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目的 :分析慢性心力衰竭 (心衰 )患者心衰程度与N终端脑钠尿肽激素原 (Nt proBNP)血浆浓度的相关性 ,并与血浆肾素 血管紧张素 醛固酮系统 (RAS)的激素水平及内皮素 (ET)浓度比较 ,了解心衰发生发展过程中神经内分泌方面的变化 ,以探讨心衰的早期诊断和治疗的理论依据。方法 :38例心脏病患者根据纽约心脏病协会分级标准分为A组 (心功能Ⅰ级 )、B组 (Ⅱ级 )、C组 (Ⅲ级及Ⅳ级 )三组 ,正常对照组 2 2例。分别用ELISA法检测Nt proBNP血浆浓度 ,放射免疫法检测RAS的激素水平、ET血浆浓度 ,心脏彩色B超检测其射血分数(EF)。结果 :B组和C组患者的Nt proBNP、ET血浆浓度、RAS的激素水平与正常对照组比较 ,差异均有统计学意义 (P <0 .0 5 ) ;B组与C组比较 ,Nt proBNP、ET血浆浓度的差异仍然具有统计学意义 (P <0 .0 5 ) ,而RAS的激素水平虽升高 ,但差异无统计学意义 (P >0 .0 5 )。在无症状性心衰患者 (EF <5 0 %但无心衰症状 )则仅Nt proBNP浓度升高有统计学意义 (EF≥ 5 0 %∶EF <5 0 % ,P <0 .0 5 )。结论 :慢性心衰患者均存在神经内分泌的过度激活 ,而以Nt proBNP血浆浓度升高更为敏感 ,可望作为评价心衰严重程度和早期心功能受损的指标。
OBJECTIVE: To analyze the correlation between the degree of heart failure and plasma concentration of N-terminal pro-brain natriuretic peptide (Nt-proBNP) in patients with chronic heart failure (CHF) and with the plasma levels of plasma renin-angiotensin aldosterone system (RAS) Endothelin (ET) concentration, to understand the occurrence and development of heart failure neuroendocrine changes in order to explore the theory of early diagnosis and treatment of heart failure. Methods: According to the New York Heart Association grading criteria, 38 patients with heart disease were divided into three groups: group A (group Ⅰ), group B (group Ⅱ), group C (group Ⅲ and group Ⅳ), and group Ⅱ . The plasma concentration of Nt proBNP was detected by ELISA, the hormone level of RAS by radioimmunoassay, ET plasma concentration and the color Doppler ultrasound were used to detect the ejection fraction (EF). Results: The levels of Nt proBNP, ET plasma and RAS in B group and C group were significantly different from those in normal control group (P <0.05). Compared with C group, Nt proBNP (P <0.05), while the plasma levels of ET were still statistically significant (P <0.05), while the plasma levels of RAS were elevated, but the difference was not statistically significant (P> 0.05). Elevated Nt proBNP was statistically significant only in patients with asymptomatic HF (EF <50% but no HF) (EF ≥ 50%: EF <50%, P <0.05) . CONCLUSIONS: Patients with chronic heart failure have neuroendocrine over-activation, whereas Nt proBNP is more sensitive to plasma concentration, which is expected to be used as an index to evaluate the severity of heart failure and early cardiac dysfunction.