脑钠肽和心肌收缩力储备在评估慢性心力衰竭长期预后中价值的研究

Long-term prognostic value of brain natriuretic peptide and myocardial contractile reserve in chronic heart failure

目的探讨脑钠肽(BNP)和心肌收缩力储备(MCR)在评估慢性心力衰竭(CHF)长期预后中的价值。方法将64例合乎研究条件的患者进行血浆BNP浓度、MCR、静息左室射血分数(LVEF)的检测及NYHA心功能评估;根据上述参数的中位数进行分组,每2个月随访患者1次,观察终点为心源性死亡,随访期为54个月。结果随访期末,数据显示BNP与MCR和心源性死亡的关系紧密(r分别为0.421和-0.443;P分别为0.001和0.000);而静息LVEF和NYHA心功能与死亡没有相关性(r分别为-0.057和0.110;P分别为0.652和0.384)。高于BNP中位数组的死亡例数比低于BNP中位数组的死亡例数明显多(11/22和8/41,P=0.020),两组死亡相对危险比为2.56(95%CI);相反,高于MCR中位数组的死亡例数比低于MCR中位数组的死亡例数明显少(4/30和14/26,P=0.002),死亡相对危险比为1.88(95%CI);两者之间BNP的死亡危险比高于MCR。高于静息LVEF中位数组的死亡例数和低于静息LVEF中位数组的死亡例数差别很小(11/38和8/27,P=1.000),死亡相对危险比为1.01(95%CI);同样,高于NYHA心功能分级中位数组的死亡例数和低于NYHA心功能分级中位数组的死亡例数差别也很小(3/15和13/45,P=0.738),死亡相对危险比为1.13(95%CI)。还可以看到A组(MCR<24,BNP>189)和B组(MCR>24,BNP<189)之间死亡相对危险比竟高达12.8(95%CI)。结论BNP和MCR在评价CHF长期预后中具有重要意义,其中BNP甚至优于MCR;如果联合使用MCR和BNP可以更有力预示CHF的远期死亡;而静息LVEF和NYHA心功能分级与CHF的长期预后无关,不能够用来评估CHF的长期预后。容易获取又完全客观的BNP应该成为CHF患者常规检查;有条件的医院应该把MCR检测作为评估CHF远期预后的重要手段。

Objective To explore if brain natriuretic peptide （BNP） and myocardial contractile reserve （MCR） play important role in long-term prognosis of patients with chronic heart failure （CHF）. Methods Sixtyfour enrolled patients underwent measurement of plasma concentration of BNP, MCR and rest left ventricular ejection fraction （rest LVEF） and assessment of New York Heart Association （NYHA） functional class. They were divided into groups according to the median of above parameters. Endpoint was cardiac death and was recorded for each group during average 54 months of follow-up. Results At the end of the follow-up, it was found that BNP and MCR closely related with death （r= 0. 421 and -0. 443; P= 0. 001 and 0. 000, respectively）. Between the two indicators the death risk ratio of BN.P is higher than that of MCR （2.56 vs 1.88, 95% CI, respectively）. However, the rest LVEF and NYHA functional class had no relation with death （r=-0. 057 and 0. 110, respectively; P= 0. 652 and 0. 384, respectively）, and the death risk ratios of them had no significance. More important is that if BNP and MCR were combined the death risk ratio was increased to 12.8, even higher than either of them. Conclusion BNP and MCR are excellent predictors of long-term prognosis in patients with CHF, between them, BNP is superior to BNP. If the two indicators joined together, the prediction would become more powerful. Rest LVEF and NYHA have no significance in long-term prediction of CHF. The simple test for BNP should become routine for patients with CHF, and MCR is an important marker to assess the long-term prognosis of CHF as well.