慢性充血性心力衰竭患者血浆脑利钠肽及血清尿酸的表达及其临床意义

目的探讨慢性充血性心力衰竭患者血浆脑利钠肽和血清尿酸浓度的变化情况,并分析其与超声心动图以及心功能指标的相关性。方法选择2010年3-9月海南省第三人民医院慢性充血性心力衰竭患者30例为研究对象。入院后完善检查,快速BNP检测仪检测血浆脑利钠肽,全自动生化分析仪检测血清尿酸浓度。检测患者的各心功能指标,行超声心动图检查。另选择无充血性心力衰竭患者30例以及健康志愿者30例,并分别检查以上各指标。结果心力衰竭组的左心房内径（LAD）（47.2±7.9）mm]、左室舒张末内径（LVEDD）（60.6±12.4）mm]、左室收缩末期内径（LVESD）（45.1±13.1）mm]、左室重量指数（LVMI）（155.8±43.1）g/m2]、脑利钠肽（BNP）（633.8±117.4）ng/L]、尿酸（393.6±143.7）μmol/L]显著高于对照组和无心力衰竭组（P〈0.01）,左心室射血分数（LVEF）（46.3±6.9）%]显著低于另外两组（P〈0.01）,无心力衰竭组和心力衰竭组血肌酐（100.5±14.8μmol/L）,102.8±16.3）μmol/L]均显著高于对照组（P〈0.01）。心功能Ⅲ级和Ⅳ级的BNP（550.3±117.3）ng/L],（831.7±218.6）ng/L]和尿酸（371.2±117.8）μmol/L）,（445.9±151.6）μmol/L]水平均显著高于心功能Ⅱ级的患者,而Ⅳ级的患者又显著高于心功能Ⅲ级的患者（均P〈0.01）。瓣膜性心脏病患者BNP水平最高（1040.6±386.9）ng/L],其次为冠心病患者（744.1±311.8）ng/L]和扩张性心脏病患者（725.2±309.5）ng/L]。扩张性心肌病患者的尿酸水平最高（464.4±189.8）μmol/L],其次为冠心病患者（395.8±104.1）μmol/L]和高血压性心脏病患者（380.3±115.7）μmol/L]。BNP和尿酸与NYHA分级、LVEDD、LVESD呈正相关（r=0.541,0.298,0.352）,与LVEF呈负相关（r=-0.421）。结论心力衰竭患者血浆BNP和血清尿酸水平显著升高,检测其浓度简单易行,在临床上可用于心力衰竭的诊断和筛查。

Clinical efficacy of detection of brain-type natriuretic peptide and serum uric acid in chronic congestive heart failure

Objective To discuss clinical efficacy of detection of brain-type natriuretic peptide and serum uric acid in chronic congestive heart failure.Methods Thirty cases with chronic congestive heart failure in the Third People ′s Hospital of Sanya from September to March in 2010 were selected as study subjects.Brain-type natriuretic peptide was detected by rapid BNP detector.Serum uric acid was detected by fully automatic biochemical analyser.Cardiac func tion indexes were detected,and all of the cases received echocardiography.30 cases without chronic congestive heart failure and 30 cases healthy volunteers were selected,and were detected all of index above.Results LAD of（47.2±7.9） mm,LVEDD of（60.6±12.4） mm,LVESD of（45.1±13.1） mm,LVMI of（155.8±43.1） g/m2,BNP of（633.8±117.4） ng/L,uric acid of（393.6±143.7）μmol/L of heart failure group were higher than those of control group and without heart fail ure group（P 0.01）,and LVEF of（46.3±6.9）% was lower than control group and without heart failure group（P 0.01）.Cr of heart failure group and without heart failure group of（100.5 ±14.8）,（102.8±16.3） μmol/L were higher than control group（P 0.01）.BNP of（550.3±117.3）,（831.7±218.6） ng/L and uric acid of（371.2 ±117.8）,（445.9±151.6） μmol/L of NAHA Ⅲ and Ⅳ were higher than Ⅱ,and NAHA Ⅳ was higher than NAHA Ⅲ patients（all P 0.01）.Level of BNP of（1040.6±386.9） ng/L of cases with Valvular Heart Disease was highest.Next were patients with coronary heart disease of（744.1±311.8） ng/L and dilated heart disease patients of（725.2 ±309.5） ng/L.Level of uric acid of dilated heart disease patients was highest of（464.4 ±189.8）μmol/L,and next were patient with coronary heart disease of（395.8±104.1） μmol/L and hypertensive patients of（380.3±115.7） μmol/L.BNP and uric acid showed positive correlation with NYHA,LVEDD,LVESD（r=0.541,0.298,0.352）,and showed negative correlation with LVEF（r=-0.421）.Conclusion BNP and serum uric acid of chronic congestive heart failure patients increase apparently.To detect the level of BNP and serum uric acid can be used for diagnosis.