Nt-proBNP 和血钠水平与老年慢性心力衰竭患者预后的关系

Serum Nt-proBNP and sodium levels are correlated with major adverse cardiac and cerebral events in elderly patients with chronic heart failure

目的探讨 N 末端脑利钠肽原（Nt-proBNP）和血钠水平与老年慢性心力衰竭（CHF）患者预后的关系.方法以老年 CHF 患者为研究对象,随访1年,根据随访期间是否发生心血管事件分为心血管事件组（65例）和非心血管事件组（50例）.采用双抗夹心免疫荧光法测定两组患者血浆 Nt-proBNP 水平,常规测定电解质、生化、血常规、血管紧张素原、肾素、血管紧张素Ⅱ和醛固酮水平,比较两组间的差异.并采用 Lgistic 回归分析探讨心血管事件的危险因素.结果心血管事件组 Nt-proBNP 明显高于非心血管事件组,血钠明显低于非心血管事件组,差异均有统计学意义（均 P〈0.01）.Nt-proBNP 与血钠水平呈显著负相关（r=-0.865,P〈0.01）.Nt-proBNP 及血钠与心血管事件明显相关（P〈0.05或0.01）,左室舒张末期内径、左室射血分数、年龄均与心血管事件无明显相关（P〉0.05）.结论 Nt-proBNP 是老年 CHF 患者心血管事件的独立危险因素,但受心室大小和 LVEF 影响不大,可能与低钠血症有关.

： Objective To investigate the correlation of serum N-terminal-pro-brain natriuretic peptide （Nt-proBNP） and sodium levels with major adverse cardiac and cerebral events （MACCE） in patients with chronic heart failure （CHF）. Methods One hundred and fifteen elderly patients with CHF were included in the study. Patients were followed up for 1 year and the inci-dence of MACCE was recorded. The blood Nt-proBNP, electrolytes, angiotensinogen, renin, angiotensin II and aldosterone levels were measured along with blood routine and blood biochemistry on the admission. Logistic regression analysis and survival analysis were applied for the risk factors of MACCE. Results During the 1-y fol ow-up period MACCE developed in 65 cases. The Nt-proBNP level in the MACCE group （n=65） was significantly higher than that in non-MACCE group （n=50）（P〈0.01）. The Nt-proBNP was negatively correlated with serum sodium level（r=-0.865, P〈0.01）. Nt-proBNP was positively and serum sodium was negatively correlated with MACCE, while LVEDD, LVEF and age were not correlated with MACCE. Conclusion Nt-proBNP is an independent risk factor of MACCE in elderly patients with CHF. Nt-proBNP level may be related to the decreased level of serum sodium, not the LVEDD or LVEF.