脑利钠肽与甲状腺激素水平对超高龄老年心力衰竭患者心功能及预后的评估价值

Value of brain natriuretic peptide and thyroid hormone in evaluation the cardiac function and prognosis of superaged patients with congestive heart failure

目的：探讨血浆脑利钠肽（BNP）和甲状腺激素水平对超高龄老年患者心力衰竭严重程度及预后的评估价值。方法将46例超高龄老年充血性心力衰竭患者依照心功能分级分为Ⅰ～Ⅳ级4组，测定血清中FT3、FT4、TSH及BNP水平。并随访1年，临床终点为心源性死亡。评价各检测指标与心力衰竭程度及预后的关系。结果随着NYHA心功能分级的增加，FT3逐渐降低，BNP逐渐升高（均P＜0.05），而FT4、TSH变化不明显。在1年的随访中发生心源性死亡13例，11例失访，回归分析示BNP值越高，FT3越低的患者越易死亡。结论血浆BNP和FT3是评估超高龄老年心力衰竭严重程度及预后的良好指标。

Objective To investigate the value of brain natriuretic peptide （BNP） and thyroid hor-mone level for cardiac function and prognosis in super-senior elder patients with congestive heart failure （CHF）. Methods according to the New York Heart Association （NYHA）cardiac functional standard,46 super-senior elder patients were divided into 4 groups,gradeⅠ gradeⅡ,Ⅲand Ⅳ groups. The serum levels of free triiodothyronine （FT3 ）,free thyroxine （FT4 ）,thyroid-stimulating hormone （TSH）and BNP were measured in patients. All patients were monitored for one year.Cardiac death was defined as end-point.The re-lationship between serum thyroid hormone,BNP and cardiac function and prognosis were evaluated.Results With the increase of the cardiac functional grade,there were significant differences in serum levels of FT3, BNP in 4 groups （P＆lt;0.05 ）. The serum levels of FT3 significantly decreased,and BNP significantly increased with the improvement of increased cardiac function. But there were no significant differences in FT4 and TSH.1 3 patients died during this monitored period,1 1 patients were lost to follow-up.Logistic regression analysis showed that patients more prone to death when BNP became higher and FT3 lower. Conclusion The levels of plasma BNP and thyroid hormone can be used as the indicators to evaluate the extent of cardiac function and prognosis in super-senior elder CHF patients.