尹其云 张建霞 柳贵蓉

北京市门头沟中医医院内二科，北京 102300

[摘要]目的 通过对高敏C反应蛋白和脑钠肽在心力衰竭患者治疗检测后结果的对比分析，研究其与心功能的关系。方法选取2014年1月～2017年1月我院收治的90例慢性心力衰竭患者作为心衰组，将其心功能按照国际标准中的NYHA标准进行功能级别分类，分别为二级组、三级组以及四级组，每组各30例。另选取同期的30例确定生命体征正常的健康者作为常规组。比较两组的脑尿钠肽、高敏C-反应蛋白、左心室射血水平和其舒张程度进入尾声时的内径水平，并对患者治疗前后的各指标水平变化情况进行对比。将以上数据与接受治疗6个月后的数据进行对比分析，观察其变化。另通过随访对患者发生心脑血管事件的情况进行了解，对发生过事件的患者和未发生事件患者的BNP、hs-CRP、LVEF、LVDD四项指标进行比较。结果 治疗前，心衰组患者的hs-CRP[（12±2）mg/L]、BNP[（483±16）ng/L]和 LVDD[（58±2）mm]水平高于常规组[（3±1）mg/L、（33±13）ng/L、（42±2）mm]，LVEF[（31±3）%]低于常规组[（43±4）%]，差异均有统计学意义（P<0.05）。 心衰组患者接受治疗后，患者的 hs-CRP[（10±1）mg/L]、BNP[（129±21）ng/L]、和 LVDD[（46±2）mm]水平高于常规组，LVEF[（43±4）%]低于常规组，但是心衰组患者治疗后 hs-CRP[（10±1）mg/L]、BNP[（129±21）ng/L]和 LVDD[（46±2）mm]水平低于治疗前，LVEF[（43±4）%]高于治疗前，差异均有统计学意义（P<0.05）。 三级组患者的 BNP 为（427±41）ng/L，LVDD 为（58±3）mm，hs-CRP 为（12±3）mg/L，四级组患者的 BNP 为（780±59）ng/L，LVDD 为（64±3）mm，hs-CRP 为（780±59）mg/L，三级组及四级组患者的上述指标水平均高于二级组，四级患者的以上指标水平高于三级组，差异均有统计学意义（P<0.05）。出院6个月后，患者出现二次恶化事件20例，未出现70例。发生心血管恶化组患者的BNP、hs-CRP、LVDD指标水平高于未发生心血管恶化组，但左心室功能低于未出现心衰事件组，LVEF低于未出现心衰事件组，差异均有统计学意义（P<0.05）。结论心力衰竭高敏C反应蛋白和脑钠肽变化可以作为诊断慢性心力衰竭的可靠指标，且在诊断后核对疾病等级的有效区分提供有效参考。

[关键词]心力衰竭；高敏C反应蛋白；脑钠肽变化；心功能

[中图分类号]R541.605

[文献标识码]A

[文章编号]1674-4721（2018）8（a）-0066-04

Relationship between changes of high sensitivity C-reactive protein，brain natriuretic peptide and heart function in the patients with heart failure

YIN Qi-yun ZHANG Jian-xia LIU Gui-rong
Department of No.2 Internal Medicine,Beijing Mentougou District Hospital of Chinese Medicine,Beijing 102300,China

[Abstract]Objective To compare and analyze the results of high sensitivity C-reactive protein and brain natriuretic peptide in the treatment of patients with heart failure,and to study its relationship with heart function.Methods A total of 90 patients with chronic heart failure from January 2014 to January 2017 in our hospital were selected as the heart failure group,and their cardiac function was classified according to NYHA standards in international standards.The group name was secondary group,tertiary group,and quaternary group.There were 30 patients in each group.Another 30 healthy people were selected during the same period as the study group,and they were assigned to the regular group after their vital signs were determined to be normal.The levels of brain natriuretic peptide,high-sensitivity C-reactive protein,left ventricular ejection fraction,and the level of internal diameter at the end of diastolic degree were compared between the two groups.The changes of each indicator before and after the treatment were compared in the patients.The above data were compared with the data 6 months after receiving the treatment,and the changes were observed.In addition,the occurrence of cardiovascular and cerebrovascular events in the patients was understood through follow-up visits.The four indicators of BNP,hs-CRP,LVEF,and LVDD in the patients who had an incident and those who did not have an incident were compared.Results Before treatment,hs-CRP([12±2]mg/L),BNP([483±16]ng/L),and LVDD([58±2]mm)in the heart failure group were higher than those in the conventional group([3±1]mg/L,[33±13]ng/L,[42±2]mm),and LVEF([31±3]%)was lower than those inthe conventional group([43±4]%).The differences were statistically significant(P<0.05).Patients in the heart failure group had higher levels of hs-CRP([10±1]mg/L),BNP([129±21]ng/L),and LVDD([46±2]mm)than those in the conventional group after treatment,and LVEF([43±4]%)was lower than that in the conventional group.However,the levels of hs-CRP([10±1]mg/L),BNP([129±21]ng/L),and LVDD([46±2]mm)after treatment in the heart failure group were lower than those before treatment,and LVEF ([43±4]%)was higher than that before treatment.The differences were statistically significant(P<0.05).Patients in the tertiary group had BNP of(427±41)ng/L,LVDD of(58±3)mm,and hs-CRP of(12±3)mg/L.In the quaternary group,BNP was(780±59)ng/L,LVDD was (64±3)mm,and hs-CRP was (780±59)mg/L.The above indicators in the tertiary group and quaternary group were higher than those in the secondary group.The above indicators in the quaternary group were higher than those in the tertiary group.The differences were statistically significant(P<0.05).Six months after discharge,20 cases of the patient experienced secondary deterioration,and 70 cases did not appear any events.The levels of BNP,hs-CRP and LVDD in the patients with cardiovascular deterioration were higher than those in patients without cardiovascular deterioration.However,the left ventricular function was lower than the group without heart failure,and LVEF was lower than the group without heart failure.The differences were statistically significant(P<0.05).Patients in the tertiary group had BNP of(427±41)ng/L,LVDD of(58±3)mm,and hs-CRP of(12±3)mg/L.In the quaternary group,BNP was(780±59)ng/L,LVDD was(64±3)mm,and hs-CRP was(780±59)mg/L.The above indicators in the tertiary group and quaternary group were higher than those in the secondary group.The above indicators in the quaternary group were higher than those in the tertiary group.The differences were statistically significant(P<0.05).Six months after discharge,20 cases of the patient experienced secondary deterioration,and 70 cases did not appear any events.The levels of BNP,hs-CRP and LVDD in the patients with cardiovascular deterioration were higher than those in patients without cardiovascular deterioration.However,the left ventricular function was lower than the group without heart failure,and LVEF was lower than the group without heart failure.The differences were statistically significant(P<0.05).Conclusion The changes of high-sensitivity C-reactive protein and brain natriuretic peptide in heart failure can be used as a reliable indicator for the diagnosis of chronic heart failure.It also can provide an effective reference for checking the effective classification of disease levels after diagnosis.

[Key words]Heart failure;High sensitivity C-reactive protein;Brain natriuretic peptide;Heart function

（收稿日期：2018-01-10 本文编辑：闫 佩）