP与左室舒末内径有微弱的正相关趋势(r =0 .3 0 4,P =0 .0 76) ,而同左房内径、右房、右室内径、射血分数等指标间无明显的相关性。结论　风心病合并心力衰竭患者中NT- proBNP显著升高,这一异常同心力衰竭的严重度有一定关系,但是同左室收缩功能以及心脏结构异常程度无显著的相关性。

Plasma NT-proBNP levels and its clinical significance in patients with rheumatic heart disease

Objective To measure NT-proBNP levels in patients with RHD and to determine whether NT-proBNP concentrations correlate with clinical and echocardiographic findings.Methods 42 patients with rheumattic valve disease and 17 healthy subjects were entered in the study.NT-proBNP was measured using the commercially available assay-kits(Roche,USA).Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of LVDD,diameter of LA,LV,RA,RV and LVEF.Results The plasma concentrations of NT-BNP were significantly higher in patients with rheumatic heart disease than in control subjects (P<0.01).The plasma NT-BNP level was significantly increased with upgrading of NYHA class(P<0.05).There was a mild correlationship between higher NT-proBNP and LVDD in multivariate analysis.Conclusion We found increased plasma BNP levels in patients with rheumatic heart disease compared with healthy subjects.And the abnormality is related to the severity of heart failure (NYHA class).