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目的:探讨老年心脏病患者发生充血性心力衰竭时血浆脑钠肽(BNP)及肌钙蛋白Ⅰ(cTNI)含量改变及临床意义。方法:选择2006-01-2011-03在我院住院的各种老年心脏病患者235例,根据纽约心功能分级,分为4组(心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组),分别检测血浆脑钠肽、肌钙蛋白I及心肌酶(CK、CK-MB),进行组间比较,同时与健康老年组进行对比。结果:①老年心脏病慢性充血性心力衰竭各组(心功能Ⅱ～Ⅳ级)血浆BNP水平均高于健康对照组及心功能正常组(心功能Ⅰ级组);且心功能Ⅳ级组BNP水平>心功能Ⅲ级组>心功能Ⅱ级组。各组之间比较,差异有统计学意义。但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。②各组之间CK及CK-MB水平差异均无统计学意义。③充血性心力衰竭各组(心功能Ⅱ～Ⅳ级)血浆cTNI水平均高于健康对照组及心功能正常组(心功能Ⅰ级组);且心功能Ⅳ级组cTNI水平>心功能Ⅲ级组>心功能Ⅱ级组。各组之间比较,差异有统计学意义。而心功能Ⅰ级组及健康对照组血浆cTNI水平差异无统计学意义。结论:血浆BNP水平及肌钙蛋白水平在老年人不同程度的充血性心力衰竭时均较正常人及慢性心脏病患者心功能正常时增高,且心功能损害程度越重,血浆BNP及肌钙蛋白I水平越高。两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。在临床诊断过程中,如能结合临床表现及其他检查结果,同时参考血浆BNP及肌钙蛋白水平,将会明显增加对慢性充血性心力衰竭诊断的及时性及正确性。
Objective: To investigate the changes and clinical significance of plasma brain natriuretic peptide (BNP) and troponin Ⅰ (cTNI) in congestive heart failure in elderly patients with heart disease. Methods: A total of 235 elderly patients with various types of heart disease were enrolled in our hospital from January 2006 to November 2011. According to New York Heart Association grading, they were divided into 4 groups (Ⅰ group, Ⅱ group, Ⅲ group, Group). Plasma BNP, Troponin I and CK (CK-MB) were measured and compared between groups. At the same time, they were compared with those in healthy elder group. Results: ① The plasma BNP levels in elderly patients with congestive heart failure (heart function Ⅱ ~ Ⅳ) were significantly higher than those in healthy control group and normal heart function group (cardiac function Ⅰ group) Level> cardiac function grade Ⅲ group> cardiac function grade Ⅱ group. The differences between the groups were statistically significant. However, there was no significant difference in plasma BNP levels between Ⅰ level group and healthy control group. ② There was no significant difference in CK and CK-MB levels between groups. ③ The levels of plasma cTNI in congestive heart failure group (cardiac function Ⅱ ~ Ⅳ grade) were higher than those in healthy control group and normal cardiac function group (cardiac function Ⅰ group); and the level of cTNI in cardiac function Ⅳ group was higher than that in grade Ⅲ Group> Cardiac function grade II group. The differences between the groups were statistically significant. However, there was no significant difference in plasma cTNI levels between Ⅰ level group and healthy control group. Conclusions: Plasma BNP and troponin levels in elderly patients with congestive heart failure at different levels were higher than those in normal subjects and patients with chronic heart disease, and the degree of cardiac dysfunction was more severe. Plasma BNP and troponin I level is higher. Both of them have an important reference value for the clinical diagnosis of chronic congestive heart failure. In the clinical diagnosis process, if combined with clinical manifestations and other test results, with reference to plasma BNP and troponin levels, will significantly increase the timely and correct diagnosis of chronic congestive heart failure.