血清游离三碘甲状腺原氨酸及脑钠肽水平在慢性心力衰竭患者长期预后中的价值

The value of serum free triiodothyronine and BNP in long term prognostic of patients with chronic heart failure

目的测定血清游离三碘甲状腺原氨酸(FT_3)、脑钠肽(BNP)水平的变化,探讨其对慢性心力衰竭患者预后的价值。方法收集2005年9月—2009年9月于我院住院治疗的334例慢性心力衰竭患者资料,包括一般资料、血液生化、心脏超声、用药情况,并对主要心血管事件(MCEs)进行电话或门诊随访,分析FT_3、BNP与相关指标的相关性。结果在随访期间,92例(27.5%)发生MCEs,平均BNP水平较未发生MCEs患者明显升高(P<0.01),FT_3水平则明显降低(P<0.01),FT_3和BNP呈负相关(r=-0.22,P<0.01)。多元回归分析提示预测截断值:FT_3<2.12ng/L,BNP>686ng/L,超过预测截断值MCEs发生率升高(P<0.05,P<0.01)。多变量分析表明,对MCEs有独立预测价值的因素包括:年龄、血清FT_3和BNP的水平。结论高水平BNP和低水平FT_3可作为慢性心力衰竭患者预后不佳的预测指标。

Objective To determine the serum free triiodothyronine（FT3） and brain natriuretic peptide（BNP） levels in patients with chronic heart failure,and to explore the value of them in the prognostic of chronic heart failure.Methods Totally 334 consecutive patients who were admitted to our clinic from September 2005 to September 2009 with the diagnosis of chronic heart failure.The general materials,blood biochemical,and echocardiographic results,medication,and the major cardiovascular events（MCEs） were collected throw phone or outpatient follow up.The relationship between FT_3 and BNP was analyzed.Results During the follow up period,92 patients（27.5%） experienced MCEs.Mean level of BNP was higher than that without major cardiac events（P〈0.01 ）,while the level of FT_3 was lower（P〈0.01 ）.A significant negative correlation was found between the levels of FT_3 and BNP（r=-0.22,P〈0.01）.Multiple regression analysis showed that the predictive cutoff values were less than 2.12 ng/L for FT3 and more than 686 ng/L for BNP.Besides,the multivariate analysis showed that the independence predictors included age,serum FT3 level and BNP level.Conclusion It demonstrated that the higher level of BNP and lower level of serum FT3 may be predictive markers for worse outcomes.