摘要
目的通过对充血性心力衰竭(CHF)患者肌钙蛋白T(TnT)和B型钠尿肽(BNP)联合检测及随访研究,探讨影响心衰预后的因素,并对CHF患者预后及危险分层进行评价。方法对该院明确诊断为CHF的103例不同病因、不同心功能分级的心力衰竭患者及30例正常对照组,测定入院时血清cTnT、血浆BNP及LVEF变化,并进行治疗前后对比观察,随访观察患者心脏事件的再发生。结果不同心功能分级心力衰竭患者cTNT、BNP与对照组比较差异均有显著性(P<0.01),不同分级的患者治疗前、后cTNT、BNP水平及LVEF差异均有显著性(P<0.01),cTNT、BNP水平越低预后越好。出院后随访2～14个月,其中失访23例。随访期间80例中发生心脏事件30例(37.5%),其中因心衰死亡8例,因心衰恶化而再次入院22例。通过对治疗后心脏事件再发生者的年龄、性别、心功能等级、左心室射血分数(LVEF)、cTnT和BNP诸因素进行单变量和Cox模型多变量回归分析显示,cTnT、BNP的浓度检测作为治疗后独立心脏事件发生的预测指标,但与年龄有关,与性别无关。cTnT和BNP浓度越高,心脏事件危险性越高,从而进行危险分层。入院时cTnT≥0.05ug/L,BNP≥639.5ng/L,LVEF≤32%;出院时cTnT≥0.03μg/L、BNP≥210ng/L,LVEF≤39%的患者因心脏事件死亡和再次住院率提高。结论联合检测血清cTnT及BNP对于判断CHF患者病情严重程度及预后,尤其治疗后cTnT和BNP的浓度监测对CHF患者的风险评估具有重要的临床意义。
[Objective ] To investigate prognostic factors of chronic heart failure（CHF） and examine the prognostic ability of combination of cardiac troponin T and B-type natriuretic peptide in patients with CHF. [Methods]103 consecutive patients hospitalized for CHF were prospectively studied, cTNT, BNP and left ventricular ejection（LVEF） were measured and compared in 103 patients and 30 normal control subjects before medical treatment and on discharge. [Results] The values of cTNT, BNP and LVEF in patients of CHF group were significantly different from those of normal control group（P 〈0.01）and had significant difference before medical treatment and on discharge（P 〈 0.01）. The lower the values of cTNT and BNP were, the better the prognosis of chronic heart failure was. During a median follow-up period of 426 days, 23 patients were lost, the recurrence rate for cardiac events reached 37.5% （30/80）, 8 patients died of cardiac failure, 22 patients were re-hospitalized. The univariate and multivariate predictors of cardiac events and cardiac death were summarized in Table 4. On a stepwise Cox regression analysis of age, sex, NYHA class, LEVF, cTNT and BNP, cTNT and BNP were independent predictors of cardiac events, which were associated with age but not sex. The higher the values of cTNT and BNP were, the more dangerous the patients were. In addition, when cTNT≥0.03 μg/L, BNP≥210 ng/L, LVEF≤39% after treatment were included in multivariate model as continuous variables, cTNT≥0.03 μg/L, BNP≥210 ng/L were independent predictors of cardiac events and were associated with increased cardiac mortality and morbidity rates. [Conclusion] cTNT and BNP could be used as indexes to judge the severity and prognosis of chronic heart failure, combination of cTNT and BNP measurements may be highly effective for risk stratification in patients with CHF.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2008年第9期1208-1211,1214,共5页
China Journal of Modern Medicine
基金
邯郸市科技局资金资助课题(No:2004093)
