血浆脑钠肽对射血分数保留心力衰竭患者的诊断价值研究

目的 探讨射血分数保留心力衰竭患者的血浆脑钠肽变化及其诊断价值。方法 收集2015年1月～2018年1月江苏省盐城市第三人民医院心内科收治的69例无症状舒张功能不全患者（ADD）、射血分数保留心力衰竭（HFPEF）患者为研究对象。均行BNP检测及超声心动图检查，利用受试者工作特征曲线（ROC）分析BNP对HFPEF的诊断价值。结果 与ADD组患者相比，HFPEF患者的超声心动图指标LVEDD、IVST、LVPWT、LAd、E值较大，Ad值较小，差异具有统计学意义（P＜0.05）。但两组患者的LVEF、LVESD、E/A、DT、IVRT、PVs2、PVd、PVa、PVad，差异无统计学意义（P＞0.05）。相关性研究结果显示，LVEDD、IVST、LVPWT、LAd、LAV水平与血浆BNP水平呈正相关关系（P＜0.05），LVEF、IVRT与血浆BNP水平呈负相关关系（P＜0.05）。NYHAⅡ级、Ⅲ级、Ⅳ级患者的BNP水平分别为（86.6±34.6）pg/ml、（376.6±248.8）pg/ml、（1347±643）pg/ml，差异具有统计学意义（F=764.12，P＜0.001）。ROC曲线检验结果显示，曲线下面积为0.844，以BNP=131.2 pg/ml为界值，对HFPEF诊断的敏感性为80.70%，特异性为73.60%。结论 HFPEF患者血浆BNP水平显著更高，且BNP水平与超声心动图指标有一定的相关关系，对HFPEF有一定的诊断价值。

Diagnostic Value of Plasma Brain Natriuretic Peptide in Patients with Heart Failure Preserved by Ejection Fraction

Abstract:Objective To investigate the changes of plasma brain natriuretic peptide and its diagnostic value in patients with heart failure by ejection fraction.Methods From January 2015 to January 2018,69 patients with asymptomatic diastolic dysfunction(ADD) and ejection fraction retention heart failure(HFPEF)were enrolled in the Department of Cardiology,Yancheng Third People's Hospital, Jiangsu province.Both BNP and echocardiography were performed,and the receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of BNP for HFPEF.Results Compared with ADD group,LVEDD,IVST,LVPWT,LAd,E value of HFPEF patients were higher,and the value of Ad was smaller,the difference was statistically significant(P<0.05).However,there were no significant differences in LVEF,LVESD,E/A,DT,IVRT,PVs2,PVd,PVa and PVad between the two groups(P>0.05).Correlation study showed that LVEDD,IVST,LVPWT,LAd,LAV levels were positively correlated with plasma BNP levels (P<0.05),and LVEF and IVRT were negatively correlated with plasma BNP levels (P<0.05).The BNP levels of NYHAI I,III,and IV patients were(86.6±34.6)pg/ml, (376.6±248.8)pg/ml,(1347±643)pg/ml,and the difference was statistically significant(F=764.12,P<0.001).The ROC curve test showed that the area under the curve was 0.844,which was bounded by BNP=131.2pg/ml.The sensitivity to the diagnosis of HFPEF was 80.70% and the specificity was 73.60%.Conclusion The plasma BNP level of HFPEF patients is significantly higher,and the BNP level has a certain correlation with echocardiographic index,which has certain diagnostic value for HFPEF.