论文部分内容阅读
目的观察慢性心力衰竭(CHF)患者血浆N端脑钠素原(NtproBNP)水平和肾素血管紧张素系统的动态变化及其临床意义。方法选择CHF病人44例,随机接受β阻滞剂比索洛尔或卡维地洛治疗共7个月。测定血管紧张素原、肾素、血管紧张素Ⅱ、醛固酮水平和NtproBNP水平。结果基线血管紧张素原、肾素、血管紧张素Ⅱ、醛固酮水平在正常参考值范围内;NtproBNP明显高于正常参考值上限,且随着心功能分级的增加而明显增加。与用药前相比,血管紧张素原、肾素、血管紧张素与醛固酮药后各时点无显著变化(P值均>0.05);用药后达标时的血浆NtproBNP水平明显减低(P<0.01)。事件组NtproBNP明显高于非事件组。多元回归结果显示:基线时左室射血分数与NtproBNP水平负相关(β=-0.389,P=0.009),与血管紧张素Ⅱ正相关(β=0.341,P=0.020),用药后左室射血分数剂量与调整期结束后NtproBNP水平明显负相关(β=-0.424,P=0.020),与NYHA分级呈正相关(β=0.410,P=0.024)。结论NtproBNP水平比肾素血管紧张素醛固酮系统在定量评价心功能受损程度、疗效及预后判定等方面更加敏感及准确。
Objective To observe the dynamic changes of plasma N-terminal pro-brain natriuretic peptide (NtproBNP) and renin-angiotensin system in patients with chronic heart failure (CHF) and its clinical significance. METHODS: Forty-four patients with CHF were randomized to receive β-blocker bisoprolol or carvedilol for 7 months. Angiotensinogen, renin, angiotensin II, aldosterone and NtproBNP were measured. Results The baseline levels of angiotensinogen, renin, angiotensin Ⅱ and aldosterone were within the normal reference values. NtproBNP was significantly higher than the upper limit of normal reference value and significantly increased with the increase of cardiac function. Compared with pretreatment, there was no significant change at all time points after angiotensinogen, renin, angiotensin and aldosterone (P> 0.05), and the plasma NtproBNP level was significantly lower after treatment (P <0.01) . Event group NtproBNP was significantly higher than non-event group. Multiple regression analysis showed that left ventricular ejection fraction was negatively correlated with NtproBNP at baseline (β = -0.389, P = 0.009) and positively correlated with angiotensin Ⅱ (β = 0.341, P = 0.020) There was a significant negative correlation between blood dose and NtproBNP level after adjustment (β = -0.424, P = 0.020), which was positively correlated with NYHA classification (β = 0.410, P = 0.024). Conclusion The level of NtproBNP is more sensitive and accurate than renin-angiotensin-aldosterone system in quantitative evaluation of cardiac function impairment, curative effect and prognosis.