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慢性心力衰竭患者血浆N末端脑钠肽前体和血清胱抑素C的水平及意义

Plasma N-terminal probrain natriuretic peptides and serum cystatin C in patients with chronic heart failure and their significance

摘要:

目的 分析慢性心力衰竭(心衰)患者血浆N末端脑钠肽前体(NT-proBNP)、血清胱抑素C(CysC)水平及心功能与肾功能的相互关系,进一步探讨CysC在心衰患者早期肾脏损害的诊断价值.方法 检测162例慢性心衰患者(心衰组)、150例健康体检者(对照组)的血浆NT-pmBNP、CysC水平,同时查血清尿素氮、肌酐及超声心动图,用简化的肾病饮食改良方程计算肾小球滤过率(eGFR).结果 心衰组NT-pmBNP、CysC、血肌酐、尿素氮水平及左室舒张末期内径均高于对照组,而左室射血分数、eGFR低于对照组(P<0.05或<0.01),合并肾功能异常的比例明显高于对照组(P<0.01).心衰组心功能NYHA分级Ⅱ、Ⅲ、Ⅳ级各组NT-proBNP、CysC水平均高于对照组,左室射血分数低于对照组;NYHA分级各组问两两比较NT-proBNP、CysC差异均有统计学意义(P<0.05).NT-proBNP、CysC水平与左室射血分数呈负相关(r=-0.36,P<0.01;r=-0.39,P<0.01);CysC、NT-proBNP呈显著正相关(r=0.87,P<0.01).Logistic回归分析示,NT-proBNP、CysC水平升高是慢性心衰患者住院期间死亡的危险因素.结论 慢性心衰患者更易合并肾功能异常,主要表现为肾小球滤过功能受损;心衰程度愈重,肾功能损害愈明显;NT-proBNP、CysC可作为评价慢性心衰患者病情加重的指标,CysC可用于慢性心衰患者早期肾脏损害诊断.

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abstracts:

Objective To evaluate and analyze relationship of plasma level of N-terminal probrain natriuretic peptides (NT-proBNP) and serum level of cystatin C (CysC) with cardiac and renal functions in patients with chronic heart failure (CHF) , and explore significance of CysC measurement in early diagnosis for renal damage in patients with CHF. Methods Totally, 162 patients with CHF and 150 normal healthy (controls) undergone routine physical check-up at, Taizhou People's Hospital, Jiangsu were enrolled in the study. Their plasma level of NT-proBNP and serum level of CysC, as well as serum levels of creatinine ( SCr) , urea nitrogen ( BUN) were measured and echocardiography was performed. Glomerular filtration rate (eGFR) was evaluated by modification of diet in renal disease (MDRD) study group formula. Results Compared with the control group, blood levels of NT-proBNP, CysC, SCr, BUN and left ventricular end diastolic diameter ( LVEDD) all elevated, both eGFR and left ventricular ejection fraction ( LVEF) decreased (P <0. 05 or P <0. 01 ) in CHF group, and CHF patients were prone to complicate with renal dysfunction (P<0. 01). Blood levels of NT-proBNP and CysC elevated significantly and LVEF lowered significantly in CHF patients with NYHA functional classes II , III and IV than those in control group. There was significant difference in blood levels of NT-proBNP and CysC between patients with varied NYHA functional classes (P<0. 05). Blood levels of NT-proBNP and CysC reversely correlated with LVEF (r = -0. 36, P < 0. 01 and r = - 0. 39, P < 0. 01) . Blood level of CysC correlated with that of NT-proBNP ( r = 0. 87 , P < 0. 01). Results of logistic regression analysis showed that elevated blood levels of NT-proBNP and CysC were risk factors for mortality during hospitalization in patients with CHF. Conclusions Patients with CHF were more likely to complicate with renal dysfunction than controls, with main manifestations of more severe damaged eGFR, more severe heart failure and more obviously renal damage. Blood levels of NT-proBNP and CysC can be used as indicators for evaluating exacerbation of chronic condition, and serumlevel of CysC can be used as marker for early diagnosing renal damage in patients with CHF.

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作者: 阮中宝 [1] 朱莉 [1] 殷屹岗 [1] 王如珠 [1] 任寅 [1] 陈各才 [1] 陈铭 [1]
分类号: R541.61
栏目名称: 论著|%Original Articles
DOI: 10.3760/cma.j.issn.1671-7368.2011.05.007
发布时间: 2011-07-29
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