扩张型心肌病合并慢性重度心力衰竭血B型脑钠肽浓度正常的临床意义

Clinical significance of normal blood B-type natriuretic peptide in dilated cardiomyopathy with severe chronic heart failure

目的评价扩张型心肌病合并慢性重度心力衰竭(心衰)血B型脑钠肽(B-type natriuretic peptide,BNP)浓度正常的临床意义。方法选取92例扩张型心肌病合并慢性重度心衰(心功能III～IV级)患者,血BNP浓度正常的24例为研究组,血BNP浓度升高的68例为对照组。对比两组患者的左室舒张末期内径(LVEDd)、左室射血分数(LVEF)及死亡率。结果研究组LVEDd值明显高于对照组,LVEF值明显低于对照组,两组比较差异均有统计学意义(均P<0.05)。研究组随访(17.36±10.38)个月,死亡率为54.2%;对照组随访(30.55±16.63)个月,死亡率为13.2%。两组死亡率比较差异有统计学意义(P<0.05)。Logistic多因素回归分析:血BNP降低为预测心源性死亡的独立预测因素,回归系数3.622,OR值42.466,95%可信区间5.115～355.796(P<0.05)。结论扩张型心肌病合并重度心衰血BNP浓度正常预示BNP分泌机制耗竭及心脏功能进一步恶化。

Objective To investigate the clinical characteristics of severe chronic heart failure patients with dilated cardiomyopathy and normal blood B-type natriuretic peptide（BNP）.Methods A total of 92 patients with dilated cardiomyopathy and severe chronic heart failure（NYHA III-IV）were included.The study group included 24 patients with normal BNP（100 ng/L）.There were 68 patients with increased BNP（100 ng/L）in the control group.Left ventricular end diastolic diameter、Left ventricular ejection fraction and cardiovascular mortality of all patients were evaluated.Results Left ventricular end diastolic diameter（LVEDd） of the patients in the study group was larger than the control group[（69.83±3.68）mm与（62.39±4.26）mm,P0.05].Left ventricular ejection fraction in the study group was lower than the control group[（21.28 ±2.34）%与（29.29±3.66）%,P0.05].The cardiovascular mortality of the study group was higher than the control group（54.2%与13.2%,P0.05）.The binary logistic regression analysis showed that normal B-type natriuretic peptide was an independent predictor of cardiovascular mortality in patiets with dilated cardiomyopathy and severe chronic heart failure（P0.05）.Conclusion Normal BNP in patients with dilated cardiomyopathy and severe chronic heart failure suggests the exhaustion of BNP secretion and associated poor prognosis.