血浆脑钠肽正常水平对重度慢性心力衰竭患者预后的影响

Effects of B-type natriuretic peptide on prognosis in patients with severe chronic heart failure

目的探讨血浆脑钠肽(BNP)正常水平对重度慢性心力衰竭(CHF)患者预后的影响。方法回顾性分析心功能分级为Ⅲ～Ⅳ级的CHF患者临床资料,对所有入选患者进行电话随访。根据首次入院时血浆BNP水平将患者分为BNP正常组(≤100 pg/mL)和BNP升高组(>100 pg/mL);根据患者预后分为存活组和死亡组。通过组间单因素比较及多因素logistic回归分析等方法评价各因素对重度CHF患者不良预后的预测价值相关性。结果共592例重度CHF患者纳入本次研究,平均随访2年。BNP正常组和BNP升高组分别为106例(17.91%)和486例(82.09%),存活组和死亡组分别为416例(70.27%)和176例(29.73%)。BNP正常组和BNP升高组全因死亡率分别为68.85%和24.91%。存活组与死亡组组间基线资料比较发现年龄、心力衰竭病程、收缩压、心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、血浆BNP正常患者人数构成比及β受体阻滞剂使用率差异有统计学意义,此8项指标经多因素logistic回归分析结果显示血浆BNP正常(OR=2.68,95%CI:2.47～2.84,P<0.01)、心力衰竭病程(OR=1.56,95%CI:1.41～1.68,P<0.01)、心功能分级(OR=1.79,95%CI:1.67～1.91,P<0.01)、LVEF(OR=0.91,95%CI:0.87～0.93,P<0.01)、LVEDd(OR=1.37,95%CI:1.25～1.42,P<0.01)以及β受体阻滞剂使用(OR=0.87,95%CI:0.82～0.94,P<0.01)与重度CHF患者死亡有显著相关性。结论对于重度CHF而言,血浆BNP水平正常患者较血浆BNP水平升高患者预后差,血浆BNP水平正常是影响重度CHF患者预后的独立危险因素。

Objective To determine the prognostic effects of B -type natriureic peptide （BNP） on patients with severe chronic heart failure （CHF）. Methods Retrospective analysis was carried out on the clinical data of the in - hos- pital patients with CHF （ New York Heart Association class Ⅲ or Ⅳ ）. All patients were followed up by telephone contact. Patients were divided into normal - BNP （ ≤ 100 pg/mL） and abnormal - BNP （ 〉 100 pg/mL） groups according to the plasma BNP in the first time admitted to hospital ; and divided into survive and death groups according to the result of follow - up. Univariate and multivariate Cox proportional hazard models were applied to determinate the difference of prognosis be- tween normal - BNP group and abnormal - BNP group. The correlation between plasma BNP and prognosis of severe CHF patients was evaluated through independent t -teat, χ2 -test and multivariate logistic regression analysis. Results A total of 592 in- hospital patients were enrlled from January 2007 to January 2010, with 106 （ 17.91% ） amd 486 （82. 09% ） patients in normal - BNP and abnormal - BNP groups, respectively. Over the 2 years follow - up, 176 （29. 73% ） deaths were reported. The all -cause mortalities were 68.85% and 24. 91% in normal - BNP and abnormal - BNP groups, re- spectively. According to multivariable logistic analysis, normal plasma BNP, course of heart failure, NYHA classification, LVEF, LVEDd and the use of 13 - Blocker significant independent predicted factors of the death of patients with severe CHF. Conclusion To the patients with severe CHF, the normal - BNP patients suffer worse prognosis. The normal plas- ma BNP is an independent risk factor of death in patients with severe CHF.