不同NYHA分级慢性心力衰竭患者血清cTnI、NT-proBNP、UA水平变化及其与预后转归的关系

Changes of serum cTnI, NT-proBNP and uric acid levels in patientswith chronic heart failure of different NYHA grades andtheir relationship with prognosis and outcomes

目的探讨不同纽约心脏病协会(NYHA)分级慢性心力衰竭(CHF)患者血清肌钙蛋白I(cTnI)、氨基末端B型利钠肽前体(NT-proBNP)、尿酸(UA)水平的变化,并分析其与预后转归的关系。方法收集2020年1月—2022年1月本院收治的95例CHF患者临床资料,采用NYHA分级分为Ⅱ级29例(Ⅱ级组),Ⅲ级38例(Ⅲ级组),Ⅳ级28例(Ⅳ级组),比较3组血清cTnI、NT-proBNP、UA水平,分析CHF患者心功能与血清cTnI、NT-proBNP、UA水平的相关性;评估CHF患者出院后1个月复查时血清cTnI、NT-proBNP、UA水平变化情况,比较血清cTnI、NT-proBNP、UA短期(出院后1个月)升高与未升高者出院12个月心血管终点事件发生情况。结果3组患者性别、年龄、患病史等基线资料比较,差异无统计学意义(P>0.05);Ⅱ级组、Ⅲ级组与Ⅳ级组左心室舒张末期内径(LVEDD)及血清cTnI、NT-proBNP、UA水平依次明显升高,左心室射血分数(LVEF)则依次明显下降,且两两比较差异均有统计学意义(P<0.05)。Pearson相关系数分析显示,CHF患者血清cTnI、NT-proBNP、UA水平均与LVEDD呈显著正相关(P<0.05),均与LVEF呈显著负相关(P<0.05)。出院后1个月,3组患者血清cTnI、NT-proBNP、UA水平均较入院次日显著降低(P<0.05),但cTnI、NT-proBNP、UA升高>20%者分别有4.21%、7.37%、30.53%。95例CHF患者中有72例获得出院后12个月随访,有心血管终点事件31例(43.06%)。血清cTnI、NT-proBNP短期升高与未升高者出院后12个月心血管终点事件发生率比较,差异无统计学意义(P>0.05);血清UA短期升高者出院后12个月心血管终点事件发生率明显高于未升高者(P<0.05),无心血管终点事件发生的生存时间明显低于未升高者(P<0.05)。结论入院时血清cTnI、NT-proBNP、UA水平与CHF患者心功能分级有关,血清UA短期升高者心血管终点事件发生风险更高。

Objective To evaluate the changes of serum troponin I(cTnI),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and uric acid(UA)levels in patients with chronic heart failure(CHF)of different New York Heart Association(NYHA)grading,and analyze their association with prognosis and outcomes.Methods The clinical data of 95 patients with CHF admitted to the hospital from January 2020 to January 2022 were collected,including 29 cases of NYHA grade II(grade II group),38 cases of grade III(grade III group)and 28 cases of grade IV(grade IV group).The levels of serum cTnI,NT-proBNP and UA among the three groups were compared.The correlation between cardiac function and serum cTnI,NT-proBNP and UA levels in patients with CHF was analyzed.The changes of serum cTnI,NT-proBNP and UA levels were evaluated among patients with CHF during re-examination at 1 month after discharge.The occurrence of cardiovascular endpoint events at 12 months after discharge was compared between patients with and without elevated serum cTnI,NT-proBNP and UA levels in a short time period(1 month after discharge).Results There were no statistically significant differences in baseline data such as gender,age and disease history among the three groups(P>0.05).The left ventricular end-diastolic diameter(LVEDD)and levels of serum cTnI,NT-proBNP and UA in grade II group,grade III group and grade IV group were significantly increased in turn while the left ventricular ejection fraction(LVEF)was significantly decreased,and the differences were statistically significant between any two groups(P<0.05).Pearson correlation coefficient analysis showed that serum cTnI,NT-proBNP and UA levels in patients with CHF were significantly positively correlated with LVEDD(P<0.05),and were significantly negatively correlated with LVEF(P<0.05).At 1 month after discharge,serum levels of cTnI,NT-proBNP,and UA in patients with CHF were significantly lower than those on the next day of admission(P<0.05),but cTnI,NT-proBNP and UA increased by>20%in 4.21%,7.37%and 30.53%respectively.72 of 95 patients with CHF were followed up for 12 months after discharge,including 31 cases(43.06%)with cardiovascular endpoint events.There was no statistical difference in the incidence rate of cardiovascular endpoint events at 12 months after discharge between patients with and without short-term elevations of serum cTnI and NT-proBNP(P>0.05).The incidence rate of cardiovascular endpoint events at 12 months after discharge in patients with short-term serum UA elevation was significantly higher than that in patients without elevation(P<0.05),and the survival time in patients without cardiovascular endpoint events was significantly lower than that in patients without elevation(P<0.05).Conclusion The levels of serum cTnI,NT-proBNP and UA at admission are related to the cardiac function grading in patients with CHF.Patients with short-term elevation of serum UA have a higher risk of cardiovascular endpoint events.