血浆NT-proBNP对高龄收缩性心力衰竭急性失代偿期患者预后判断价值

Predictive value of plasma NT-pro BNP to prognosis in elderly patients with acute decompensated systolic heart failure

目的探讨血浆N末端脑钠肽前体（NT-pro BNP）对高龄收缩功能不全性心力衰竭（SHF）急性失代偿期患者预后判断价值。方法纳入128例SHF急性失代偿期高龄患者,根据NT-pro BNP数值四分位数法分成四组,为Q1~Q4组,每组32例,随访6月。依据预后结局不同分为：对照组（70例）,未再入院;研究组（58例）,再入院或死亡。比较组间左室射血分数（LVEF）、左室缩短率（LVFS）、左室收缩末期容量指数（LVESVI）、6分钟步行距离及再入院率与死亡率的差异。应用受试者工作曲线（ROC）分析NT-pro BNP对预后的最佳预测值。结果 Q1~Q4组的LVESVI、再入院率及死亡率顺序依次为：Q4最高、Q3次之、Q1最低（P〈0.05）,而LVEF、LVFS及6分钟步行距离水平顺序依次为：Q1最高、Q2次之、Q4最低（P〈0.05）。随访6月时,与对照组比较,研究组患者NT-pro BNP及LVESVI显著增高（P〈0.05）,而LVEF、LVFS及6分钟步行距离则降低（P〈0.05）。ROC曲线显示NT-pro BNP对患者短期发生死亡的曲线下面积（AUC）为0.826,血浆NT-pro BNP≤205 ng/L死亡率高于NT-pro BNP〉205ng/L。结论 NT-pro BNP能独立评估SHF急性失代偿期高龄患者的病情及近期预后结局。

Objective To investigate the predictive value of plasma N-terminal pro brain natriuretic peptide （NT-proBNP） to prognosis in elderly patients with acute decompensated systolic heart failure （ADSHF）. Methods ADSHF patients （n=128） were chosen and divided into 4 groups （Q1 group to Q4 group, each n=32）. After followed up for 6 m and according to prognosis, the patients were divided into control group （n=70, non-readmission） and research group （n=58, readmission or death）. The difference in left ventricular ejection fraction （LVEF）, left ventricular fraction shortening （LVFS）, left ventricular end-systolic volume index （LVESVI）, 6-minute walk test （6MWT）, readmission rate and mortality were compared among all groups. The best predictive value of NT-proBNP to prognosis was analyzed by using receiver operating curve （ROC）. Results LVESVI, readmission rate and mortality were in a descending order from Q4 group, Q3 group to Q1 group （P〈0.05）, and LVEF, LVFS and 6MWT were in a descending order from Q1 group, Q2 group to Q4 group （P〈0.05）. After follow-up for 6 m, NT-proBNP and LVESVI increased significantly （P〈0.05）, and LVEF, LVFS and 6MWT decreased （P〈0.05） in research group compared with control group. ROC analysis showed that area under curve （AUC） of short-term mortality predicted by NT-proBNP was 0.826. The mortality of patients with NT-proBNP≤205 ng/L was higher than those with NT- proBNP〉205 ng/L. Conclusion NT-proBNP can independently review the severity and short-term prognosis in patients with ADSHF.