摘要
目的探讨急性失代偿性心衰患者N端脑钠肽前体／脑钠肽（NTpro—BNP／BNP）与N端脑钠肽前体（NTpro—BNP）、脑钠肽（BNP）对患者预后的预测价值。方法选取2012年1月～2013年8月广东省东莞市第五人民医院收治的急性失代偿性心衰患者182例为研究对象，采用酶联免疫吸附法（ELISA）检测患者治疗前（Tn）、治疗1d（T1）、5d（T2）、10d（T3）的血浆NTpro—BNP、BNP水平，统计随访2年间患者的存活率并比较存活患者和死亡患者的NTpro—BNP／BNP和血浆NTpro—BNP、BNP水平并采用受试者操作特性曲线（ROE）分析急性失代偿性心衰患者NTpro—BNP／BNP与NTpro—BNP、BNP对患者预后的预测价值。结果与T0比较，急性失代偿性心衰患者T1、T2、T3的NTpro—BNP／BNP和血浆NTpro—BNP、BNP水平均降低（P〈0．05）。与存活患者比较，死亡患者T0、T1、T2、T3的NTpro—BNP／BNP和血浆NTpro—BNP、BNP水平均升高（P〈0．05）。ROC曲线分析结果显示，血浆NTpro—BNP、BNP水平和NTpro—BNP／BNP对其预后预测的截断值分别为800ng／mL、60ng／mL和6．4，敏感度分别为79．17％、75．00％和95．83％，准确性分别为86．26％、85．71％和98．35％；NTpro—BNP／BNP预测急性失代偿性心衰患者预后情况的敏感度和准确度均高于血浆NTpro—BNP、BNP水平（NTpro—BNP／BNP＆NTpro—BNP：χ^2=12．688、10．289．P=0．000、0．000；NTpro—BNP／BNP＆BNP：χ^2=17．414、10．891，P=0．000、0．000），而血浆NTpro—BNP和BNP水平预测急性失代偿性心衰患者预后情况的价值比较差异无统计学意义（χ^2=0．492、1．255，P=0．868、0．412）。结论急性失代偿性心衰患者NTpro—BNP／BNP和血浆NTpro—BNP、BNP水平预测其预后的价值均较高，其中以NTpro—BNP／BNP最优，因此NTpro—BNP／BNP可能作为急性失代偿性心衰患者预后评估的参考指标。
Objective To investigate the predicting value of NT pro-BNP/ BNP, NT pro - BNP and BNP of patients with acute decompensated heart failure prognosis. Methods 182 cases of patients with acute decompensated heart failure in the Fifth People＇s Hospital of Dongguan City from January 2012 to August 2013 were selected as the research object. Enzyme-linked immunosorbent （ELISA） was applied to detect plasma NT pro-BNP and BNP levels of the patients with before treatment （To） and after treated with 1 d （T1）, 5 d （T2） and 10 d （T3）. 2 years survival rate of followed up was statistically analyzed, and NT pro-BNP/BNP and plasma NT pro-BNP and BNP level of the survived and death patients were compared. Subjects＇ operating characteristic curve （ROC） was applied to analyze the value of NT pro-BNP/ BNP, NT pro-BNP and BNP of patients with acute decompensated heart failure to predict the prognosis. Results Compared with To, T1, T2 and T3 NT pro-BNP/BNP and plasma NT pro-BNP and BNP level of patients with acute decompensated heart failure were lower （P 〈 0.05）. Compared with survived patients, T0, T1, T2 and T3 NT pro-BNP/BNP and plasma NT pro-BNP and BNP level of the death patients were elevated （P 〈 0.05）. ROC curve analysis results showed that cut off value of plasma NT pro-BNP, BNP level and NT pro BNP/BNP was 800 ng/mL, 60 ng/mL and 6.4 respectively, the sensitivity of the above 3 factors predicting the prognosis was 79.17%, 75.00% and 95.83% respectively, and the accuracy of the above 3 factors predicting the prognosis was 86.26%, 85.71% and 98.35% respectively, which showed that sensitivity and accuracy of NT pro-BNP/BNP predicting the prognosis of patients with acute decompensated heart failure was higher than those of the plasma NT pro-BNP and BNP levels （NTpro-BNP/BNP ＆ NTpro-BNP：χ^2 = 12.688, 10.289; P = 0.000,0.000; NTpro-BNP/BNP＆ BNP：χ^2 = 17.414, 10.891, P = 0.000, 0.000）, while value of plasma NT pro-BNP levels and plasma BNP levels predicted the prognosis of patients with acute decompensated heart failure had no statistical significant differences （χ^2 = 0.492, 1.255, P = 0.868, 0.412）. Conclusion NT pro-BNP, BNP level and NT pro BNP/BNP of patients with acute decompensated heart failure are high and have high value in predicting the prognosis, and the value of NTpro-BNP/BNP predicting the prognosis is the best, hence NTpro-BNP/BNP may be the reference index for evaluation of prognosis of patients with acute decompensated heart failure.
出处
《中国医药导报》
CAS
2016年第2期16-19,共4页
China Medical Herald
基金
国家自然科学基金项目(81470447)
关键词
急性失代偿性心衰
N端脑钠肽前体/脑钠肽
N端脑钠肽前体
脑钠肽
预后
Acute decompensated heart failure
N-terminal pro-brain natriuretic peptide/Brain natriuretic peptide
N-terminal pro-brain natriuretic peptide
Brain natriuretic peptide
Prognosis
