N末端脑钠肽前体与脑钠肽比值对急性失代偿性心力衰竭患者预后的评估价值

Value of ratio of N-terminal Pro-brain natriuretic peptide to brain natriuretic peptide on evaluating prognosis of patients with acute decompensated heart failure

目的探究N末端脑钠肽前体与脑钠肽比值对急性失代偿性心力衰竭(acute decompensated heart failure,ADHF)患者预后的评估价值。方法选取惠东县第二人民医院2013年1月至2014年1月收治的167例ADHF患者,采用酶联免疫吸附试验测定患者治疗前(T0)、治疗1 d(T_1)、5 d(T_2)、10 d(T_3)的血浆N末端脑钠肽前体、脑钠肽浓度,并对患者进行随访,统计记录2年内患者的存活率。比较存活患者和死亡患者的N末端脑钠肽前体与脑钠肽比值和N末端脑钠肽前体、脑钠肽浓度,并采用受试者工作特征曲线(receiver operator charac-teristic curve,ROC)分析ADHF患者N末端脑钠肽前体与脑钠肽比值与血浆N末端脑钠肽前体、脑钠肽浓度对患者预后的评估价值。结果 ADHF患者T_1、T_2、T_3治疗期间与T_0比较,N末端脑钠肽前体与脑钠肽比值和血浆N末端脑钠肽前体、脑钠肽浓度的均降低,差异有统计学意义(P<0.05)。死亡患者T_0、T_1、T_2、T_3时的N末端脑钠肽前体与脑钠肽比值和血浆N末端脑钠肽前体、脑钠肽浓度均是高于存活患者,差异有统计学意义(P<0.01)。ROC分析结果显示,ADHF患者N末端脑钠肽前体与脑钠肽比值和血浆N末端脑钠肽前体、脑钠肽浓度对患者预后评估的敏感度分别为96.01%、79.26%和74.89%,准确性分别为98.41%、86.33%和85.82%;N末端脑钠肽前体与脑钠肽比值预测ADHF患者预后情况的敏感度和准确度均高于血浆N末端脑钠肽前体、脑钠肽浓度,差异均有统计学意义(χ~2=12.946、10.350,P<0.01;χ~2=17.938、10.912,P<0.01)。而血浆N末端脑钠肽前体与脑钠肽浓度评估ADHF患者预后情况的评估价值比较,差异无统计学意义(χ~2=0.540、0.011,P=0.462、0.917)。结论 N末端脑钠肽前体与脑钠肽比值和血浆N末端脑钠肽前体、脑钠肽浓度对评估ADHF患者预后的价值均不错,其中N末端脑钠肽前体与脑钠肽比值更为准确,因此,N末端脑钠肽前体与脑钠肽比值在一定程度上可作为ADHF患者预后评估的参考指标。

Objectives To explore the value of ratio of N-terminal Pro-brain natriuretic peptide（NT-pro-BNP）tobrain natriuretic peptide（BNP）on evaluating prognosis of patients with acute decompensated heart failure（ADHF）.Methods From January 2013 to January 2014,167 patients with ADHF were admitted in The Second People′sHosipotal of Huidong City.Plasma concentrations of NT-pro BNP,BNP were measured using enzyme-linkedimmunosorbent assay before treatment（T0）,one day（T1）,5 days（T2）,10（T3）after treatment.Survival rate ofpatients during 2 years follow-up was recorded.Ratio of NT-pro BNP to BNP and plasma concentrations of NT-pro BNP,BNP of survival patient and dead patients were compared.Receiver operator characteristic curve（ROC）was used toanalyze the value of raito of NT-pro BNP to BNP and plasma concentrations of NT-pro BNP,BNP on evaluating prognosisof patients with ADHF.Results Raito of NT-pro BNP to BNP and plasma concentrations of NT-pro BNP,BNP in T1,T2,T3 of patients with ADHF were significantly lower than those in T0（P〈0.01）.Raito of NT-pro BNP to BNP andplasma concentrations of NT-pro BNP,BNP in T1,T2,T3 of survival patients were significantly higher than those ofdead patients（P〈0.01）.ROC indicated that sensitivities of ratio of NT-pro BNP to BNP and plasma concentrations of NT-pro BNP,BNP to evaluate prognosis of patients with ADHF were 96.01%,79.26%,74.89%,and accuracies were98.41%,86.33%,85.82%.Sensitivity and accuracy of ratio of NT-pro BNP to BNP in evaluating prognosis of pa-tients with ADHF were higher than those of plasma concentrations of NT-pro BNP,BNP（χ2=12.946,10.350,P〈0.01;χ2=17.938,10.912,P〈0.01）,while they had no differences between plasma concentrations of NT-pro BNP and BNP（χ2=0.540,0.011,P=0.462,0.917）.Conclusions Ratio of NT-pro BNP to BNP and plasma concentrations of NT-pro B-NP,BNP to evaluate prognosis of patients with ADHF are good.Ratio of NT-pro BNP to BNP has better accuracy,andit can be used as an reference index for evaluation of the prognosis in patients with ADHF.