肾上腺髓质中段肽水平对老年慢性心力衰竭病人的预后评估价值

Value of MR-pro ADM in the prognostic evaluation in the elderly patients with chronic heart failure

目的研究肾上腺髓质中段肽(MR-proADM)水平对老年慢性心力衰竭(CHF)病人的预后评估价值。方法随机入选330例CHF病人,按照纽约心脏协会(NYHA)心功能分级将其分为Ⅱ级120例,Ⅲ级120例,Ⅳ级90例,入组后24 h内及症状缓解后7 d均测定氨基末端B型钠尿肽原(NT-proBNP)、MR-proADM、左室舒张末内径(LVEDD)及左心室射血分数(LVEF),所有病人均随访6个月,以心衰再入院及全因死亡为终点,分为事件组与非事件组,分析MR-proADM对CHF病人的预后评估价值。结果 CHF病人的MR-proADM水平随着心衰病情加重而升高,且与NT-proBNP水平及NYHA分级呈显著正相关,多元逐步COX回归分析显示,MR-proADM、NT-proBNP、LVEF是CHF病人心衰再入院及死亡的独立预测因素。结论 MR-proADM水平对老年CHF病人的预后评估有重要指导意义。

Objective To investigate the value of MR-proADM in the prognostic assessment in elderly patients with chronic heart failure（CHF）.Methods A total of 330 patients with CHF were divided into three groups according to the cardiac function classification of New York Heart Association（NYHA）,with 120 cases of grade Ⅱ,120 cases of grade Ⅲ and 90 cases of grade Ⅳ.24 hours within admission and 7 days after symptom relief,the levels of NT-proBNP,MR-proADM,left ventricular enddiastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF） were detected.All patients were followed up for 6 months,and were divided into cardiac event group and non-cardiac event group according to whether the patients presented with rehospitalization for heart failure or death.The prognostic value of MR-proADM for the patients with CHF was assessed.Results The level of MR-proADM was increased with the aggravation of heart failure.MR-proADM level was significantly positively correlated with NT-proBNP level and NYHA classification in patients with CHF.Multiple stepwise COX regression analysis showed that,MR-proADM,NT-proBNP and LVEF were independent predictors of cardiac events in patients with CHF.Conclusions The level of MR-proADM has important guiding significance for the prognosis evaluation of elderly patients with CHF.