B型利钠肽水平对慢性心力衰竭患者预后的影响被引量：82

Prognostic value of admission B-type natriuretic peptide on outcome for patients with congestive heart failure

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摘要目的探讨不同B型利钠肽（BNP）水平对慢性心力衰竭（CHF）患者预后的影响。方法162例CHF患者初次人院后测定血液BNP水平，并行常规超声心动图和组织多普勒检查。根据BNP水平高低分为高BNP组（BNP〉1500ng／L）和低BNP组（BNP≤1500ng／L）。对两组患者的一般临床资料、心脏超声和组织多普勒数据及2年内心血管事件发生率进行分析。再按随访2年内是否发生心血管事件分为事件组与非事件组，并对相关数据进行统计学分析。结果高BNP组和低BNP组左心室射血分数（LVEF）分别为（40．9±5．6）％和（44．04-5．9）％（P〈0．01）。高BNP组和低BNP组总心血管事件发生率分别为49．1％和21．0％（P〈0．01）、心原性病死率分别为25．5％和9．0％（P〈0．01）。事件组和非事件组BNP水平分别为（2875．4±325．7）ng／L和（1136．94-298．6）ng／L（P〈0．000）。事件组BNP水平与组织多普勒心肌做功指数（TDI—Tei）呈正相关（r=0．793，P〈0．001），与LVEF呈负相关（r=-0．57，P〈0．001）。多因素logistic回归分析显示BNP、LVEF、TDI．Tei和B受体阻滞剂的应用是预测心血管事件发生的危险因素。BNP水平预测事件组CHF患者2年内发生死亡的ROC曲线下面积为0．795，以事件组患者BNP水平均数1910ng／L作为分组的界值，通过Kaplan—Meier法作BNP不同水平患者在随访期间心血管事件发生率曲线，计算Log．rank为24．11（P=0．000）。结论BNP水平是CHF患者心血管事件发生的独立危险因素，不同BNP水平对CHF患者的预后影响不同，界值超过1910ng／L的患者预后较差。 Objective To observe the prognostic value of admission B-type natriuretic peptide （BNP） on outcome for patients with congestive heart failure （CHF）. Methods Blood BNP levels, routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [ 95 male, mean age：（71.8 ± 3.7） years ] at admission. Patients were divided into high BNP （BNP 〉 1500 ng/L, n = 104） and low BNP （BNP≤ 1500 ng/L, n =58） groups. All patients were followed up for 2 years and clinical characteristics, echocardiography including Doppler image and cardiovascular events results were analyzed. Data were also compared between patients with （ n = 48 ） or without （ n = 107 ） cardiovascular events. Results Left ventricular ejection fractions （LVEF） was significantly lower [ （40. 9 ±5.6）% vs. （44. 0 ±5.9）%, P 〈 0. 01 ] while the total cardiovascular events rate （49. 1% vs. 21.0% , P 〈0. 01 ） and cardiac mortality rate （25.5% vs. 9.0% , P 〈0. 01 ） were significantly higher in high BNP group than in low BNP group. BNP level at admission in event group was significantly higher than in event-free group [ （2875.4 ± 325.7 ） ng/L vs. （1136. 9 ±298. 6） ng/L, P 〈0. 000]. BNP level was positively related to Tei-index （r =0. 793, P 〈 0. 001 ） and negatively correlated with LVEF （ r = - 0. 57, P 〈 0. 001 ）. Multiple logistic regression analysis demonstrated that BNP, LVEF, Tei-index and β-blocker use were independent risk factors for cardiovascular events. The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0. 795 （ 95 % CI 0. 693 - 0. 935, sensitivity ： 72. 31% and specificity ： 84. 62% , cut-off BNP value ： 1910 ng/L）. The event risk was 2. 17 times higher in CHF patients with admission BNP 〉 1910 ng/L compared CHF patients with admission BNP ≤ 1910 ng/L （ 95% CI： 1. 852 - 2. 954, P = 0. 000 ） . Conclusion Admission BNP level, LVEF, Tel-index and 13-blocker use are independent risk factors for cardiovascular events in patients with CHF. Patients with higher admission BNP level （〉 1910 ng/L） is linked with worse prognosis in this patient cohort.

作者邓新桃石桂良王如兴赵建祥郑金国鲍颖芳

机构地区扬州大学医学院附属兴化市人民医院心内科南京医科大学附属无锡市人民医院心内科

出处《中华心血管病杂志》 CAS CSCD 北大核心 2012年第6期462-466,共5页 Chinese Journal of Cardiology

关键词心力衰竭充血性利钠肽脑预后 Heart failure, congestive Natriuretic peptide, brain Prognosis

分类号 R541.6 [医药卫生—心血管疾病]

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参考文献11

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