脑钠肽和内皮素对充血性心力衰竭诊断及预后判断的比较  

Comparison of B type natriuretic peptide and endothelin in the diagnosis and prognosis of congestive heart failure

作　　者：郑世良[1] 刘瑜[1] 王敏[1] 崔洪伟[1] 

机构地区：[1]潍坊医学院附属医院急诊科,山东潍坊261031

出　　处：《中国急救医学》2007年第7期596-598,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨脑钠肽(BNP)和内皮素(ET)对充血性心力衰竭(CHF)诊断及预后判断的价值。方法56例CHF患者入院和出院时测定血浆BNP和ET浓度,同时用心脏彩色多普勒测定其左室射血分数(LVEF);分析CHF患者血浆BNP和ET与LVEF的相关性;并以同期住院治疗的无CHF患者32例为对照。随访CHF患者出院后6个月心脏病意外事件的发生情况。结果CHF患者血浆BNP和ET浓度明显高于非CHF患者(P<0.01);BNP和ET浓度随CHF加重而升高(P<0.01),但ET浓度心功能Ⅲ级和Ⅱ级比较差异却无统计学意义(P>0.05);CHF患者BNP和ET与LVEF呈负相关(P<0.01)。血浆BNP和ET诊断CHF的敏感性分别为93.6%和80.7%,特异性分别为90.8%和75.6%,阴性预测值分别为95.2%和85.3%。发生心脏病意外事件组血浆BNP浓度明显高于未发生事件组,而ET浓度两组比较差异却无统计学意义(P>0.05)。结论血浆BNP对CHF诊断和预后的判断价值均高于血浆ET。Objective To explore the value of B type natriuretic peptide （ BNP） and endothelin （ ET ） concentration in the diagnosis and prognosis of congestive heart failure （ CHF ）. Methods Plasma BNP and ET concentration were measured in 56 patients with CHF on admission and discharge. Left ventricular ejection fraction （ LEVEF ） was determined by echocardiography at the same time. The results were compared between the 56 patients with CHF and 32 patients without CHF. All CHF patients were followed up for mean 6 months to investigate clinical main adverse cardiac events （ MACE ） including cardiac death, re - admission of CHF, the second MACE. Correlation of BNP and ET with LVEF of CHF patients and influence of BNP and ET on short - term prognosis were analyzed. Results Plasma BNP and ET levels were higher in CHF patients than in no - CHF patients （ P 〈 0. 01 ） , and BNP and ET levels were increased in accordance with the severity of CHF （ P 〈 0.01 ） ,but there was no significant difference in ET concentration between cardiac function grade Ⅲ and Ⅱ P 〉 0.05 ）. Plasma BNP and ET levels were nega- tively related with LVEF（ P 〈 0.01 ）. The sensitivity, specificity and negative predictive values of plasma BNP levels 〉 100 ng/L for predicting CHF were 93.6%, 90.8% and 95.2%, and ET levels 〉 50 ng/L for predicting CHF were 80.7%, 75.6% and 85.3%, respectively. Patients suffering from cardiac death, re- admission of CHF, the second MACE had higher levels of BNP, but there was no significant difference in the levels of ET（ P 〉 0.05 ）. Conclusion The value of BNP in the diagnosis and predicting prognosis of patients with CHF is higher than that of ET.

关 键 词：脑钠肽 内皮素 心力衰竭 诊断 预后 

分 类 号：R541.6[医药卫生—心血管疾病]