血尿酸联合N-末端钠尿肽前体对老年急性心力衰竭患者近期不良预后的预测价值

The clinical value of serum uric acid combined with N-terminal pro brain natriuretic peptide in the evaluation of prognosis in eldly patients with acute heart failure

目的:探讨血尿酸联合N-末端钠尿肽前体(NT-proBNP)对老年急性心力衰竭患者近期不良预后的预测价值。方法:前瞻性的收集2015年5月至2017年5月期间,就诊我院的154例老年急性心力衰竭患者为研究对象,按90d内是否出现心力衰竭,再次入院或死亡分为两组(预后不良组和预后良好组)。测定所有研究对象的血尿酸和NT-proBNP水平,同时采用受试者工作曲线(ROC)评价血清尿酸、NT-proBNP以及联合检测对近期预后的评估价值。结果:90d内出现心力衰竭再次入院或死亡的患者共38例,预后不良组和预后良好组患者在年龄、NYHA心功能分级、HGB、尿酸、NT-proBNP等方面,差异有统计学意义(P<0.05);多因素Logistic回归分析结果表明,NYHA心功能分级(OR=1.09,95%CI=1.05~1.13)、尿酸(OR=1.11,95%CI=1.08~1.32)、NT-proBNP(OR=1.22,95%CI=1.13~1.45)是急性心力衰竭患者近期不良预后的预测因素。通过ROC曲线判断血尿酸和NT-proBNP水平对老年急性心力衰竭不良预后诊断的曲线下的面积分别为0.613和0.684,联合检测的曲线下面积为0.757,准确性高于单独检测。结论:血清尿酸联合NT-proBNP对老年急性心力衰竭近期不良预后的预测效能比单一标志物更高。

Objective： To explore the clinical value of serum uric acid combined with NT-proBNP in the evaluation of prognosis in eldly patients with acute heart failure. Methods： A prospective study was conducted in 154 eldly patients with acute heart failure admitted from May 2015 to May 2017 in our hospital. They were indivded into poor prognosis group and good prognosis group,according to heart failure secondary to admission or death in 90 d. The serum uric acid,NT-proBNP in two groups were measured,and the short-term prognostic value of serum uric acid,NT-proBNP and combined test were evaluated by receiver operating curve（ ROC）. Results： There were 38 patients with poor prognosis for all patients. There were significant differences in age,NYHA cardiac function classification,hemoglobin,uric acid and NT-proBNP in the two groups. Multivariate Logistic regression analysis showed that NYHA cardiac function classification（ OR = 1. 09,95% CI =1. 05-1. 13）,uric acid（ OR = 1. 11,95% CI = 1. 08-1. 32） and NT-proBNP（ OR = 1. 22,95% CI = 1. 13-1. 45） were independent predictors of recent poor prognosis in patients with acute heart failure.. The area under the ROC curve of serum uric acid,NT-proBNP were 0. 613,0. 684,and the combined detection of serum uric acid and NT-proBNP were 0. 757. Conclusion： Serum uric acid combined with NT-proBNP was more effective than any single one of them in the evaluation of prognosis in eldly patients with acute heart failure.