脑利钠肽检测对心力衰竭患者院内死亡的预测价值

Prognostic value of brain natriuretic peptide on in-hospital mortality in patients with chronic heart failure

目的研究血浆脑利钠肽（BNP）检测对心力衰竭患者院内死亡风险的预测价值。方法76例心力衰竭患者分别在入院时（BNP1）和治疗5d后（BNF2）检测血浆BNP水平，并定义bnp=BNP2-BNP1。记录院内死亡事件，并进行统计分析。结果住院期间院内死亡7例，性别、年龄、NYHA分级、原发病与院内死亡风险之间无相关性。血浆BNP依次为BNP1（1495.6±1218.4）ng／L、BNP2（1088.5±1214.9）ng／L、bnp（407.0±1062.8）ng／L，均与院内死亡风险呈正相关（相关系数分别为0.381、0.669、0.399），ROC曲线下面积依次为0.784、0.933、0.812，P值和95％可信区间依次为0.006（O.645～0.922）、0.000（0.862～1.003）、0.003（0.650～0.973）。BNP1、BNP2和bnp的cut-off值分别取2245.0ng／L、938.5ng／L和-1.0ng／L时，灵敏度分别为55.6％、89.6％和100.0％，特异度分别为74.6％、77.8％和86.6％。结论血浆BNP水平可作为院内死亡风险的预测指标。

Objective To observe prognostic value of brain natriuretic peptide （BNP） on in-hospital mortality in patients with chronic heart failure. Methods The plasma BNP levels of 76 pa- tients with chronic heart failure were measured by a rapid immunofluorescence assay through triage biosite diagnostics, and defined BNP1 as the plasma BNP level when being hospitalized, BNP2 as the plasma BNP level after being treated 5 days and bnp as BNP2-BNP1. The primary end point was death in hospi-tal, and the data was analyzed. Results The average levels of BNP1 ,BNP2 and bnp were （ 1495.6±1218.4） ng/L,（1088.5±1214.9）ng/L, （407.0±1062.8）ng/L respectively. They had relationships with in-hospital death in multi-factors bivariate relevance analysis, whereas sex, age, NYHA grades and pathogens had not. In ROC cure analysis, the area under the ROC curves of BNP1、 BNP2 and bnp were 0.784, 0.933, 0.812 respectively （ the P value in turn were 0.006, 0.000, 0.003, Null hypothesis ： true area= 0.5 ）. The positive prospective values were 78.4%, 93.3%, 81.2% respectively. Accord-ing to the maxim Youden index,wben the cut-off values of BNP1, BNP2 and bnp were 2245.0 ng/L, 938.5 ng/L and - 1.0 ng/L, the sensitivity and the specificity were 55.6%, 89.6% , 100.0% and 74.6%, 77.8% and 86.6% respectively. Conclusion The plasma BNP level is strong predictors of in-hospital mortality.