B型钠尿肽对评价充血性心力衰竭患者近期预后的应用价值

Role of B-type natriuretic peptide in the evaluation of short GA term prognosis of patients with congestive heart failure

目的:探讨B型钠尿肽(BNP)浓度变化对充血性心力衰竭患者近期预后的判断价值。方法:40例充血性心力衰竭患者入院2h内用免疫荧光法测定血BNP浓度,按慢性心力衰竭治疗指南治疗2～26d,于出院前或临终前重复测定血BNP浓度,探讨BNP水平变化在评价心力衰竭患者治疗效果和近期预后中的价值。结果:院内死亡的3例患者临终前24h内血BNP水平((3534.0±907.0)ng/L)较入院时((1416.0±872.0)ng/L)升高,未发生临床终点事件的患者出院时BNP水平较入院时((459.1±154.3)ng/Lvs(932.3±309.8)ng/L,P<0.05)降低。而院外发生临床终点事件的患者治疗后BNP仅轻度下降((1007.9±266.9)ng/Lvs(749.1±214.4)ng/L,P<0.05),且2组降低的均值比较差异有统计学意义(P<0.05)。结论:充血性心力衰竭患者血BNP浓度增高,提示近期预后差;BNP浓度降低幅度大的患者较降低幅度小的患者近期预后好。

Aim ： To explore the value of blood B-type natriuretic peptide（BNP） in the short-term prognosis of patients with congestive heart failure. Methods ： Blood BNP was measured in 40 patients with congestive heart failure using fluorescence immunoassay at 2 h after admission. After 2 to 26 d treatment according to the treatment guide for heart failure, blood BNP was measured before discharge or death. Results ： Three died during hospitalization whose blood BNP levels greatly increased from （ 1 416.0±872.0） ng/L to （3 534.0±907.0） ng/L. Blood BNP at discharge in patients without MACE decreased compared with that at admission （ （932.3±309.8 ） ng/L vs （459.1±154.3 ） ng/L, P 〈 0.05 ）. However, blood BNP after treatment of patients with MACE decreased slightly （ （1 007.9±266.9 ） ng/L vs （749.1±214.4） ng/L, P 〈 0.05） ,and there was significant difference between the changes of BNP level. Conclusion： The persistent increasing of BNP level suggests poor prognosis. Patients with BNP level decreased greatly have better prognosis than those with BNP level decreased slightly.