B型利钠肽预测住院心血管病患者近期预后的价值

Value of B-type natriuretic peptide in predicting short-term prognosis for patients with cardiovascular disease

目的：探讨B型利钠肽（BNP）与住院心血管病患者近期预后的关系。方法：采用BIOSITE Triage BNP干氏床旁快速检测方法对107例住院心血管病患者入院1～3d的BNP水平进行测定，随访1个月，存活90例（存活组），死亡17例（死亡组）。结果：死亡组血BNP水平（中位数1132ng／L）高于存活组（中位数116ng／L）（P〈0．0005）；血BNP浓度与心率、左室舒张末期内径、心衰史和心梗史呈正相关（r=0．28，0．49，0．39，0．21，P均〈0．05），与左室射血分数呈负相天（r=-0．63，P〈0．0005）；BNP预测1个月内心源性死亡的ROC曲线下面积为0．89，95％可信区间为0．79～0．98，P〈0．0005；Logistic逐步回归分析表明，血BNP浓度大于755ng／L是近期心源性死亡的独立预测因子（OR=17．6.95％可信区间为8．7～66．5，P〈0．0005）。结论：血BNP水平与住院心血管病患者近期预后关系密切，可用于预测1个月内心源性死亡的发生情况。

Aim： To explore the value of B-type natriuretic peptide （BNP） inpredicting short-term prognosis for patients with cardiovascular disease. Methods： A total of 107 inpatients with cardiovascular disease, whose blood BNP concentration was measured with BIOSITE Triage BNP test within 1 - 3 days of admission, were divided into 2 groups according to the results of I month follow-up： the survival group（ n = 90） and the non-survival group（ n = 17 ）. Results： The blood BNP concentration in the non-survival group was significantly higher than that in the survival group （ the medians were 1 132 ng/L vs 116 ng/L, P 〈 0. 000 5 ） ; the blood BNP concentration was positively correlated with heart rate, left ventricular end-diastolic dimension,history of cardiac failure and myocardial infarction （ r was 0. 28 ,0. 49,0. 39 ,0. 21 ,respectively, P 〈 0.05 ） , and negatively correlated with left ventricular ejection fraction （ r = - 0.63, P 〈 0. 000 5 ） ; area under the curve of the receiver operating characteristic： （ROC） of BNP to predict cardiac death within 1 month was 0.89, and 95% confidence interval was 0.79 -0.98,P 〈 0. 000 5; stepwise logistic regression analysis indicated that BNP（ ≥ 755 ng/L） were the only independent predictor of I month cardiac death（ OR = 17.6, and 95% confidence interval was 8.7 - 66.5, P 〈 0. 000 5 ）. Conclusion ： Blood BNP level is closely correlated with the short-term prognosis of inpatients with cardiovascular disease,and can be used to predict occurrence of cardiac death within 1 month.