对比分析N端前体B型钠尿肽和心脏超声心动图对收缩性和舒张性心力衰竭的鉴别诊断意义

目的 通过对比来分析N端前体B型钠尿肽(NT-proBNP)和超声心动图(UCG)对收缩性心力衰竭(SHF)和舒张性心力衰竭(DHF)的鉴别诊断意义,为临床判断和处理不同类型的心力衰竭提供方法和依据.方法 采集符合美国纽约心脏学会(NYHA)心力衰竭诊断标准的SHF患者80例(SHF组)和DHF患者106例(DHF组),测定所有患者的血清NT-proBNP水平,NT-proBNP＞2 000 ng/L为心力衰竭确诊标准.分别比较SHF组和DHF组同一NYHA级别者的NT-proBNP水平.患者均进行UCG检查,左室射血分数(LVEF)＜50%为收缩功能不全,比较SHF组和DHF组的左室舒张末内径(LVEDD)、左房内径(LAD)和左房压力(LAP).结果 SHF组的LVEDD、LAD及LAP明显高于DHF组,差异有统计学意义(P＜0.05);SHF组和DHF组同一NYHA级别患者NT-proBNP水平比较,SHF组明显高于DHF组,差异有统计学意义(P＜0.05).DHF组NYHA Ⅲ、Ⅳ级患者NT-proBNP水平在心力衰竭不能确定范围内,NYHA Ⅱ级患者NT-proBNP水平在心力衰竭排除范围.结论 UCG检查对SHF和DHF有鉴别诊断意义,可为临床诊断和治疗提供帮助;NT-proBNP对同一NYHA心功能级别的SHF和DHF有鉴别诊断意义.

Application of N-terminal pro-Brain Natriuretic Peptide and Ultrasound Cardiogram in the Differential Diagnosis of Systolic Heart Failure and Diastolic Heart Failure

Objective To explore the potential application of N-terminal pro-brain natriuretic peptide (NT-proBNP) and ultrasound cardiogram (UCG) in the differential diagnosis of systolic heart failure (SHF) and diastolic heart failure (DHF).Methods Totally 80 patients with SHF and 106 patients with DHF (confirmed according to the heart failure standard of New York Heart Association) were included and divided into three groups: NYHA grade Ⅱ,grade Ⅲ,and gradeⅣ.The NT-proBNP value was determined in all patients and compared among these three groups,with NT-proBNP＞2 000 pg/ml was taken as the diagnostic standard for heart failure.UCG examination was performed on all the patients.Left ventricular end-diastolic dimension (LVEDD),left atrial diameter (LAD),and left atrial pressure (LAP) in SHF and DHF groups were measured and compared.Results The NT-proBNP level in SHF group was significantly higher than that in DHF group of the same NYHA grade (P＜0.05).The average NT-proBNPs in DHF group of NYHA grade Ⅲ and Ⅳ were within the range unascertainable of heart failure.The average NT-proBNP in DHF group of NYHA grade Ⅱ was within the range of exclusion.LVEDD,LAD,and LAP in SHF group were significantly higher than those in DHF group(P＜0.05). The average LVEDD in DHF group was within the normal range and the average LAD and LAP in DHF group were only slightly higher.Conclusion NT-proBNP has the differential diagnostic value for SHF and DHF of the same NYHA grade. UCG examination has the differential diagnostic value for SHF and DHF and it is helpful for the clinical diagnosis and treatment.