联合应用脑钠素、肌酸磷酸肌酶和超声心动图评价多发性肌炎所致慢性心力衰竭的价值  

Application Value of Combining Brain Natriuretic Peptide,Creatine Phosphokinase and Echocardiogram in the Evaluation of Polymyositis-related Chronic Heart Failure

作　　者：尹耕[1] 毛蕾[2] 岑筱敏[1] 杨闵[1] 谢其冰[1] 

机构地区：[1]四川大学华西医院风湿免疫科,成都610041 [2]四川省双流县第一人民医院儿科,成都610200

出　　处：《四川大学学报（医学版）》2011年第5期646-648,660,共4页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(批准号30901339)资助

摘　　要：目的探讨联合应用脑钠素（BNP）、肌酸磷酸肌酶（CPK）和超声心动图评价多发性肌炎（PM）患者心肌病变所致慢性心力衰竭（CHF）的价值。方法采用纽约心脏病学会（NYHA）标准对心功能评级,酶联免疫法检测25例PM伴CHF患者（NYHAⅡ~Ⅳ级）和30例PM不伴CHF患者的血浆BNP浓度,全自动生化分析仪测定血浆CPK浓度,应用超声心动图指标计算左心室射血分数（LVEF）。结果 PM伴CHF患者血浆BNP、CPK浓度高于不伴CHF的PM患者（P〈0.01）;治疗后14 d PM伴CHF组BNP低于治疗前水平（P〈0.05）,PM不伴CHF组BNP与治疗前比较差异无统计学意义（P〉0.05）;治疗后14 d两组CPK浓度低于治疗前水平（P〈0.05）。NYHAⅡ、Ⅲ、Ⅳ级的PM患者BNP浓度有递增趋势,组间两两比较差异有统计学意义（P〈0.05）;NYHAⅣ级比Ⅱ级的PM患者CPK浓度高（P〈0.05）,Ⅱ级与Ⅲ级、Ⅲ级与Ⅳ级比较差异无统计学意义（P〉0.05）;CPK〉2 000 IU/L但不伴CHF的PM患者血浆BNP浓度与NYHAⅡ级的PM患者比较差异无统计学意义（P〉0.05）,此组患者中有2例在病程中出现CHF;LVEF≤40%的患者BNP浓度高于LVEF〉40%的患者（P〈0.05）,而CPK在两组间的差异无统计学意义（P〉0.05）。结论 BNP是反映PM心肌病变所致CHF的良好指标;CPK明显增高（〉2 000 IU/L）的PM患者更易出现CHF,BNP具有早期提示作用。Objective To explore the application value of combining brain natriuretic peptide（BNP）,creatine phosphokinase（CPK） and echocardiogram in the evaluation of olymyositis-related chronic heart failure（CHF）.Methods Twenty-five polymyositis（PM） patients with CHF（NYHA gradeⅡ-Ⅳ） were evaluated with New York Heart Association（NYHA） criteria for heart failure.Serum concentration of BNP and CPK were detected by the methods of enzyme linked immunosorbent assay and automatic biochemistry analyzer respectively.Echocardiogram was used to calculate left ventricular ejection fraction（LVEF）.Thirty PM patients without CHF were also investiaged as control.Results Serum concentrations of BNP,CPK in PM with CHF were significantly higher than those in PM without CHF（P0.01）.Compared with the level before intervention,BNP concentration in PM with CHF decreased sharply after 14 days therapy（P0.05）,while the decrease of BNP concentration was not statistically significant（P0.05） in PM without CHF after the therapy.The concentration of CPK was much lower in PM patients either with or without CHF after therapy（P0.05）.Among each group of NYHA grade Ⅱ-Ⅳ,there was statistical significant difference of BNP concentration（P0.05）.Statistical significant difference of CPK concentration was only found between grade Ⅱ and grade Ⅳ patients.The difference of BNP was not statistical significant between PM patients without CHF but CPK2 000 IU/L and PM with grade Ⅱ CHF.BNP concentration was significantly different between PM patients with LVEF40% and those with LVEF≤40%（P0.05）.Conclusion BNP is a good marker for PM with CHF and correlates well with LVEF and NYHA grades.In addition,it plays a suggestive role in diagnosing CHF in PM with CPK2 000 IU/L.

关 键 词：脑钠素 肌酸磷酸肌酶 左心室射血分数 多发性肌炎 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病] R593.2[医药卫生—内科学]