老年心力衰竭患者血浆脑钠肽前体质量浓度与QTc间期关系及对预后的预测

QTc interval and plasma pro-B-type natriuretic peptide in relation to predicting the prognosis of heart failure in elderly patients

目的:分析老年充血性心力衰竭患者血浆脑钠肽前体与QTc间期的关系、以及二者对充血性心力衰竭预后的判断价值。方法:选择2003-05/2005-07在桂林医学院附属医院心内科住院的充血性心力衰竭患者208例[年龄(66.1±13.5)岁]。①使用罗氏2010全自动分析仪测定其脑钠肽前体质量浓度,根据测定值把患者分为<2000ng/L组,2000-3999ng/L组,4000-5999ng/L组和≥6000ng/L组4组。②12导同步心电图自动测算QTc间期,同时人工测量QT间期离散度,比较4组间的差异。③对患者随访2年,比较死亡和生存者QTc间期和QT间期离散度的差异。④采用直线相关回归分析法分析脑钠肽前体质量浓度与心脏各腔室直径、左室射血分数值、QTc间期和QT间期离散度的关系。结果:①随着脑钠肽前体质量浓度的增加,QTc也随之增宽,<2000ng/L组QTc间期比其他3组窄(P<0.01);QTd的改变只显示≥6000ng/L组宽于<2000ng/L组(P<0.05)。②随访期间的死亡率为15.4%(32/208),死亡者的平均QTc间期大于生存者[(430.80±39.16),(423.01±29.42)ms,P<0.01],但间期离散度差别不显著[(52.72±10.09),(53.38±18.89)ms,P>0.05]。③相关回归分析示脑钠肽前体质量浓度,左心房及左心室直径与QTc间期呈直线正相关(P<0.05-0.01),QTc间期与QT间期离散度呈直线正相关(P<0.014)。结论:①充血性心力衰竭患者患者血浆脑钠肽前体质量浓度与QTc间期有很好的相关性。②二者联合应用有助于充血性心力衰竭患者危险程度的分层,同时增高示预后不良。

AIM： To assess the prolonged QTc interval plasma N-terminal pro-B-type natriuretic peptide （pro-BNP） for predicting prognosis and long-term mortality in elderly patients with heart failure. METHODS： 208 patients with congestive heart failure of （66.1＋13.5） years old in the Department of Cardiology, Affiliated Hospital of Guilin Medical College were selected between May 2003 and July 2005. （1）The plasma pro-BNP was measured by Luo＇s 2010 autoanalyzer, and according to the measurements, the patients were divided into 〈 2 000 ng/L group （group A）, 2 000-3 999 ng/L group （group B）, 4 000-5 999 ng/L group （group C） and ≥ 6 000 ng/L group （group D）. （2）QTc interval was measured by computer automately from 12-lead electrocardiogram, and the QTc interval dispersion （QTd） was measured manually at the same time. The results of four groups were compared. （3）The differences in the QTc and QTd between death and survivals were compared during the two-year follow-up. （4）The association of plasma pro-BNP with diameters of all heart chambers, left ventricular ejection fraction （EF）, QTc and QTd was analyzed by linear correlative regression analysis. RESULTS： （1）The QTc intervals were widened with the increase in plasma pro-BNP; QTc interval of group A was narrower than the other groups （P 〈 0.01）; the changes in QTd showed that group D was wider than the group A （P 〈 0.05）. （2）The mortality was 15.4% （32/208） during the foUow-up, and the mean QTc interval in death was much higher than that of the survivals [（430.80±39.16）, （423.01±29.42） ms, P 〈 0.01], but there were no significant difference in QTd between the death and survival groups [（52.72±10.09）, （53.38±18.89） ms, P 〉 0.05]. （3）The regression analysis showed that the values of pro-BNP, diameters of left atrium and left ventricle were positively related with QTc interval （P 〈 0.05- 0.01 ）, and QTc interval was positively related with QTd （P 〈 0.01 ）. CONCLUSION： （1）Pro-BNP has a strong correlation with QTc interval in the heart failure patients. （2）Pro-BNP combined with QTc interval could better stratify the risk degrees of patients with congestive heart failure, and stimultaneously increased levels predict bad prognosis.