心肌^(123)I标记苄基胍闪烁摄影与脑钠肽在评估慢性心力衰竭长期预后中的价值

Long-term prognostic value of myocardial^(123)I-metaiodobenzylguanidine scintigraphy and brain natriuretic peptide in chronic heart failure

目的探讨心肌123I标记苄基胍(123I-MIBG)闪烁摄影及血浆脑钠肽(BNP)浓度在评价慢性心力衰竭(CHF)远期预后中的价值。方法64位CHF患者接受123I-MIBG闪烁摄影,血浆BNP浓度检测,静息左室射血分数(rest-LVEF)测定和NYHA心脏功能分级的评估。根据各参数中位数分组,连续随访54个月,观察终点为心源性死亡。结果随访期末发现123I-MIBG闪烁摄影照片的心脏/纵膈(H/M)比值和血浆BNP浓度与CHF远期死亡有着显著的相关性(r分别为-0.592和0.421;P值分别为0.000和0.001);rest-LVEF和NYHA心脏功能分级与死亡没有相关性(r分别为-0.057和0.110;P值分别为0.652和0.384);123I-MIBG闪烁摄影照片的H/M值低于中位数组(Ⅰ组)和高于及等于中位数组(Ⅱ组)之间死亡例数和血浆BNP值之间有明显的统计学差异(P值分别为0.001和0.003),两组的rest-LVEF和NYHA心脏功能分级之间没有统计学意义(P值分别为0.195和0.781);H/M和BNP值高于等于中位数组与低于中位数组死亡相对危险比分别为4.66和2.56(95%CI),差异有统计学意义(P分别为0.001和0.020),但是高于等于和低于中位数的rest-LVEF和NYHA心脏功能分级组之间死亡相对危险比没有统计学意义(P分别为1.000和0.738)。结论心肌123I-MIBG闪烁摄影及血浆BNP浓度与CHF远期死亡密切相关,可以用来评价CHF的远期预后。

Objective To explore if myocardial ^123I-metaiodobenzylguanidine（^123I-MIBG）scintigraphy and plasma concentration of brain natriuretic peptide （BNP） play important long-term prognostic roles in chronic heart failure （CHF）. Methods Sixty four enrolled patients underwent myocardial ^123I-MIBG scintigraphy, exeminations of plasma concentration of BNP, resting left ventricular ejection fraction （resting-LVEF） and New York Heart Association functional class （NYHA） assessment. They were divided into groups according to the median values of above parameters. Endpoint was cardiac death and was recorded for each group during average 54 month follow-up. Results At the end of the follow-up, the heart/mediastinum （H/M） ratio and BNP had close correlation with death （r= -0. 592 and 0. 421, P=0. 000 and 0. 001, respectively）, but resting-LVEF and NYHA class had no correlation with death during 54 month follow-up（r= -0. 057 and 0.110,P=0. 652 and 0. 384, respectively）. There were significant difference in the number of deaths and the plasma concentration of BNP between group Ⅰ （H/M ratio lower than median value） and group Ⅱ （H/M ratio higher than and equal to median value） , but there was no difference in resting- LVEF and NYHA class. The relative risk ratio of death betweeen the groups with H/M and BNP above and below the median values had significant difference, but no significant difference between the groups with the resting-LVEF and NYHA class higher and lower than median values. Conclusion Myocardial ^123 I-MIBG scintigraphy and BNP are related with the long-term prognosis of CHF, and may be used for evaluating the long-term prognosis of CHF, but the resting-LVEF and NYHA have no significance in long-term prediction of CHF.