急性心力衰竭入院时收缩压水平与心功能及预后关系

Relationship among cardiac function,prognosis and level of systolic blood pressure at admission in patients with acute heart failure

目的:探讨急性心力衰竭患者入院时收缩压(SBP)水平与心功能及预后的关系。方法:研究对象为急性心力衰竭住院的患者229例,按入院时SBP水平分为:A组(SBP≤100mmHg,22例),B组(100mmHg<SBP≤140mmHg,123例),C组(SBP>140mmHg,84例),测定入院后N末端B型利钠肽前体(NT-proBNP)、肌酐等水平,并测量心胸比例、左室舒张末容积(LVEDV)、左室射血分数(LVEF)等。半年后根据有无心源性死亡分为事件组(65例)和非事件组(164例)。结果:不同血压组间lgNT-proBNP、LVEF、LVEDV均有显著性差异(P均<0.01);Pearson相关分析显示,SBP水平与lgNT-proBNP、心胸比、LVEDV呈负相关(r分别为-0.382,-0.546,-0.401,P均<0.01),与LVEF呈正相关(r=0.678,P<0.01)。与非事件组比较,事件组的心功能NYHAⅣ级比例(42.1%比70.8%)、心胸比[(0.55±0.07)比(0.60±0.07)]、LVEDV[(87.85±36.93)ml比(119.74±70.38)ml]明显增加,lgNT-proBNP[(3.58±0.37)pg/ml比(4.05±0.32)pg/ml]水平明显升高(P均<0.05);而其肌酐清除率[(57.81±24.98)ml/min比(49.40±28.32)ml/min],LVEF[(51.51±8.95)%比(42.45±8.41)%],SBP[(141.19±27.80)mmHg比(120.30±21.03)mmHg]水平则显著降低(P均<0.05)。A组患者心源性死亡事件发生率明显高于B、C组患者(54.6%比34.2%比13.1%,P<0.01)。结论:入院收缩压水平是反映急性心力衰竭患者心功能的一项重要指标。收缩压水平越低,预后越差。

Objective： To study relationship among cardiac function, prognosis and different level of systolic blood pressure （SBP） at admission in patients with acute heart failure （AHF）. Methods： A total of 229 AHF inpatients were enrolled and their cardiac function was assessed by NYHA classification. According to SBP level at admission, 229 patients were divided into group A （SBP≤100mmHg, n = 22）, group B （100mmHg〈SBP≤140mmHg, n = 123） and group C （SBP〉 140mmHg, n = 84）. Levels of N terminal pro brain natriuretic peptide （NT-proBNP）, creatinine, cardiothoracic ratio （C/T）, left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） were measured after admission. According to cardiogenic death or not after six-month follow-up, patients were divided into event group （n = 65） and no event group （n = 164）. Results： There were significant difference in lgNT-proBNP, LVEF and LVEDV among three groups （P〈0. 01 all）; Pearson correlation analysis indicated that SBP level was negatively correlated with lgNT-proBNP, C/T and LVEDV （r = -0. 382, -0. 546, - 0. 401 respectively, P〈0.01 all）, and positively correlated with LVEF （r = 0. 678, P〈0.01）. Compared with no event group, there were significant increase in percentage of patients with NYHA cardiac function classⅣ （42.1% vs. 70.8%）, C/T[ （0.55±0.07） vs. （0.60±0.07）], LVEDV [ （87.85±36.93） mlvs. （119.74±70.38） ml], lgNT-proBNP [ （3.58 ± 0.37） pg/ml vs. （4.05 ± 0.32） pg/ml], P〈0.05 all; and significant decrease in creatinineclearance rate [ （57. 81 ± 24.98） ml/min vs. （49.40 ± 28.32） ml/min], levels of LVEF [ （51.51 ± 8. 95）% vs. （42.45 ± 8.41） %] and SBP [ （141.19 ± 27.80） mmHg vs. （120.30 ± 21.03） mmHg] in event group, P〈0.05 all. Incidence rate of cardiogenic death in group A was significantly higher than those of group B and C （54.5% vs. 34.1% vs. 13.1%, P〈0.01）. Conclusion.. Level of systolic blood pressure at admission is an important index re- flecting cardiac function in patients with acute heart failure.