老年心衰患者脑钠肽的预测价值

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。方法入选96例诊断CHF的住院患者,测定入院时血清BNP(BNP0)、入院常规治疗7天后BNP(BNP7)治疗30天后BNP(BNP30)以及入院时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 96例CHF患者,发生终点事件组患者年龄、NYHA分级、BNP0、BNP7及BNP30中位数水平均明显高于未发生终点事件组,BNP7-0%、BNP30-0%中位数水平均明显低于未发生终点事件组。年龄>75岁的心衰患者,其心源性死亡或心血管事件再住院的风险是年龄≤75岁的心衰患者的3.27倍;BNP7>555.26pg/ml的心衰患者,其心源性死亡或心血管事件再住院的风险是BNP7≤555.26pg/ml的心衰患者的3.45倍。BNP30>300.68pg/ml的心衰患者,其心源性死亡或心血管事件再住院的风险是BNP30≤300.68pg/ml的心衰患者的2.89倍。BNP7-0%≤57.82%的心衰患者,其心源性死亡或心血管事件再住院的风险是BNP7-0%>57.82%的心衰患者的2.10倍;BNP30-0%≤72.30%的心衰患者,其心源性死亡或心血管事件再住院的风险是BNP30-0%>72.30%的心衰患者的2.03倍。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.[Methods] We prospectively studies 96 consecutive patients hospitalized for CHF.Serum concentration of BNP0,BNP7,BNP30 as well as NYHA classification were measured.[Results] Patients with endpoint events were older,in a higher functional class,had higher levels of BNP0,higher levels of BNP7 and higher levels of BNP30 compared with those without endpoint events.Patients with endpoint events had lower levels of BNP7-0%、BNP30-0%compared with those without endpoint events.BNP7555.26pg/ml on admission were associated with increased cardiac events;BNP30300.68pg/ml on admission were associated with increased cardiac events;BNP7-0%≤57.82% on admission were associated with increased cardiac events;BNP30-0%≤72.30% on admission were associated with increased cardiac eventsand age75 years were associated with increased cardiac events too.[Conclusions] Measurement of BNP in patients with CHF can help to identify patients at higher risk for cardiac event.