摘要
目的了解老年左室功能下降患者脑钠肽前体N末端(NT-proBNP)变化;分析纽约心脏协会(NYHA)心功能分级、左室射血分数(LVEF)、各种临床因素与NT-proBNP之间的关系,评价NT-proBNP诊断老年人左室功能不全的临床价值.方法采用电化学发光免疫学方法(Elecsys免疫分析系统)测定102例老年左室功能下降患者的血清NT-proBNP水平,分析其与NYHA心功能分级、LVEF等因素的关系.结果单因素分析显示,NT-proBNP水平随着NYHA分级的增加而升高,NYHAⅡ级患者 NT-proBNP 中位数为185.2 pg/ml 、NYHAⅢ级患者为964.1 pg/ml、NYHAⅣ级患者为2878.0 pg/ml,不同NYHA分级的各组患者间 NT-proBNP 水平的差异均有显著性(P<0.001).LVEF<40%组的NT-proBNP中位数为7456.0 pg/ml、 LVEF 40% ～<50%组为1669.0 pg/ml、LVEF≥50%组为249.2 pg/ml,不同LVEF的各组患者NT-proBNP水平的差异均有显著性(P<0.001).LVEF值与NT-proBNP之间呈良好的负相关性(r=-0.735, P<0.001 ).多元回归分析显示,NYHA分级和LVEF可能对NT-proBNP有影响;NT-proBNP水平与性别、年龄、不同临床既往史不相关.结论 NT-proBNP水平是确定老年左室功能下降的良好指标,其与心力衰竭的严重程度以及左室功能密切相关.
Objective Amino-terminal portion of pro-brain natriuretic peptide (NT-proBNP) appears to be useful in the screening, diagnosis and prognosis of left ventricular dysfunction and congestive heart failure. The purpose of this study was to determine the value of serum NT-proBNP in Shanghai elderly patients with left ventricular dysfunction. Methods Serum NT-proBNP in 102 elderly patients with left ventricular dysfunction (87 males) from the Geriatrics and Cardiology departments of Huashan Hospital, was measured by using Elecsys 2010 (Roche Diagnostics, Switzerland). Left ventricular ejection fraction (LVEF) was assessed by echocardiography. Results Mono-factor analysis showed that NT-proBNP level was elevated with increment of NYHA categorization. The median value of NT-proBNP was 185.2 pg/ml in NYHA Ⅱ group, 964.1 pg/ml in NYHA Ⅲ group and 2878 pg/ml in NYHA Ⅳ group. The differences were significant (P<0.001). NT-proBNP (median)value in LVEF < 40% group was 7456 pg/ml, that in LVEF between 40% and 49% group was 1669 pg/ml and that in LVEF≥50% group was 249.2 pg/ml, the differences were significant too (P<0.001). The NT-proBNP level was negatively correlated with LVEF (r=-0.735, P<0.001 ). Multi-factors linear regression analysis showed that NYHA categorization and LVEF were correlated with NT-proBNP excluding with other factors. They were not relevant with sex, age and past clinical history. Conclusions The NT-proBNP level is a sensitive indicator of left ventricular dysfunction in elderly patients and is closely related to the degree of severity of heart failure.
出处
《上海医学》
CAS
CSCD
北大核心
2005年第4期287-290,共4页
Shanghai Medical Journal
