老年慢性心力衰竭患者血浆氨基末端脑钠肽前体测定的临床意义

目的探讨测定血浆氨基末端脑钠肽前体（NT-proBNP）对老年慢性心力衰竭（CHF）患者的临床价值。方法收集2010年1月~2012年9月某院老年病房收治的符合美国纽约心脏病协会心功能分级（NYHA）的老年CHF患者58例（CHF组）,另选择同期住院的26例非心力衰竭的老年患者作为对照组。比较不同心功能级别患者血浆NT-proBNP水平、左心室射血分数（LVEF）;分析老年CHF患者血浆NT-proBNP水平与急性生理和慢性健康状况评分Ⅱ系统（APACHEⅡ评分）的相关性及与多脏器功能障碍发生率、临床预后的关系。结果 CHF组与对照组血浆NT-proBNP分别为（4080±6364）pg/ml、（89±33）pg/ml,LVEF分别为（41.69±6.37）%、（61.56±3.31）%,两组比较,差异有统计学意义（P〈0.05）;随心功能分级的增加,血浆NT-proBNP水平明显增加,LVEF下降,各级别之间比较,差异有统计学意义（P〈0.01）;血浆NT-proBNP水平与APACHEⅡ评分呈显著正相关（r=0.770,P〈0.01）,APACHEⅡ分值越高,血浆NT-proBNP水平越高;CHF组中,存活50例、死亡8例,存活、死亡患者血浆NT-proBNP分别为（2871±4056）pg/ml、（10 350±9721）pg/ml,二者比较,差异有统计学意义（t=2.769,P=0.011）;未合并多脏器功能障碍（MODS）30例,合并MODS 28例,未合并、合并MODS患者血浆NT-proBNP分别为（786±867）pg/ml、（6881±7121）pg/ml,二者比较,差异有统计学意义（t=3.063,P=0.005）。CHF合并肾功能不全老年患者血浆NT-proBNP显著升高。结论血浆NTproBNP水平测定可作为老年CHF的一个观察指标,对判断老年CHF的严重程度、多脏器功能障碍综合征的发生率及临床预后有一定帮助,与肾功能不全的关系尚需进一步临床研究证实。

Clinical value of NT-proBNP in elderly patient with congestive heart failure

Objective To investigate the plasma N-terminal pro-B-type natriuretic peptide（NT-proBNP） levels on the elderly patients with chronic heart failure（CHF）. Methods The clinical data of 58 elderly patients with CHF（CHF group） were analyzed. The plasma NT-proBNP levels,left ventricle ejection fractions （LEVF）,acute physiology and chronic health evaluationsⅡ （APACHE Ⅱ ） scores were measured and compared with 26 non-heart failure patients as normal control. Results The plasma NT-proBNP levels in CHF group and control group were（4080-＋6364）pg/ml and（89_＋33）pg/ml,respectively. Compared to control group,plasma NT-proBNP levels in CHF group arose greatly,LVEFs reduced significantly （P〈0.05）. The NT-proBNP levels increased progressively and LVEFs decreased gradually with the NYHA grades increased,and there were significant differences among grades （P〈0.01）. the APACHE I scores increased,combained wilh the plasma NT-proBNP levels increased,and showed a positive correlation between the two subjects （r=0.770,P〈0.01）. In the 58 patients,the plasma NT-proBNP levels of 50 survivors and 8 dead were （2871±4056）pg/ml and （10 350± 9721）pg/ml respectively ;compared with each other, the difference was significant（t=2.769, P=0.011）. The plasma NT-proBNP levels of 30 patients with non-MODS and 28 with MODS were respectively（786_＋867） pg/ml and （6881±7121） pg/ml;cmnpared with each other, the difference was significant （t=3.063,P=0.005）. We also find that the plasma NT-proBNP levels increased particularly in the elderly patients suffered CHF and RF simuhaneously. Conclusions The plasma NT-proBNP can be used as a good index to evaluate the degree, incidence of MODs and clinical prognosis in elderly patients with CHF. More data are needed to analyze the relationship between plasma NT-proBNP and RF.