N氨基末端脑钠肽前体水平对急性心力衰竭患者近期预后评估的临床研究

Prognostic value of N-terminal pro-brain natriuretic peptide in patients with acute heart failure

目的探讨床旁检测N氨基末端脑钠肽前体(NT-proBNP)在急性心力衰竭患者预后评估中的临床价值。方法选取因急性心力衰竭住院的患者162例,正常对照30例。床旁检测患者入院时NT-proBNP和肌钙蛋白I(cTnI)水平,入院后72 h内进行心脏超声检测左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)。心力衰竭组治疗7 d后复查NT-proB-NP。对所有患者随访30 d,观察两组随访期内主要心血管事件(全因死亡、恶性心律失常、心力衰竭加重或再入院)发生情况。结果 NT-proBNP水平可用于急性心力衰竭的预后评估,NT-proBNP水平升高者其心血管事件发生率高,NT-proBNP联合cTnI检测能提高对心血管事件的预测价值治疗后NT-proBNP下降<30%者,其主要心血管事件发生率升高。结论 NT-proBNP水平同急性心力衰竭患者病情严重性相关,对判定疗效及评估预后有重要价值。

Objective To investigate the clinical value of point-of-care detection of N-terminal pro-brain natriuretic peptide（NT-proBNP） in prognostic evaluation for acute heart failure patients.Methods 162 patients hospitalized with acute heart failure were selected,30 normal as control group.The level of NT-proBNP and troponin I（cTnI） for these patients by pointof-care on admission,the left ventricular ejection fraction（LVEF） and left ventricular end-diastolic dimension（LVEDD） by cardiac ultrasonic inspection were measured in 72 hours after admission.The NT-proBNP after 7 days of treatment was reviewed.All patients were followed up for 30 days.The major cardiovascular events（all cause mortality,malignant arrhythmia,heart failure deteriorated or re-admission） of two groups in follow-up duration was observed.Results NT-proBNP levels can be used to assess the prognosis of acute heart failure.Higher NT-proBNP level can lead to high incidence of cardiovascular events.NT-proBNP combined with cTnI detection could improve the predictive value in cardiovascular events,and incidence of major cardiovascular events increased when NT-proBNP decreased less than 30% after treatment.Conclusion NT-proBNP level is related to the severity of acute heart failure and it provides an important value for judgment of curative effect and prognostic assessment.