血浆皮质醇对慢性心力衰竭患者预后的预测价值

Evaluation of serum cortisol as a predictor of cardiac events in patients with chronic heart failure

目的:探讨慢性心力衰竭(CHF)患者血浆皮质醇(COR)水平与预后的关系。方法:连续入选278例CHF患者,测定血浆去甲肾上腺素(NE)、脑钠肽(BNP)、肾素(REN)、C反应蛋白(CRP)和COR水平。进行24个月随访,根据有无心脏事件(心脏性猝死和再住院)分为事件组(39)和无事件组(239例),比较两组血浆NE、BNP、REN、CRP和COR水平,逐步回归分析心血管事件的独立预测因子,及COR对CHF心血管事件的预测价值。结果:事件组血浆COR水平显著高于无事件组[(15.1±6.2)μg/dl︰(10.5±4.8)μg/dl,P=0.01]。逐步回归分析显示,血浆BNP、REN、CRP和COR是CHF患者心血管事件的独立预测因子(均P<0.05)。高COR(≥15.5μg/dl)并高BNP(≥306.2pg/ml)水平患者心血管事件发生的危险是低COR并低BNP患者的7.4倍(P=0.001)。结论:血浆COR可能是CHF心血管事件的独立预测因子,与BNP联合对CHF预后具有较高预测价值。

Objective：To evaluate the predictive value of plasma cortisol（COR）level for cardiac events in patients with chronic heart failure（CHF）.Method：Consecutive 278 CHF patients were studied and plasma levels of BNP,CRP,REN,NE and COR were measured.According to the cardiac events at 24-month follow-up,patients were divided into event-group（n=39）and non-event group（n=239）.Result：Plasma levels of BNP,CRP,REN,and COR were significantly higher in event-group than in non-event group.High levels of BNP,REN,CRP and COR were independent predictors of cardiac events in CHF（all P〈0.05）.Patients with serum COR≥15.5μg/dl and BNP≥306.2pg/ml,had a 7.4-fold higher cardiac event risk than patients with low levels of COR and BNP（P=0.001）.Conclusion：Serum COR level might be an independent predictor of cardiac events in CHF patients,and could get a better predictive value for cardiac events in combination with BNP.