血清CRP、Fib及NT-proBNP对慢性房颤并发早期心衰的诊断价值

摘要

Objective To investigate the changes of serum C reactive protein (CRP), fibrinogen (Fib), amino terminal B type natriuretic peptide the precursor (NT-proBNP) in patients with chronic atrial fibrillation complicated with early heart failure, and to explore its clinical significance. Methods A total of 120 patients with atrial fibrillation, who admitted to Guangning People's Hospital of Zhaoqing City from Dec 2014 to May 2016, were selected and divided into A group (gradeⅢ-Ⅳ, n=35), B group (gradeⅠ-Ⅱ, n=48) and C group (simple chronic atrial fibrillation, n=37) ac-cording to the New York Heart Association (NYHA) Functional Classification. At the same time, 50 subjects undergoing healthy physical examination were selected as the control group. The serum levels of CRP, Fib and NT-proBNP in the four groups were observed and compared. Results There were significant differences in CRP, Fib and NT-proBNP be-tween the four groups (P<0.01). The levels of CRP, Fib, NT-proBNP in A group were respectively (118.52±20.43) mg/L, (278.27±41.22) mg/L, (1102.08±186.54) ng/L, which were significantly higher than those in the other three groups (P<0.05). The levels of CRP, Fib, NT-proBNP in B group were respectively (51.42 ± 14.81) mg/L, (38.72 ± 10.20) mg/L, (685.29±94.08) ng/L, which were significantly higher than those in C group and the control group (P<0.05). The diagnos-tic sensitivity and specificity of NT-proBNP (98.2%, 90.4%, respectively) for chronic atrial fibrillation complicated with early heart failure were significantly higher than CRP (91.3%, 50.2%, respectively) and Fib (89.4%, 65.2%, respectively) (P<0.05). The area under NT-proBNP curve (0.922) was significantly higher than that of CRP (0.816) and Fib (0.802) (P<0.05). Conclusion Serum CRP, Fib and NT-proBNP can be used as predictors of early heart failure in patients with chronic atrial fibrillation, among which, NT-proBNP has the highest diagnostic value.%目的 观察慢性房颤合并早期心力衰竭患者血清C反应蛋白(CRP)、纤维蛋白原(Fib)、氨基末端B型钠尿肽前体(NT-proBNP)水平的变化,并探讨其临床意义.方法 选取2014年12月至2016年5月间广宁人民医院房颤患者120例,其中以NYHA心功能分级Ⅲ~Ⅳ级35例为A组,Ⅰ~Ⅱ级48例为B组,单纯慢性房颤37例为C组,选取同期进行门诊体检的健康正常人群50例作为对照组,比较四组受检者的血清CRP、Fib及NT-proBNP水平.结果 四组受检者的CRP、Filb、NT-proBNP比较差异均有统计学意义(P<0.01),其中A组患者的CRP[(118.52±20.43)mg/L]、Fib[(278.27±41.22)mg/L]、NT-proBNP[(1102.08±186.54)ng/L]均明显高于其他三组,差异均有统计学意义(P<0.05);B组患者的CRP[(51.42±14.81)mg/L]、Fib[(38.72±10.20)mg/L]、NT-proBNP[(685.29±94.08)ng/L]均明显高于C组和对照组,差异均有统计学意义(P<0.05);NT-pro BNP对慢性房颤并发早期心衰患诊断敏感性(98.2%)和特异度(90.4%)均明显高于CRP(91.3%、50.2%)和Fib(89.4%、65.2%),差异有统计学意义(P<0.05);NT-pro BNP曲线下面积为0.922,明显高于CRP的0.816和Fib的0.802,差异有统计学意义(P<0.05).结论 血清CRP、Fib及NT-proBNP可作为慢性房颤并发早期心衰的预测指标,其中NT-proBNP诊断价值最高.