B型脑利钠肽对于老年心衰患者的预测价值

Prognostic value of BNP in old patients with chronic heart failure

目的评价B型脑利钠肽(BNP)对于慢性充血性心力衰竭(CHF)患者预后及危险分层的预测价值。方法对中国医科大学附属盛京医院明确诊断为CHF的142例住院患者测定入院时、入院静脉治疗一天后及住院第七天血清BNP(BNP0、BNP1、BNP7)以及入院时按纽约心脏病协会心功能分级(NYHA分级)等指标随访观察患者心脏事件的再发生。结果142例CHF患者,中位随访425.50天(21-668天),发生心脏事件50例(35.21%)。发生终点事件组与未发生终点事件组相比,患者的年龄、NYHA分级、BNP0、BNP1、BNP7中位数水平均明显偏高;入院静脉治疗一天后BNP指标变化百分比(BNP1-0%)中位数水平均明显偏低。分别以年龄和BNP1-0%及BNP7指标对心衰患者进行危险分层。结果年龄>76岁的心衰患者,其死亡或心血管事件再住院的风险是年龄≤76岁的心衰患者的2.55倍(95%CI:1.38-4.69,P=0.003)。BNP1-0%≤12.62%的心衰患者,其死亡或心血管事件再住院的风险是BNP1-0%>12.62%的心衰患者的2.00倍(95%CI:1.10-3.64,P=0.023)。BNP7>552.15 pg/ml的心衰患者,其死亡或心血管事件再住院的风险是BNP7≤552.15 pg/ml的心衰患者的2.60倍(95%CI:1.43-4.75,P=0.002)。结论BNP可以用于对心衰患者进行心衰后心脏事件再发生的预后分析及及危险分层评估。

Objective To evaluate the prognostic value of B-type natriuretic peptide in patients with chronic heart failure. Meth- ods We prospectively studies 142 consecutive patients hospitalized for CHF. Serum concentration of BNP, BNP1, BNtr7 as well as NYHA classification were measured. Results During a median follow-up period of 425.50 （21 -668） days, the endpoint of recurrence for cardiac events was reached in 50（35.21% ） patients. Patients with endpoint events were older, in a higher functional class, had higher levels of BNP0, higher levels of BNP1 and higher levels of BNP7 compared with those without endpoint events. Patients with endpoint events had lower levels of BNP1-0% （0. 0535 vs.0. 1592, P = 0. 018） compared with those without endpoint events. BNP1-0% 〉 12.62% on admission were associated with increased cardiac events（HR = 2.00,95% CI： 1.10 - 3.64, P = 0.023）, BNP7 〉 552.15 pg/ml on admission were associated with increased cardiac events（HR = 2.609 5% CI： 1.43 - 4.75, P = 0.002）, and age 〉 76 years were associated with increased cardiac events too（ HR = 2.55,95 % CI ： 1.38 - 4.69, P = 0. 003 ） Conclusion Measurement of BNP in patients with CHF can help to identify patients at higher risk for cardiac event.