利钠肽与急性心肌梗死后心功能不全和住院病死率相关性研究

Correlation of B-type natriuretic peptide with heart failure and hospital mortality in AMI patients

目的探讨急性心肌梗死(AMI)患者血浆利钠肽浓度与其急性期心力衰竭和住院病死率之间的相关性。方法选择初发AMI患者294例,其中住院期间存活272例,死亡22例;LVEF≥40%262例,<40%32例;Killip分级Ⅰ级152例,Ⅱ级99例,Ⅲ～Ⅳ级43例。记录发病14～18h血浆利钠肽浓度,发病24～48 h超声心动图检查测定LVEF和左心室二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)比值(E/A),对各因素间的利钠肽浓度进行比较。结果血浆利钠肽随着Killip分级Ⅰ、Ⅱ、Ⅲ～Ⅳ级逐渐升高,差异有统计学意义(P<0.01)。AMI后急性期心功能Killip分级及肌酸激酶同工酶峰值与利钠肽呈正相关,E/A与利钠肽呈负相关。死亡患者血浆利钠肽明显高于存活患者[(2399.0±1626.0)ng/L vs(480.8±676.0)ng/L,P<0.01]。利钠肽是AMI患者住院死亡的强预测因素(OR=1.259,P=0.028)。结论血浆利钠肽在AMI后的高危患者中明显升高,与急性期心功能Killip分级、舒张功能及死亡均显著相关,可以尝试用于AMI后心功能不全及死亡危险性的早期预后评估。

Objective To investigate the correlation of B-type natriuretic peptide（BNP） levels with acute heart failure and hospital mortality in patients with acute myocardial infarction （AMI）. Methods 294 patients with newly diagnosed AMI were divided into 2 groups,22 in death group and 272 in survival group. Killip classification of cardiac function, determination of plasma BNP concentration 14 to 18 hours after disease onset,echocardiographic determination of LVEF and E/A ratio 24 to 48 hours after disease onset,and occurrence of death during hospitalization were recorded. 262 patients＇ LVEF was ≥40%, while 32 patients＇ LVEF was 〈40%; 152 patients were in Killip classification I ,99 in Killip classification Ⅱ ,and 43 in Killip classification Ⅲ-Ⅳ. Results Blood BNP increased significantly in accordance with the Killip classification Ⅰ , Ⅱ,Ⅲ-Ⅳ （P 〈 0.01）. In acute stage of AMI,Killip classification of cardiac function and cardiac enzymes peak were positively correlated with BNP, E/A ratio was negatively correlated with BNP. BNP level was significantly higher in death group than in survival group[（2399.0± 1626.0） ng/L vs （480.8±676.0） ng/L, P 〈 0.01]. BNP was a predictive factor of hospital mortality of AMI patients （OR = 1. 259, P = 0. 028）. Conclusion Plasma BNP in high-risk patients with AMI is significantly increased and significantly correlated with Killip classification, diastolic function and death. BNP may be a predictive factor for hospital mortality of AMI patients.