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目的探讨脑钠肽(BNP)测定在慢性充血性心力衰竭(CHF)患者诊断及预后评估中的临床价值。方法150例CHF患者,在入院时测定血浆BNP浓度,同时测定左室射血分数(LVEF)、左室舒张末期容积(EDV)、左室收缩末期容积(ESV),随访3个月观察患者的病死率、再住院率作为终末事件。结果NYHA心功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者的BNP水平逐级升高,差异均有高度统计学意义(P<0.01)。LVEF、EDV、ESV正常的患者组BNP水平均明显低于异常患者组,差异均有高度统计学意义(均P<0.01)。相关性检检显示,LVEF与BNP成负相关(P<0.001),EDV、ESV与BNP成正相关(分别P<0.01和P<0.05)。以出院前BNP>10ng/ml作为评估终末事件的界值,其预测预后的敏感度为86.4%,特异度为95.3%。结论BNP对CHF的早期诊断及预后判断均有重要参考价值。
Objective To investigate the clinical value of brain natriuretic peptide (BNP) in diagnosis and prognosis of patients with chronic congestive heart failure (CHF). Methods 150 patients with CHF were enrolled in the determination of plasma BNP concentration, simultaneous determination of left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (EDV), left ventricular end systolic volume (ESV), followed up for 3 months to observe the patients Mortality, rehospitalization rates were used as terminal events. Results The levels of BNP in NYHA functional class Ⅰ, Ⅱ, Ⅲ and Ⅳ were gradually increased, the differences were highly statistically significant (P <0.01). BNP levels in patients with normal LVEF, EDV and ESV were significantly lower than those in patients with abnormalities (all P <0.01). Correlation examination showed that LVEF was negatively correlated with BNP (P <0.001), and EDV and ESV were positively correlated with BNP (P <0.01 and P <0.05, respectively). The pre-discharge BNP> 10ng / ml was used as the cutoff value to evaluate the final event. The sensitivity and specificity of predicting prognosis were 86.4% and 95.3% respectively. Conclusion BNP has important reference value for the early diagnosis and prognosis of CHF.