B型利钠肽短期改变对慢性肺源性心脏病急性加重期患者预后的评估价值

Role of Short-term Change of Plasma B-type Natriuretic Peptide in Predicting the Prognosis of Patients with Acute Exacerbation of Cor Pulmonale

目的探讨B型利钠肽(BNP)短期改变对慢性肺源性心脏病急性加重期患者预后的评估价值。方法选取2007年2月—2010年2月我院收治的完成2年随访的185例肺源性心脏病急性加重期患者,检测入院时及入院后48 h时BNP水平,利用BNP水平的短期改变(△BNP)预测患者预后,进行2年的随访。结果入院时患者BNP水平为(718±331)ng/L,入院后48 h为(437±291)ng/L,差异有统计学意义(t=8.672,P<0.05)。27例患者收住ICU治疗,收住ICU治疗的患者△BNP值为(115±62)ng/L,未收住ICU的患者为(269±74)ng/L,差异有统计学意义(t=10.212,P<0.05)。受试者工作特征(ROC)曲线评价△BNP对患者收住ICU的预测,曲线下面积(AUC)为0.82〔标准差(s)=0.04,95%CI(0.74,0.90)〕。10例患者在住院过程中死亡,住院死亡患者△BNP值为(87±36)ng/L,住院生存患者为(315±93)ng/L,差异有统计学意义(t=7.703,P<0.05)。AUC为0.75〔s=0.09,95%CI(0.58,0.92)〕。28例患者在随访6个月过程中死亡,死亡患者△BNP值为(136±54)ng/L,存活患者为(272±93)ng/L,差异有统计学意义(t=13.023,P<0.05);AUC为0.84〔s=0.05,95%CI(0.74,0.94)〕。53例患者在2年随访过程中死亡,死亡患者△BNP值为(167±74)ng/L,存活患者为(296±105)ng/L,差异有统计学意义(t=8.124,P<0.05);AUC为0.82〔s=0.04,95%CI(0.74,0.89)〕。结论对于肺源性心脏病急性加重期的患者,BNP水平的短期改变能预测患者需要收住ICU的危险,并可以预测患者短期、长期病死率。

Objective To evaluate the role of the short - term changes of B - type natriuretic peptide （ A BNP） in predicting the prognosis of patients with an acute exacerbation of cor pulmonale. Methods BNP levels were determined in 185 patients with acute exacerbation of cor pulmonale at admission and after 48h. Death at a 2 - year follow - up was set as the prima- ry end point and admission to intensive care unit as secondary end points. Results After 48 hours, the BNP levels were signifi- candy decreased than at admission [ （437±291） pg/ml vs. （718±331） pg/ml, P =0. 001]. The ABNP in patients who nee- ded ICU admission were significantly smaller than those did not [ （115±62） pg/ml vs （269 ＋74） pg/ml, P =0. 0061. The A BNP in the admission death group, short - term （ six months） death group, and long - term （ two years） death group were smaller than in the survival group. In the receiver operating characteristic analysis for evaluating the potential of A BNP levels for predicting short - term and long - term mortality rates, the areas under the curve was 0. 84 （ s = 0. 05 ; 95% CI, 0. 74 to 0. 94） and 0. 82 （s = 0.04 ; 95% CI, 0. 74 to 0. 89, respectively）. Conclusion In patients with acute exacerbation of cor pulmona- le, the short - term change of BNP levels is useful for predicting the need for intensive care and short - term and long - term mor- tality.