B型利钠肽水平对慢性心力衰竭患者预后的影响

Prognostic value of admission B-type natriuretic peptide on outcome for patients with congestive heart failure

目的探讨不同B型利钠肽（BNP）水平对慢性心力衰竭（CHF）患者预后的影响。方法162例CHF患者初次人院后测定血液BNP水平，并行常规超声心动图和组织多普勒检查。根据BNP水平高低分为高BNP组（BNP〉1500ng／L）和低BNP组（BNP≤1500ng／L）。对两组患者的一般临床资料、心脏超声和组织多普勒数据及2年内心血管事件发生率进行分析。再按随访2年内是否发生心血管事件分为事件组与非事件组，并对相关数据进行统计学分析。结果高BNP组和低BNP组左心室射血分数（LVEF）分别为（40．9±5．6）％和（44．04-5．9）％（P〈0．01）。高BNP组和低BNP组总心血管事件发生率分别为49．1％和21．0％（P〈0．01）、心原性病死率分别为25．5％和9．0％（P〈0．01）。事件组和非事件组BNP水平分别为（2875．4±325．7）ng／L和（1136．94-298．6）ng／L（P〈0．000）。事件组BNP水平与组织多普勒心肌做功指数（TDI—Tei）呈正相关（r=0．793，P〈0．001），与LVEF呈负相关（r=-0．57，P〈0．001）。多因素logistic回归分析显示BNP、LVEF、TDI．Tei和B受体阻滞剂的应用是预测心血管事件发生的危险因素。BNP水平预测事件组CHF患者2年内发生死亡的ROC曲线下面积为0．795，以事件组患者BNP水平均数1910ng／L作为分组的界值，通过Kaplan—Meier法作BNP不同水平患者在随访期间心血管事件发生率曲线，计算Log．rank为24．11（P=0．000）。结论BNP水平是CHF患者心血管事件发生的独立危险因素，不同BNP水平对CHF患者的预后影响不同，界值超过1910ng／L的患者预后较差。

Objective To observe the prognostic value of admission B-type natriuretic peptide （BNP） on outcome for patients with congestive heart failure （CHF）. Methods Blood BNP levels, routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [ 95 male, mean age： （71.8 ± 3.7） years ] at admission. Patients were divided into high BNP （BNP 〉 1500 ng/L, n = 104） and low BNP （BNP≤ 1500 ng/L, n =58） groups. All patients were followed up for 2 years and clinical characteristics, echocardiography including Doppler image and cardiovascular events results were analyzed. Data were also compared between patients with （ n = 48 ） or without （ n = 107 ） cardiovascular events. Results Left ventricular ejection fractions （LVEF） was significantly lower [ （40. 9 ±5.6）% vs. （44. 0 ±5.9）%, P 〈 0. 01 ] while the total cardiovascular events rate （49. 1% vs. 21.0% , P 〈0. 01 ） and cardiac mortality rate （25.5% vs. 9.0% , P 〈0. 01 ） were significantly higher in high BNP group than in low BNP group. BNP level at admission in event group was significantly higher than in event-free group [ （2875.4 ± 325.7 ） ng/L vs. （1136. 9 ±298. 6） ng/L, P 〈0. 000]. BNP level was positively related to Tei-index （r =0. 793, P 〈 0. 001 ） and negatively correlated with LVEF （ r = - 0. 57, P 〈 0. 001 ）. Multiple logistic regression analysis demonstrated that BNP, LVEF, Tei-index and β-blocker use were independent risk factors for cardiovascular events. The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0. 795 （ 95 % CI 0. 693 - 0. 935, sensitivity ： 72. 31% and specificity ： 84. 62% , cut-off BNP value ： 1910 ng/L）. The event risk was 2. 17 times higher in CHF patients with admission BNP 〉 1910 ng/L compared CHF patients with admission BNP ≤ 1910 ng/L （ 95% CI： 1. 852 - 2. 954, P = 0. 000 ） . Conclusion Admission BNP level, LVEF, Tel-index and 13-blocker use are independent risk factors for cardiovascular events in patients with CHF. Patients with higher admission BNP level （ 〉 1910 ng/L） is linked with worse prognosis in this patient cohort.