心肌肌钙蛋白I、利钠肽对急性心力衰竭患者预后的预测价值研究

Predictive Value of c TnI and BNP on Prognosis of Patients with Acute Heart Failure

目的探讨心肌肌钙蛋白I(cTnI)、利钠肽(BNP)对急性心力衰竭(AHF)患者预后的预测价值。方法选取2011年2月—2014年1月济宁市鱼台县人民医院收治的AHF患者147例作为AHF组,根据美国纽约心脏病学会(NYHA)心功能分级标准分为Ⅲ级组86例,Ⅳ级组61例;根据患者转归情况分为预后良好组101例,预后不良组46例。另选取同期在本院体检健康者30例作为对照组。比较Ⅲ级组、Ⅳ级组及对照组受试者入院时血清cTnI、BNP、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平及入院24 h内心功能指标〔左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心房内径(LAD)〕,比较预后良好组与预后不良组患者入院时血清cTnI、BNP水平;分析入院时血清cTnI、BNP水平与AHF患者心功能指标、预后的关系,并绘制ROC曲线评价入院时血清cTnI、BNP水平对AHF患者死亡的预测价值。结果Ⅲ级、Ⅳ级组患者入院时血清cTnI、BNP水平高于对照组(P<0.05);Ⅲ级、Ⅳ级组及对照组受试者入院时血清CK、CK-MB水平比较,差异无统计学意义(P>0.05);Ⅲ级组患者入院时血清cTnI、BNP水平低于Ⅳ级组(P<0.05)。Ⅲ级、Ⅳ级组患者入院24 h内LVEF低于对照组,LVEDd、LAD高于对照组(P<0.05);Ⅲ级组患者入院24 h内LVEF高于Ⅳ级组,LVEDd、LAD低于Ⅳ级组(P<0.05)。AHF组患者入院时血清cTnI水平与LVEF呈负相关(r=-0.527,P<0.05),与LVEDd、LAD呈正相关(r值分别为0.443、0.406,P<0.05);血清BNP水平与LVEF呈负相关(r=-0.542,P<0.05),与LVEDd、LAD呈正相关(r值分别为0.416、0.372,P<0.05)。预后良好组患者入院时血清cTnI、BNP水平低于预后不良组(P<0.05)。入院时血清cTnI水平预测AHF患者死亡的ROC曲线下面积为0.814〔95%CI(0.614,0.862)〕,当其为0.4μg/L时,灵敏度为55.72%,特异度为88.96%,诊断指数为1.447;入院时血清BNP水平预测AHF患者死亡的ROC曲线下面积为0.869〔95%CI(0.733,0.931)〕,当其为1 600 ng/L时,灵敏度为69.15%,特异度为85.30%,诊断指数为1.545。结论血清cTnI、BNP水平与AHF患者病情严重程度、心功能及预后有关,且血清cTnI、BNP水平对AHF患者预后具有一定的预测价值。

Objective To explore the predictive value of cTnl and BNP on prognosis of patients with acute heartfailure. Methods From February 2011 to January 2014, a total of 147 patients with acute heart failure were selected asobservation group in the Peopled Hospital of Yutai County, Jining, there into 86 cases with IE - grade NYHA cardiac functionalgrading were served as A group, others 61 cases with IV - grade NYHA cardiac functional grading were served as B group, 101cases with good prognosis were served as C group, 46 cases with poor prognosis were served as D group ; meanwhile a total of 30healthy people admitted to this hospital for physical examination were selected as control group. Serum levels of cT nl, BNP, CK and CK-MB at admission,LVEF, LVEDd and LAD within 24 hours after admission were compared among A group, B group andcontrol group, meanwhile serum levels of cTnl and BNP at admisson were compared between C group and D group; of patientswith acute heart failure, correlations between serum level of cTnl, of BNP and index of cardiac function, prognosis wereanalyzed, and ROC curve was drawn to evaluate the predictive value of serum levels of cTnl and BNP on death in patients withacute heart failure. Results Serum levels of cTnl and BNP of A group and B group were statistically significantly higher thanthose of control group at admission （ P 〈 0. 05 ） , while no statistically significant differences of serum level of CK or CK-MB wasfound among A group, B group and C group （ P 〉 0. 05 ） ; serum levels of cTnl and BNP of A group were statisticallysignificantly lower than those of control group at admission （ P 〈 0. 05 ） . Within 24 hours after admission, LVEF of A group andB group was statistically significantly lower than that of control group, respectively, while LVEDd and LAD of A group and Bgroup were statistically significantly higher than those of control group （ P 〈 0.05 ） ; LVEF of A group was statisticallysignificantly higher than that of B group, while LVEDd and LAD of A group were statistically significantly lower than those of Bgroup （ P 〈 0.05 ） . Of patients with acute heart failure, serum cTnl level at admission was negatively correlated with LVEF （ r= - 0 .527 , P 〈 0 . 05 ） , was positively correlated with LVEDd and LAD, respectively （ r = 0 .443 , 0 .40 6 , P 〈 0 . 05 ） ; serumBNP level at admission was negatively correlated with LVEF （ r = - 0. 542, P 〈 0.05 ） , was positively correlated with LVEDdand LAD, respectively （ r = 0.416 ,0 .372 , P 〈 0 .05 ） . Serum levels of cTnl and BNP of C group were statisticallysignificantly lower than those of D group at admission （ P 〈 0.05 ） . The AUC of serum cTnl level at admission in predicting deathin patients with acute heart failure was 0. 814 [95% Cl （ 0 .614 ,0. 862 ） 〕, when it was 0. 4 μg/L, the sensitivity was55. 7 2 % , the specificity was 88. 96% , the diagnosis index was 1. 447 ; the AUC of serum BNP level at admission in predictingdeath in patients with acute heart failure was 0. 869 [95% Cl （0.733 , 0. 931）〕, when it was 1600 ng/L , the sensitivity was69. 15% , the specificity was 85. 30% , the diagnosis index was 1. 545. Conclusion Serum levels of cTnl and BNP are closelycorrelated with the disease severity, cardiac function and prognosis of patients with acute heart failure, both of them have certainpredictive value on the prognosis.