脑利钠肽对心力衰竭远期心脏事件的预测价值

Long prognostic value of B-natriuretic peptide on admission in patients with chronic heart failure

目的:研究血浆脑利钠肽(BNP)对慢性心力衰竭(心衰)患者远期心脏事件的预测价值。方法:入选134例心衰患者,双抗体夹心免疫荧光法测定血浆BNP浓度,记录发生的心脏事件。结果:134例中随访资料完整130例,随访时间平均(708±220)d。130例中发生心脏事件者44例(心脏事件组),未发生心脏事件者86例(非心脏事件组),心脏事件组左室舒张末期内径、心胸比率、BNP均较非心脏事件组显著升高(均P<0.01)。多元logistic回归分析显示,BNP为心衰患者远期心脏事件独立的预测因子。BNP预测心源性死亡ROC曲线下面积为0.846。BNP取值702.5 ng/L预测心源性死亡的敏感度和特异度达最高。血浆BNP≤702.5 ng/L患者生存率高于BNP>702.5 ng/L者(P<0.05)。结论:BNP是影响慢性心衰患者远期心脏事件的独立预测因素。

Objective：To evaluate the long prognostic value of plasma B natriuretic peptide （BNP） on predicting cardiovascular events after hospital discharge in patients with chronic heart failure （CHF）. Method： Patients with CHF （n= 134） were included in this study. Plasma BNP level was obtained by a rapid immunofluorescence assay in all patients. Left ventricular end diastolic diameter （LVEDD） and cardiothoracic ratio （CRT） were performed within 24 h before or after catheterization. All CHF patients were received conventional therapy and the rates of cardiac death and rehospitalization were used as end points during 3-year follow up. Result： ①LVEDD, CRT and BNP were increased in patients with cardiac events compared with patients without cardiac events （P〈0. 01）. ②Multivariant logistic analysis showed that the independent factors for cardiac events in patients with CHF was BNP （OR= 1. 005,95 %CI 1. 002-1. 007）. ③The areas under the receiver operating curve （ROC）, when BNP was used to predict cardiac death of C HF, was 0. 846 （95 % CI 0.771-0. 922）. For predicting cardiac death in patients with CHF, BNP cutoff point of 720.5 ng/L had a sensitivity of 76.5%, a specificity of 75.2%. ④The survival rate of patients in group of BNP≤702. 5 ng/L was much higher than that in group of BNP〉702. 5 ng/L （0R=4. 383, 95% CI 1. 407-13. 650）. Kaplan-Meier cumulative survival analysis supported the above results. Conclusion： Plasma BNP is an independent predictor for prognosis of patients with CHF.