NT-proBNP联合血清HCY检测在心力衰竭患者治疗及预后评估中的应用

Serum NT-proBNP and homocysteine levels in prognosis assessment of patients with heart failure

目的:探讨氨基末端B型脑钠肽前体(NT-proBNP)联合血清同型半胱氨酸(HCY)检测在心力衰竭(心衰)患者治疗和预后评估中的临床应用价值。方法:选取我院161例心衰患者作为研究组,50例健康对照为我科健康体检的受试者(对照组)。观测指标为治疗前及治疗后的左室射血分数(LVEF)、NT-proBNP、HCY水平。共随访1年,分别于第6个月和第12个月时采患者静脉血检测NT-proBNP和HCY水平,并记录患者心源性不良事件(心源性再入院和心源性死亡)的发生情况,通过COX风险回归分析随访1年患者的数据,确认NTproBNP和HCY水平与不良事件发生的关系;受试者工作特征曲线(ROC)确定观察指标预测不良事件发生的最佳截断值。结果:研究组的NT-proBNP和HCY水平[(6 986.56±103.78)pg/ml和(19.44±5.78)μmol/L]较对照组更高,治疗后研究组的LVEF有所改善[(50.57±13.67)%∶(36.54±8.65)%,P<0.05],NT-proBNP水平[(924.61±88.56)pg/ml∶(6 986.56±103.78))pg/ml,P<0.05]和HCY水平[(12.21±1.86)μmol/L∶(19.44±5.78)μmol/L,P<0.05]均显著降低。患者心源性不良事件的发生与NT-proBNP和HCY水平呈正相关,NT-proBNP≥2 853.14pg/ml且HCY≥15.87μmol/L时提示不良事件发生的可能性极高。结论:NTproBNP联合HCY检测可预测心衰患者心源性不良事件的发生。

Objective：To assess the clinical value of N-terminal-pro-brain natriuretic peptide（NT-proBNP）and homocysteine（HCY）in prognosis assessment of patients with heart failure.Method：Left ventricular ejection fraction（LVEF）,NT-proBNP and HCY levels were measured in 161 patients with heart failure and 50 healthy individuals,namely observed group and control group respectively.Cardiac death and re-admission events were recorded,and NT-proBNP and HCY levels were measured every month for a one-year follow-up.COX analysis was used to assess the relationship between observed indicator and adverse event.The areas under ROC curve of NT-proBNP and HCY levels in prognosis assessment of patients with heart failure were evaluated.Result：The levels of NTproBNP [（6 986.56±103.78）pg/ml vs（324.56±34.63）pg/ml,P〈0.05]and HCY [（19.44±5.78）μmol/L vs（8.36±1.93）μmol/L,P〈0.05]in the observed group were significantly higher than that in the control group.When heart failure was controlled,the LVEF level was significantly increased [（50.57±13.67）% vs（36.54±8.65）%,P〈0.05],while the levels of NT-proBNP [（924.61±88.56）pg/ml vs（6 986.56±103.78））pg/ml,P〈0.05]and HCY [（12.21±1.86）μmol/L vs（19.44±5.78）μmol/L,P〈0.05]were decreased.There exist a positive relationship between observed indicator and adverse event.The NT-proBNP level above 2 853.14 pg/ml and HCY level above 15.87μmol/L can indicate adverse event.Conclusion：NT-proBNP and HCY detection can indicate adverse event in prognosis of patients with heart failure.