心力衰竭患者血总胆红素与有创血液动力学及B型利钠肽相关研究  

The association study of serum total bilirubin, plasma N-terminal proBNP and invasive hemodynamic parameters in patients with heart failure

作　　者：张宇辉[1] 张健[1] 王东[1] 吕蓉 韦丙奇[1] 康连鸣[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院,100037

出　　处：《中华内科杂志》2010年第4期313-315,共3页Chinese Journal of Internal Medicine

摘　　要：目的评价心力衰竭（心衰）患者血胆红素与有创血液动力学监测指标、血浆N末端B型利钠肽原（NT-proBNP）和C反应蛋白（CLIP）的相关性。方法对130例心衰患者在入院12h内行漂浮导管监测和血总胆红素、血浆NT-proBNP和CRP等检测。结果肺毛细血管楔压[PCWP，（26．09比16．00）mmHg（1mmHg=0．133kPa）]、NT-proBNP[（3．36比2．91）pmol／L]和左室射血分数[（34．12比28．92）％]在高总胆红素血症组均较正常血总胆红素组显著增高（P值均〈0．05）。血总胆红素水平在高水平PCWP、右房压和NT-proBNP组较低水平组显著增高[（32．22比24．17）、（37．52比24．19）、（32．14比16．74）pmol／L，P值均〈0．05]。血总胆红素分别与NT-proBNP和右房压独立相关（β=0．39；β=0．29，P值均〈0．01）。结论心衰患者血总胆红素水平与右房压、PCWP和血浆NT-proBNP密切相关，是有助于心衰患者准确临床评价的重要生化指标。Objective To explore the correlation among serum total bilirubin （TBil） , invasive hemodynamic parameters, plasma N-terminal proBNP （NT-proBNP） and C reactive protain （CRP）in patients with heart failure. Methods Invasive hemodynamic parameters derived from Swan-Ganz catheter, TBil, plasma NT-proBNP and CRP within 12 hours after hospital admission were analyzed in 130 patients with chronic heart failure [ New York Heart Association （NYHA） class Ⅱ -Ⅳ ]. Results Compared with those in non-hyperbilirubinemia group, pulmonary capillary wedge pressure （PCWP）, NT-proBNP and left ventriculure ejection fraction were different significantly in total hyperbilirubinemia group [ （26. 09 vs 16.00） mm Hg（1 mm Hg=0. 133 kPa）, （3.36 vs2.91） pmol/L, （34. 12 vs28.92）%, P〈0.05]. The serum TBil increased significantly in higher PCWP, right atrial pressure and NT-proBNP groups than those in lower level groups [（32.22 vs 24. 17）, （37.52 vs 24. 19）, （32. 14 vs 16.74） pmol/L, P 〈0.05]. Partial correlation analysis showed serum TBil was associated with PCWP, right atrial pressure, pulmonary vascular resistance index and NT-proBNP respectively （ r = 0. 21, P = 0. 02 ; r = 0. 33, P 〈 0. 01 ; r = 0. 20, P =0. 04;r = 0. 37, P 〈 0. 01, respectively）. Multiple linear regression analysis showed both right atrial pressure and NT-proBNP correlated independently with serum TBil （β = 0. 39, P 〈 0. 01 ;β = 0. 29,P = 0. 01, respectively）. Conclusion For patients with heart failure, serum TBil correlated well with right atrial pressure, PCWP and NT-proBNP; it is a reliable indicator for exact clinical evaluation of heart failure.

关 键 词：心力衰竭 胆红素 利钠肽 脑 

分 类 号：R541.6[医药卫生—心血管疾病]