血浆氨基末端脑利钠前体水平对心力衰竭患者的近期预后价值

Prognostic value of plasma N-termina pro-brain natriuretic peptide level in heart failure patients

目的探讨血浆氨基末端脑利钠前体(NT-proBNP)水平对心力衰竭患者的近期预后价值。方法选择2007年4月至2007年9月在我院心内科住院治疗的74例心力衰竭患者为研究对象,采用双抗体夹心免疫荧光法(ELMA)检测血浆NT-proBNP水平,用改良Simpson氏法测定心衰患者的左心室射血分数(LVEF)。对存活的患者出院后随访90天,终点事件为再入院或死亡。结果共有24例患者发生了终点事件。其中,住院期间3例死亡,随访期间4例死亡,17例因失代偿心衰而再住院治疗。发生终点事件的患者的血浆NT-proBNP水平中位数显著高于未发生终点事件的患者:8236pg/mlVS1667pg/ml,P<0.01。Cox比例风险模型分析显示,NT-proBNP水平是预测心力衰竭患者是否发生终点事件的独立预测因子(RR=23.85,95%CI13.24～665.38),P<0.001,LogNT-proBNP每升高1个单位,风险增加23.85倍。NT-proBNP水平对终点事件判定的ROC曲线下面积为0.91,95%CI0.846～0.974,P<0.001,对发生终点事件的阳性预测价值为91.0%,阴性预测价值为9.0%。结论血浆NT-proBNP水平是预测心力衰竭患者近期是否发生死亡或因失代偿心衰再住院的有价值的生化指标。

Objective To evaluate the value of plasma NT-proBNP in predicting short-term outcome in heart failure patients. Methods 74 patients admitted with heart failure to our department of cardiology between April 2007 and Septemher 2007 were analyzed. Plasma level of NT-proBNP was measured by a sandwich immunoassay （ELMA）with two antihodies. Left ventrimdar ejection fi＇action （LVEF） was measured hy modified Simpson＇s equation with Doppler echocardiography. Patients discharged alive were followed for 90 days. The primary endpoint was death or readmission. Results The primary endpoint was observed in 24 patients. Three patients died during hospitalization. During the 90-day follow-up period, four patients died and seventeen patients were readmitted due to deeompensated heart failure. Among patients with primary endpoint, the median NT-proBNP level was 8 236pg/ml, which was significantly higher compared with 1 667pg/ml among patients without primary endpoint （P〈0.01）. Cox muhivariate proportional-hazards regression models were used to evaluate the independent prognostic value of Log NT-proBNP, which was the strongest independent predictors of prognosis for primary endpoint of heart failure patients （RR =23.85, 95% CI 13.24-665.38）, P〈0.001. Every time Log NT-proBNP was doubled, estimated hazard ratio increases by a factor of 23.85for primary endpoint. Receiver operating characteristic （ROC） demonstrated NT-proBNP was highly sensitive and speeifie for the predietion of primary＇ endpoint （area under the curve was 0.91, 95% CI 0.846～0.974, P〈0.001）. Conclusion Plasma level of NT-proBNP is a powerful independent marker in predieting short-term outcome for heart failure patients.