冠心病慢性心力衰竭病人住院前后血清NT-proBNP、cTnI、sST2、GDF-15变化及其影响因素  

Changes of Serum NT-proBNP,cTnI,sST2,and GDF-15 in Patients with Coronary Heart Disease and Chronic Heart Failure before and after Hospitalization and Its Influencing Factors

作　　者：陈鑫龙 田晶[1] 张青 杨弘 韩瑞[1] 任嘉 闫晶晶 张岩波[2,3] 韩清华 CHEN Xinlong;TIAN Jing;ZHANG Qing;YANG Hong;HAN Rui;REN Jia;YAN Jingjing;ZHANG Yanbo;HAN Qinghua(The First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学第一医院,太原030001 [2]山西医科大学公共卫生学院,太原030001 [3]重大疾病风险评估山西省重点实验室,太原030001

出　　处：《中西医结合心脑血管病杂志》2021年第10期1622-1626,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金(No.81970204);山西省卫生计生委项目(No.2017038);山西省科学技术厅面上青年基金项目(No.201801D221423)。

摘　　要：目的评估冠心病慢性心力衰竭病人住院前后血清N末端B型脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、血清可溶性生长刺激表达基因蛋白2(sST2)、血清分化生长因子-15(GDF-15)的变化情况,并评价其影响因素,为慢性心力衰竭的治疗和干预提供一些见解。方法选取山西医科大学第一医院诊断为冠心病慢性心力衰竭病人85例,住院前后分别测定NT-proBNP、cTnI、sST2及GDF-15的含量,评估其住院前后的差异,并分析这些变化的影响因素。结果与入院时相比,出院时NT-proBNP、cTnI、sST2降低(P<0.05),GDF-15降低但差异无统计学意义(P=0.06)。回归分析表明,既往心肌梗死病史和丙氨酸氨基转移酶(ALT)增高者,NT-proBNP降低明显;体质指数(BMI)增加和高龄者,NT-proBNP降低不显著;ALT增高者,cTnI降低显著;应用硝酸酯类药物者,cTnI降低不显著;舒张功能降低、高龄、天门冬氨酸氨基转移酶(AST)增高者,sST2降低显著(P<0.05);使用β受体阻滞剂和强心剂、心率快、高血压、吸烟的病人,GDF-15降低明显;使用钙拮抗剂的病人,GDF-15降低不明显。结论对慢性心力衰竭进行治疗和干预时,针对不同身体状况的病人,通过生物标志物的反馈,采取相对应的措施,对优化慢性心力衰竭,特别是冠心病慢性心力衰竭病人的治疗和干预有一定帮助。Objective To evaluate the changes of serum N-terminal prohormone of brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),soluble growth stimulating expression gene 2 protein(sST-2),and growth differentiation factor 15(GDF-15)in patients with chronic heart failure before and after hospitalization,and to evaluate the influencing factors of these changes,so as to provide some insights for the treatment and intervention of chronic heart failure.Methods Eighty-five patients with coronary heart disease and chronic heart failure in the First Hospital of Shanxi Medical University were selected.The contents of NT-proBNP,cTnI,sST2,and GDF-15 were determined.Results Compared with those at admission,there were significant reduction of NT-proBNP,cTnI,and sST2 at discharge(P<0.05),and there was no significant reduction of GDF-15(P=0.06).Regression analysis showed that the patients with previous history of myocardial infarction and alanine aminotransferase(ALT)increase,NT-proBNP decreased significantly,but the decrease of NT-proBNP was not significant in patients with increased body mass index,and advanced age(P<0.05).At discharge,ALT increased and cTnI decreased significantly,but the reduction of cTnI was not significant in patients taking with nitrate drugs.At discharge,patients with diastolic function decrease,aspartate aminotransferase(AST)increased,sST2 decreased significantly(P<0.05).GDF-15 was significantly reduced in patients treated with beta blockers and cardiac stimulants,rapid heart rate,high blood pressure,and smoking,but GDF-15 was not significantly reduced in patients treated with calcium antagonists.Conclusion In the treatment and intervention of chronic heart failure,corresponding measures should be taken through the feedback of biomarkers for patients with different physical conditions,which is helpful to optimize the treatment and intervention of chronic heart failure,especially chronic heart failure patients in coronary heart disease.

关 键 词：慢性心力衰竭 冠心病 生物标志物 N末端B型脑钠肽前体 心肌肌钙蛋白I 血清可溶性生长刺激表达基因蛋白2 血清分化生长因子-15 影响因素 

分 类 号：R54[医药卫生—心血管疾病]