血浆B型钠尿肽和肌钙蛋白Ⅰ在老年急性失代偿性心力衰竭患者中的临床价值

Clinical value of plasma B-type natriuretic peptide and troponin Ⅰ in elderly acute decompensated heart failure patients

目的探讨血浆B型钠尿肽(BNP)和肌钙蛋白Ⅰ(cTnⅠ)在老年急性失代偿性心力衰竭(ADHF)患者中的临床价值。方法选取老年ADHF患者155例;根据心功能分级(NYHA)分为Ⅲ级组83例和Ⅳ级组72例;根据病情转归分为预后良好组106例和预后不良组49例;同期选取老年健康人群30例作为对照组。超声心动图检测左心室舒张末期内径(LVEDD)和左心房内径(LAD)等,进行相关性分析和logistic回归模型分析,采用ROC曲线评估血清cTnⅠ和BNP水平对ADHF患者死亡预测价值。结果心功能Ⅲ级组、Ⅳ级组与对照组血清BNP和cTnⅠ水平比较,差异有统计学意义(P<0.01);预后不良组血清BNP和cTnⅠ水平明显高于预后良好组(P<0.05)。血清BNP和cTnⅠ水平与LVEF呈负相关(r=-0.521,r=-0.535,P<0.01),与LVEDD(r=0.319,r=0.366,P<0.01)和LAD(r=0.282,r=0.293,P<0.05)呈正相关;BNP(OR=3.229,P=0.027)和心功能分级(OR=3.554,P=0.004)是影响ADHF患者预后的独立危险因素;血清BNP和cTnⅠ预测ADHF患者死亡的临界值分别为1700ng/L和0.45μg/L。结论血清BNP和cTnⅠ水平与老年ADHF患者心功能及预后有关,BNP是老年ADHF患者不良预后的危险因素,且对患者死亡有一定预测价值。

Objective To study the clinical value of plasma B-type natriuretic peptide（BNP）and troponin I（cTnⅠ）in elderly acute decompensated heart failure（ADHF）patients.Methods One hundred and fifty-five elderly ADHF patients were divided into NYHA Ⅲgroup（n=83）and NYHAⅣ group（n=72）or into good outcome group（n=106）and poor outcome group（n=49）with 30 healthy old people served as a control group.Their LVEDD and LAD were measured and analyzed by correlation analysis and logistic regression model analysis.The value of serum cTnⅠ and BNP levels in predicting the mortality of ADHF patients was assessed according to their ROC curves.Results The serum BNP and cTnⅠ levels were significantly different in NYHA Ⅲ group and NYHA Ⅳ group（P〈0.01）and were significantly higher in poor outcome group than in good outcome group（P〈0.05）.The serum BNP and cTnⅠ levels were negatively related with LVEF（r=-0.521,r=-0.535,P〈0.01）and positively related with LVEDD and LAD（r=0.319,r=0.366,P〈0.01;r=0.282,r=0.293,P〈0.05）.BNP and NYHA were the independent risk factors for the outcome of elderly ADHF patients（OR=3.229,P=0.027;OR=3.554,P=0.004）.The critical value of BNP and cTnⅠ was 1700 ng/L and 0.45μg/L respectively for predicting the mortality of elderly ADHF patients.Conclusion Serum BNP and cTnⅠ levels are related with the cardiac function and outcome of elderly ADHF patients.BNP is a risk factor for the poor outcome of elderly ADHF patients and can thus be used as a predictor of their mortality.