血清肌钙蛋白Ⅰ、血浆脑钠肽及入院时收缩压水平在AHF患者治疗中的应用分析  

Application of serum cardiac troponin Ⅰ, plasma brain natriuretic peptide and level of in-hospital systolic blood pressure in treatment of patients with acute heart failure

作　　者：罗伟刚 郭亮[1] Luo Weigang;Guo Liang(Department of Cardiovascular Medicine,Central Hospital of Baoji City,Shaanxi Province,Baoji 721000,China)

机构地区：[1]宝鸡市中心医院心血管内科,宝鸡721000

出　　处：《中国循证心血管医学杂志》2018年第12期1516-1519,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：陕西省宝鸡市卫生局科研立项课题(2014-04)

摘　　要：目的探讨急性心力衰竭(AHF)患者血清肌钙蛋白I(cTnI)、血浆脑钠肽(BNP)以及入院时收缩压水平的差异性。方法选取2015年3月～2017年3月于宝鸡市中心医院确诊并接受治疗的AHF患者共116例为研究组,选取同时期年龄、性别与研究组相匹配,并于本院住院接受治疗,未有心脏病史的患者116例为对照组。将研究组患者血清cTnI>0.04 ng/ml者设为cTnI阳性组,≤0.04 ng/ml者设为阴性组;将血浆BNP>300 pg/ml者设为阳性BNP组,≤300 pg/ml者设为阴性BNP组。对两组入院、住院和出院后的各项指标进行对比分析。结果研究组患者入院时血清cTnI水平(0.5231±1.0513)ng/ml及血浆BNP水平(1162.8±820.8)pg/ml均高于对照组(0.0315±0.0163)ng/ml和(112.3±75.7)pg/ml,差异有统计学意义(P<0.05);cTnI阳性组患者的左室射血分数(LVEF)平(36.81±3.39)%低于cTnI阴性组(41.86±3.46)%,院内死亡率和出院复发率则高于cTnI阴性组,差异有统计学意义(P<0.05);BNP阳性组患者的LVEF水平(35.97±3.51)%低于BNP阴性组(41.36±3.52)%,同时院内死亡率和出院复发率则高于BNP阴性组,差异有统计学意义(P<0.05);随着AHF患者入院收缩压水平的增高,LVEF水平出现显著升高,而院内死亡率和出院复发率则显著降低,差异有统计学意义(P<0.05);cTnI阳性组和BNP阳性组的血清cTnI与血浆BNP水平在患者症状稳定后都有大幅下降,差异有统计学意义(P<0.05)。结论血清cTnI水平能够很好的反应AHF患者的心肌损伤情况,血浆BNP水平则很好的反应AHF患者的左心室负荷受损情况。入院收缩压水平能反映AHF患者的心脏失代偿和射血能力。通过对这3种指标的积极监测,对于在临床治疗AHF患者时做出正确的病情判断有着重要意义。Objective To discuss the difference in serum cardiac troponin(cTnI),plasma brain natriuretic peptide(BNP)and level of admission systolic blood pressure(SBP)in patients with acute heart failure(AHF).Methods AHF patients(n=116)were chosen into study group from Central Hospital of Baoji City from Mar.2015 to Mar.2017,and at the same time other patients with matched age and sex and without history of heart disease(n=116)were chosen into control group.The study groups was further divided into positive cTnI group(cTnI>0.04 ng/ml),negative cTnI group(cTnI≤0.04 ng/ml),positive BNP group(BNP>300 pg/ml)and negative BNP group(BNP≤300 pg/ml).All indexes were compared and analyzed in all groups at time of admission and hospitalization and after discharge from hospital.Results The level of cTnI(0.5231±1.0513)ng/ml and BNP level(1162.8±820.8)pg/ml were higher in study group than those in control group[(0.0315±0.0163)ng/ml,(112.3±75.7)pg/ml,P<0.05]at admission time.The level of LVEF(36.81±3.39)%was lower in positive cTnI group than that in negative cTnI group(41.86±3.46)%,and in-hospital death rate and discharge recurrent rate were higher in positive cTnI group than those in negative cTnI group(P<0.05).The level of LVEF(35.97±3.51)%was lower in positive BNP group(41.36±3.52)%than that in negative BNP group(41.36±3.52)%,and in-hospital death rate and discharge recurrent rate were higher in positive BNP group than those in negative BNP group(P<0.05).As the increase of admission SBP,LVEF level increased significantly,and in-hospital death rate and discharge recurrent rate decreased significantly in AHF patients(P<0.05).The levels of serum cTnI and plasma BNP decreased sharply in positive cTnI group and positive BNP group after patients'symptoms stabilized(P<0.05).Conclusion The level of serum cTnI can well reflect myocardial injury conditions,and level of plasma BNP can well reflect the impairment of left ventricular load in AHF patients.The level of admission SBP can reflect cardiac decompensation and ejection ability

关 键 词：急性心力衰竭 脑钠肽 血清肌钙蛋白 心脏失代偿 

分 类 号：R541.61[医药卫生—心血管疾病]