李文安　郭镇声　李丽霞　洪楚亮　刘东坡

[摘要] 目的 分析血浆BNP针对不同类型老年心力衰竭患者用以预测急性失代偿心衰（ADHF）的价值。 方法 选择2015年6月～2016年6月期间在我院心内科住院的患者228例（含心功能正常者40例）作为研究对象，将心衰患者按照心脏超声结果分为左室射血分数降低心衰（HFrEF）组94例和左室射血分数正常心衰（HFpEF）组94例，分别测定其初始血浆BNP值。 结果 心衰患者BNP水平均显著高于心功能正常者（P<0.05），针对心衰患者而言，HFrEF组血浆BNP水平显著高于HFpEF组。半年随访过程中，两组患者均未发生死亡，HFrEF组因ADHF再次入院30例（31.91%），HFpEF组因ADHF再次入院31例（32.98%），（P>0.05）。 结论 心衰患者失代偿前BNP升高，BNP升高可作为预测ADHF的重要指标，具有极大的推广应用价值。

[关键词] 血浆BNP；射血分数；急性失代偿心衰

[中图分类号] R725.6 [文献标识码] A [文章编号] 1673-9701（2017）14-0022-03

[Abstract] Objective To explore and analyze the value of plasma BNP in predicting acute decompensated heart failure （ADHF） in patients with different types of elderly heart failure. Methods A total of 228 patients（including patients with normal heart function） in our hospital from June 2015 to June 2016 were enrolled in the study. Heart failure patients were divided into heart failure with reduced ejection fraction （HFrEF） group （n=94） and heart failure without reduced ejection fraction （HFpEF） group （n=94）， according to the results of the heart ultrasound. The initial plasma BNP values were measured. Results BNP level was significantly higher in patients with heart failure than that in patients with normal heart function （P<0.05）. The level of BNP in HFrEF group was significantly higher than that in HFpEF group. During the half-year follow-up， none of patients in the two groups died. There were 30 patients（31.91%） in the HFrEF group who were hospitalized again caused by ADHF， and there were 31 patients（32.98%） in the HFpEF group who were hospitalized again caused by ADHF（P>0.05）. Conclusion The BNP is increased in patients with heart failure before decompensation， and the increase of BNP can be used as an important index to predict ADHF， which has great popularization and application value.

[Key words] Plasma BNP； Ejection fraction； Acute decompensated heart failure

我國人口老龄化越来越严重，老年人呈逐年增多的趋势，老年人各种疾病的治疗成为临床工作的重点，对老年人疾病的诊断也变得十分重要[1]。心力衰竭的主要病因为患者的心脏收缩和舒张功能障碍，导致其静脉回心血量难以正常而充分地排出，表现为动脉血液灌注不足[2]。按左室射血分数（LVEF）数值的不同进行区别，主要有LVEF降低（HFrEF）及参数正常（HFpEF）两种心衰类型[3]。就急性失代偿性心衰（ADHF）而言，其临床表现为疾病突然加重，具有较高的病死率，属于造成心衰患者再次住院治疗的重要因素[4]。老年心力衰竭又是一种致命的疾病，如果能够尽早发现，抓住最佳的治疗时机，可大大降低患者的死亡率，如果能够提前预测心力衰竭的发生，做到防患于未然，对于提高我国的整体健康水平具有重要价值[5]。B型利钠肽（BNP）的主要成分为人体心室肌细胞正常产生的利钠利尿多肽。……