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目的:探究扩张型心肌病慢性心力衰竭患者血浆脑利钠肽水平的临床意义。方法:收集2012年3月至2016年3月我院收治的90例扩张型心肌病慢性心力衰竭患者,将患者按照NYHA心功能分级分为A组(II级)20例、B组(III级)38例、C组(IV级)32例。比较各组患者的血浆脑力钠肽(BNP)以及超声心动图相关指标,包括左心室射血分数(LVEF)、左心房内径(LA)、左室舒张末期内径(LVEDD)以及左室收缩末期内径(LVESD),分析血浆BNP与NYHA分级和超声心动图相关指标的相关性,以及比较血浆BNP和LVEF在慢性心力衰竭病情程度中的能力。结果:C组患者的血浆BNP浓度显著高于A组和B组(P<0.05),而B组患者的血浆BNP浓度显著高于A组,比较差异具有统计学意义(P<0.05)。心脏超声检测发现,C组患者的LA显著高于A组(P<0.05),而LVEF、LVEDD及LVESD比较差异无统计学意义(P>0.05)。血浆BNP与NYHA分级呈正相关关系,但与LVEDD、LVESD、LVEF、LA无明显相关关系(P>0.05)。血浆BNP对评价心力衰竭患者病情程度呈现出较强的能力(受试者工作特征曲线下面积=0.902,P<0.001)。血浆BNP=523.5 pg/mL为中重度心力衰竭患者的诊断最佳值。LVEF对评价心力衰竭患者病情程度无明显能力(受试者工作特征曲线下面积=0.392,P=0.276)。结论:血浆BNP浓度对扩张型心肌病慢性心力衰竭患者的诊断、筛查以及心功能分级具有重要的临床意义。
Objective: To investigate the clinical significance of plasma brain natriuretic peptide in patients with chronic heart failure due to dilated cardiomyopathy. Methods: From March 2012 to March 2016, 90 patients with chronic heart failure with dilated cardiomyopathy admitted to our hospital were enrolled. Patients were divided into two groups: group A (grade II), group B (grade III) ) 38 cases, C group (level IV) 32 cases. Plasma brain natriuretic peptide (BNP) and echocardiographic parameters including left ventricular ejection fraction (LVEF), left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) to analyze the association of plasma BNP with NYHA classification and echocardiographic markers, and to compare plasma BNP and LVEF levels in patients with chronic heart failure. Results: Plasma BNP concentration in group C was significantly higher than that in group A and B (P <0.05), while plasma BNP concentration in group B was significantly higher than that in group A (P <0.05). Cardiac echocardiography showed that the LA of group C was significantly higher than that of group A (P <0.05), but there was no significant difference between LVEF, LVEDD and LVESD (P> 0.05). There was a positive correlation between plasma BNP and NYHA grade, but no significant correlation with LVEDD, LVESD, LVEF and LA (P> 0.05). Plasma BNP showed a strong ability to assess the severity of heart failure (area under the receiver operating characteristic curve = 0.902, P <0.001). Plasma BNP = 523.5 pg / mL for the diagnosis of moderate to severe heart failure in patients with the best value. LVEF was not significant for assessing the severity of heart failure (area under receiver operating characteristic curve = 0.392, P = 0.276). Conclusion: Plasma BNP concentration has important clinical significance in the diagnosis, screening and classification of cardiac function in patients with chronic heart failure due to dilated cardiomyopathy.