N末端B型钠尿肽前体对急性心力衰竭患者病死率的预测价值

Value of serum NT-proBNP level in predicitng the mortality of acute heart failure patients

目的比较入院N末端B型钠尿肽前体(NT-proBNP)和出院NT-proBNP对急性心力衰竭患者6个月病死率的预测价值。方法选择在本院住院治疗的70例急性失代偿性收缩期心力衰竭患者,根据出院后6个月生存情况将患者分为幸存组52例和非幸存组18例,进行回顾性分析,确定哪些NT-proBNP参数最能预测6个月的全因病死率。结果 70例患者中18例在6个月的随访中死亡,病死率为25.7%。与幸存组比较,非幸存组患者年龄、心房颤动、心肌梗死、肌酐、直接胆红素、入院NT-proBNP、出院NT-proBNP、入院-出院NT-proBNP降低率显著增高,仰卧收缩压和仰卧舒张压显著降低,差异有统计学意义(P<0.05,P<0.01)。ROC曲线分析结果显示,出院NT-proBNP的曲线下面积(AUC)=0.702,95%CI:0.643～0.757,P<0.01;入院NT-proBNP的AUC=0.633,95%CI:0.580～0.684,P=0.006;入院-出院NT-proBNP的AUC=0.620,95%CI:0.556～0.681,P=0.008。出院NT-proBNP的AUC显著高于入院NT-proBNP和入院-出院NT-proBNP,差异有统计学意义(P=0.022,P=0.024)。logistic回归分析显示,出院NT-proBNP和入院-出院NT-proBNP降低率均可独立预测6个月全因病死率。结论出院NT-proBNP是急性心力衰竭患者出院6个月病死率的最强预测因子。

Objective To compare the value of serum NT-proBNP level at admission and discharge in predicting the 6-month mortality of acute heart failure(AHF)patients.Methods Seventy AHF patients admitted to our hospital from September 2016 to April 2018 were divided into survival group(n=52)and non-survival group(n=18).Their clinical data were retrospectively analyzed to identify which NT-proBNP parameters can predict their 6-month mortality.Results Of the 70 AHF patients included in this study,18 died during the 6-month follow-up period with a mortality of 25.7%.The age was significantly oder,the incidence of AF and myocardial infarction and the serum levels of creatinine,direct bilirubin,NT-proBNP at admission and discharge were significantly higher while the surpine SBP and DBP were significantly lower in non-survival group than in survival group(P<0.05,P<0.01).ROC curve analysis showed that the area under the ROC curve for NT-proBNP at discharge and admission was 0.702 and 0.633 respectively(95%CI:0.643-0.757,P<0.01;95%CI:0.580-0.684,P=0.006)and was significantly larger at discharge than at admission(P=0.022,P=0.024).Logistic regression analysis showed that the serum NT-proBNP level at dischare and admission was an independent predictor for the 6-month mortality of AHF patients.Conclusion The serum NT-proBNP level at discharge is an independent predictor for the 6-month mortality of AHF patients.