血浆脑钠肽对老年急性失代偿性心力衰竭患者再入院的预测价值

The predictive value of brain natriuretic peptide for acute decompensated heart failure in rehospitalized elderly patients

目的探讨血浆脑钠肽（BNP）水平变化在预测老年急性失代偿性心力衰竭（ADHF）患者再入院风险中的价值。方法选择2015年6月至2016年6月因ADHF住院的老年（≥65岁）患者48例进行队列研究。入组患者均进行内科标准治疗，好转出院后随访1个月。依据患者出院时和出院后1个月门诊复查的BNP水平差异，分为BNP增高组20例和BNP未增高组28例。比较两组的一般资料、病史、循环淤血的体征、超声心动、BNP水平等。结果与BNP未增高组比较，BNP增高组患者患2型糖尿病、肝颈静脉回流征阳性、颈静脉怒张比例高（χ2分别为5.749、7.243、4.286，均P〈0.05或P〈0.01），而左心室射血分数水平更低（t＝－3.558，P〈0.01）。BNP增高组患者出院后1个月的BNP水平、再入院率高于未增高组[（394.2 ± 171.3）ng/L比（94.2 ± 56.3）ng/L，P〈0.01；11例（55%）比5例（17.8%），P〈0.01]。多因素COX回归分析结果显示，出院后1个月BNP浓度增高与再入院风险增高相关（HR＝4.118，95%CI：1.427～11.884，P〈0.01）。血浆BNP增高幅度达到310.0 ng/L时，预测老年ADHF患者再入院的风险增加。结论出院后1个月，BNP水平增高是老年ADHF患者再入院的有效预测因子。

To evaluate changes in brain natriuretic peptide（BNP）levels in predicting the risk of acute decompensated heart failure（ADHF）in rehospitalized elderly patients.MethodsA cohort study was performed in 48 elderly（≥65 years）patients hospitalized for ADHF from June 2015 to June 2016.All patients underwent standard treatment in internal medicine and were followed up for one month after discharge.The study endpoint was rehospitalization for ADHF.According to whether there was an increase in BNP levels in one-month follow-up, participants were divided into two groups： a group with increased BNP（n=20）and a group without increased BNP（n=28）. General clinical information, disease history, signs of circulatory congestion, cardiac ultrasound, and BNP levels were collected and compared between the two groups.ResultsCompared with the group without increased BNP, the group with increased BNP had higher rates of type 2 diabetes, positive hepatojugular reflux, and jugular vein engorgement（χ2=5.749, 7.243, 4.286, respectively, P〈0.05 or P〈0.01）and lower left ventricular ejection fraction（t=-3.558, P〈0.01）. BNP increase in the BNP group was higher than in the non-BNP group（394.2±171.3 ng/L vs.94.2±56.3 ng/L, P〈0.01）. The rehospitalizationrate in the BNP group was significantly higher than in the non-BNP group（55% or 11 patients vs.17.8% or 5 patients, P〈0.01）. Multivariate Cox regression analysis found that the increase in BNP in the one-month follow-up was correlated with the increase in rehospitalization（HR=4.118, 95%CI： 1.427-11.884, P〈0.01）. When the absolute value of BNP rose to over 310ng/L, the risk of rehospitalization in ADHF patients increased.ConclusionsIncrease in BNP one month after discharges is an effective predictor for rehospitalization in elderly patients with ADHF.