血浆B型脑钠肽在急性呼吸道感染合并心力衰竭患者动态变化及对预后的影响

Dynamic change of plasma B-type brain natriuretic peptides in acute respiratory tract infection patients com- plicated with congestive heart failure and its infuence on prognosis

目的探讨B型脑钠肽（BNP）在急性呼吸道感染合并心力衰竭（CHF）患者中的变化及对预后的影响。方法选取262例急性呼吸道感染合并CHF患者（CHF组），其中Ⅱ级68例，Ⅲ级92例，Ⅳ级102例；同期住院的老年急性呼吸道感染但无CHF的患者200例作为对照人群（非CHF组），进行BNP检测及心脏左室射血分数（LVEF）、左室舒张末期内径（LVEDD）监测，对住院1个月后再次入院率及病死率进行分析。结果非CHF组患者BNP、LVEF、LVEDD分别为（526．12±11．18）pmol／L、（65．67±6．28）％、（37．76±5．59）mm，CHF组为（1522．03±42．27）pmol／L、（36．62±8．83）％、（52．89±5．22）mm，两组差异有统计学意义（P〈0．05）；CHFⅢ级与Ⅱ级、Ⅳ级与Ⅱ级在BNP、LVEF、LVEDD等指标差异有统计学意义（P〈0．05）；CHF患者出院时BNP〈400pmol／L183例为低浓度组，BNP≥400pmol／L79例为高浓度组，1个月后再次入院率低浓度组为6．57％（12／183），高浓度组为39．24％（31／79），高浓度组病死率5．06％，低浓度无死亡，再次人院率及病死率均差异有统计学意义（P〈O．05）。结论BNP的动态变化能较好的预测急性呼吸道感染合并CHF患者的预后。

Objective To explore the dynamic change of plasma B-type brain natriuretic peptides （BNP） in acute respiratory tract infection patients complicated with congestive heart failure（CHF） and its infuence on progno- sis. Methods 262 acute respiratory tract infection patients complicated with CHF （CHF group） were selected, in which 68 cases are grade Ⅱ,92 cases are grade Ⅲ, 102 cases are grade Ⅳ. 200 elderly acute respiratory tract infec- tion patients without CHF were selected as control group（ non CHF group）. The BNP was tested and left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter（LVEDD） were monitored. The readmissions and mor- tality 1 month after the patients admitted to the hospital were analyzed. Results BNP, LVEF, LVEDD of non CHF group were （526.12 ± 11.18） pmo]/L, （ 65.67 ± 6.28 ） %, （ 37.76 ± 5.59 ） mm, respectively, and those in the CHF group were （ 1 522.03 ±42.27 ） pmol/L, （ 36.62 ± 8.83 ） % , （ 52.89 ± 5.22 ） mm, there were significant differences between the two groups（ P 〈 0.05 ）. BNP, LVEF, LVEDD and some other indicators between grade Ⅲ and grade Ⅱ , grade Ⅳ and grade Ⅱ had significant differences （P 〈 0.05 ）. According to the BNP concentration determination of CHF patients when discharged,choose 183 cases of BNP 〈 400 pmol/L as low concentration group, and 79 cases of BNP≥400pmol/L as high concentration group. One month later, readmission rate of low concentration group was 6. 57% （ 12/183 ）, and 39.24% in high concentration group （ 31/79 ）. Mortality of high concentration group was 5.06%. Readmission rate and mortality were significantly different between the two groups （ P 〈 O. 05 ）. Conclusion The dynamic change of plasma BNP can better predict the prognosis of acute respiratory tract infection patients complicated with CHF.