B型钠尿肽与心功能不全严重程度及近期愈后的关系探讨

目的:探讨B型钠尿肽与心功能不全严重程度的关系以及对近期愈后的评估价值。方法:免疫荧光法测定的52例心功能不全患者住院次日的血B型钠尿肽浓度,并对20例NYHAⅢ~Ⅳ级的患者于住院治疗5~12天重复测定,超声心动图测定不同心功能患者的心脏结构和功能,分析血液B型尿钠肽浓度与超声指标及心功能分级的关系,探讨B型脑钠肽在评价心力衰竭患者治疗效果和近期愈后中的价值。结果:血BNP浓度在心功能不全患者各组间两两比较均有显著性差异,随着心力衰竭严重程度加重,血液BNP浓度增加。血BNP浓度与左室舒张末期内径、呈显著正相关(r=0.706,P<0.001),与左室射血分数和左室短轴缩短率均呈负相关(r=-0.712和r=-0.685,均P=0.001)。其中好转出院的17例NYHA心功能Ⅲ~Ⅳ级的患者治疗后BNP平均浓度显著低于治疗前水平(539.19±219.57 pg/ml和1 072.35±352.17 pg/ml,P<0.001),而另外3例死亡患者血BNP较入院前显著升高(4 694.11±1 642.45和2 014.19±566.12,P<0.001)。结论:B型脑钠肽浓度与心功能不全严重程度密切相关,并且是评价治疗效果和近期愈后的重要指标。

Relation between blood B-type natriuretic peptide level and severity of heart dysfunction and value of BNP in short-term prognosis in patients with heart dysfunction

Objective: To explore the relation between blood B-type natriuretic peptide(BNP) concentration and severity of heart dysfunction and to review the value of BNP in short-term prognosis.Methods: Blood BNP concentration of patients with heart dysfunction was measured by the Triage BNP assay(Bosite)(n=52) after admission. Among them, Blood BNP concentration of patients with severe heart failure (NYHAⅢ～Ⅳ) was repeatedly measured after 5～12 day's therapy. Constructive and functional parameters of heart wer measured by echocardiography in 52 patients on the same time.Results: Blood BNP concentration of patients with heart dysfunction increased with the increasing severity of heart failure according to NYHA functional classification (P<0.01).Blood BNP concentration had significantly positive correlations with left ventricular end diastolic volume (r=0.706,P<0.001).Blood BNP concentration of patients with severe heart failure after treatment was lower than before treatment (539.19±219.57 pg/ml and 1 072.35±352.17 pg/ml,P<0.001),but the blood BNP concentration of three patients who died after treatment was higher than admission(4 694.11±1 642.45 and 2 014.19±566.12,P<0.001).Conclusion: Blood BNP concentration is correlative with severity of heart dysfunction. It indicates to be an important biological parameter for assessing outcome of therapy and short-term prognosis.