血浆脑钠肽水平与慢性心衰患者的左室重构和预后价值

Left ventricular remodeling and prognostic value of plasma brain natriuretic peptide level in patients with chronic heart failure

目的探讨血浆脑钠肽(BNP)水平与慢性心衰(CHF)患者的预后价值。方法入选126例CHF患者,测定血浆BNP浓度,随访住院期间、30d和6个月的主要心脏不良事件(MACE,包括心血管病死亡、新发心衰/心衰恶化再入院)。结果126例CHF患者根据BNP四分位数水平分4组:Quarter 1:8.0～91.9ng/L;Quarter 2:94.9～344.0ng/L;Quarter 3:366.0～978.0ng/L;Quarter 4:998.0～5000.0ng/L。随BNP水平的升高,各组MACE发生率明显增加。通过多变量logistic回归分析,BNP是独立于年龄、左室质量指数(LVMI)、左室舒张期内径指数(LVIDdI)、左室射血分数(LVEF)等危险因素之外的CHF预后因素,可预测30d和6个月MACE发生(r分别为0.769和0.831,P<0.01)。BNP预测6个月MACE发生的ROC曲线下面积为0.851(95%CI0.778-0.924,P<0.01)。结论BNP水平能很好地对CHF患者进行危险分层,是CHF患者近期临床预后的较好指标。

Objective To investigate the prognostic value of brain natriuretic peptide （BNP） level in chronic heart failure （CHF） patients. Methods The plasma BNP concentrations of 126 CHF patients were measured quickly by luminoimmunoassay. The main adverse cardiac events （MACE, including cardiavarscular death, recurrent heart failure/readmission for HF worsening） were analyzed at inhospital, 30 days and 6 minths. Results The CHF patients were divided four groups according to the quarter values of BNP levels,which Quarter1,8.0- 91.9 pg/ml. Quarter2, 94.9-344.0 pg/ml. Quarter3,366.0-978.0 pg/ml. Quarter4, 998.0-5000 pg/ml. With the higher BNP values in CHF group, with the higher incidence of MACE.After adjustment for clinical prognostic factors,such as ages,LVMI, LVIDdl,and LVEF in CHF groups,BNP remained significantly independent predictor for MACE at 30 days（r=0.769 ,P〈0.01 ） and 6 months（r=0.831 ,P〈0.01 ）by multivariate logistic regression analysis. The Area under receiver operating characteristic （ROC） curve was 0.851 （95%CI 0.778-0.924,P〈0.01 ） for incidence of MACE at 6 months. Conclusion Plasma BNP is a significantly independent predictor for MACE in patients with CHF.