血CTnT和NT-proBNP评价心功能的准确性对比研究  

Blood CTn T and NT-pro BNP the accuracy of the evaluation of cardiac function

作　　者：阚洪源 邢艳秋[1,4] 肖宇[4] 刘聪聪[5] 

机构地区：[1]山东省医学科学院基础医学研究所,山东济南250062 [2]济南大学山东省医学科学院医学与生命科学学院,山东济南250022 [3]中国人民解放军济南军区总医院,山东济南250031 [4]山东大学齐鲁医院,山东济南250012 [5]山东省警官总医院,山东济南250002

出　　处：《中西医结合心血管病电子杂志》2014年第7期7-9,共3页Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的：应用血肌钙蛋白T（CTnT）、氨末端脑利钠肽前体（NT－proBNP）水平的变化，评价左西孟旦治疗慢性心力衰竭临床疗效及其安全性。方法采用随机、平行、阳性对照临床研究。选择心功能Ⅲ～Ⅳ级、LVEF＜40％的住院患者80例，其中40例给予常规抗心衰治疗；试验组40例在常规治疗基础上加用左西孟旦；两组分别于治疗前及治疗72h后监测患者的生命体征及全身临床状况，检测CTnT、NT－proBNP值，并观察血流动力学指标的变化。结果2例在试验开始前退出，4例在治疗后失访，共74例纳入结果分析，其中试验组36例，对照组38例试验组。临床有效率为83．3％（30／36），对照组临床有效率为55．3％（21／38），两组比较差异有统计学意义（P＜0．05）。治疗72h后试验组与对照组CTnT分别下降了（40．3 ±10．3）pg／mL和（11．3 ±6．9）pg／mL（P＜0．05），NT－ProBNP分别下降了（2958．3 ±1001．1）pg／mL和（1936．2±1400．9）pg／mL（P＞0．05）。治疗72后试验组与对照组SBP分别下降了16．15mmHg和6．14mmHg（P＝0．044），DBP下降均值分别为20．62mmHg和10．75mmHg（P＜0．05）， HR下降均值分别为6．65次／min和2．82次／min（P＞0．05）。试验组与对照组不良反应发生率差异无统计学意义（P＞0．05）。结论左西孟旦在治疗慢性充血性心力衰竭方面疗效确切；血CTnT能够更准确评价左西孟旦治疗慢性充血性心力衰竭的疗效，特异性优于NT－proBNP。Objective To assess the efficacy of levosimendan compared with conventional treatment heart failure drμgs in chronic heart failure. Methods 80 patients were arranged into this randomized,parallel-group and positive study to receive either levosimendan or conventional treatment for heart failure. 40 were assigned to levosimendan and the other 40 were to conventional treatment group. These two group patients were both monitored vital sign and overall clin-ical status,level of cTnT,NT-proBNP and hemodynamic index variables before and 72 hours after treatment. Result 74 patients were included in the results of the analysis. Among of them,36 were levosimendan group,38 were control group. The clinical dfficacy rate was 83. 3%（30/36）in levosimendan group and 55. 3%（21 /38）in control group （P〈0. 05）. 72 hours after treatment,cardiac troponin T（cTnT）was decreased by 40. 3 ±10. 3pg/mL in levosimendan group, compared with 11. 3 ±6. 9pg/mL in control group（P〈0. 05）. N -terminal pro-bain natriuretic peptide（NT-proBNP）was decreased by 2958. 3 ±1001. 1 pg/mL in levosimendan group,compared with 1936. 2 ±1400. 9pg/mL in control group（P〉0. 05）. Systolic blood pressure（SBP）was decreased by 16. 15mmHg in levosimendan group and 6. 1 4 mmHg in control group（P=0. 044）. DBP was decreased by 20. 62 mmHg in levosimendan group and 1 0. 75 mmHg in the other respectively（P〈0. 05 ）. Heart rate was reduced by 6. 65 beats/min in levosimendan group and 2. 82 beats/min in the other（P〉0. 05 ）. There was no significant deffererce in the incidence of adverse reaction between the two groups（P〉0. 05 ）. Conclusion Levosimendan has a excatly curative effect in patients with chro-nic congestive heart failure;Blood cTnT can accurately evaluate levosimendan efficacy of the treatment of chronic congestive heart failure,which is more sensitive than NT-proBNP.

关 键 词：心力衰竭 左西孟旦 肌钙蛋白T 利钠肽 脑 治疗效果 

分 类 号：R541[医药卫生—心血管疾病]