血浆脑钠肽对左室射血分数保留的慢性心力衰竭患者预后的预测价值

Predictive value of plasma BNP for prognosis in patients with chronic heart failure preserved ejection fraction

目的:观察血浆脑钠肽(BNP)对左室射血分数保留的慢性心力衰竭(HFpEF)患者的预测价值。方法: 2014年~2016年我院CHF患者122例,根据LVEF,患者被分为LVEF减低心衰(HFrEF)组(LVEF≤40%,41例)、中间值LVEF心衰(HFmEF)组(40%<LVEF<50%,40例)和HFpEF组(LVEF≥50%,41例)。收集、测量比较三组临床资料、血浆BNP水平等指标;ROC曲线分析血浆BNP预测CHF患者短期主要不良终点事件(SMAE)的界值和价值;COX风险回归模型分析预测上述三组SMAE的危险因素。结果: LVEDd:HFpEF组<HFmEF组<HFrEF组,两两比较均有显著差异, P 均=0.001。HFpEF组、HFmEF组LAD显著大于HFrEF组, P 均<0.05。与HFpEF组比较,HFmEF组和HFrEF组的血浆BNP[(789.39±455.62)pg/ml比(1143.40±567.99)pg/ml比(2341.51±1029.99)pg/ml]水平显著升高,且HFrEF组的显著高于HFmEF组, P 均<0.01。多因素Logistic回归结果显示血浆BNP水平是HFmEF、HFrEF患者SMAE事件的独立危险因素(OR=1.006,1.001, P 均<0.05)。ROC曲线分析显示,血浆BNP预测CHF患者SMAE的AUC=0.818,界值为1415pg/ml,敏感度和特异度分别为82.6%和72.7%。三组间住院期间及出院后12个月随访期内的再住院及死亡率无显著差异, P =0.328。结论:血浆BNP对HFmEF和HFrEF患者的短期再入院和死亡事件有良好的预测价值,但不能预测HFpEF患者的终点事件。

Objective: To observe predictive value of plasma brain natriuretic peptide (BNP) for prognosis in patients with chronic heart failure preserved left ventricular ejection fraction (HFpEF). Methods: A total of 122 CHF patients from 2014 to 2016,according to LVEF,patients were divided into LVEF reduced HF (HFrEF) group (LVEF≤40%,n=41),HF with medium LVEF (HFmEF) group (40%<LVEF<50%,n=40) and HFpEF group (LVEF≥50%,n=41). Clinical data,plasma BNP level etc. were measured and compared among three groups;ROC was used to analyze cutoff point of plasma BNP predicting short-term major adverse endpoint (SMAE) in CHF patients. Results: For LVEDd,HFpEF grou P <HFmEF group<HFrEF group,there existed significant difference between any two groups, P =0.001 all. Left atrial diameter (LAD) of HFpEF group and HFmEF group were significantly higher than that of HFrEF group, P <0.05 both. Compared with HFpEF group,there was significant rise in plasma BNP level [(789.39±455.62)pg/ml vs.(1143.40±567.99)pg/ml vs.(2341.51±1029.99) pg/ml] in HFmEF group and HFrEF group,and that of HFrEF group was significantly higher than that of HFmEF group, P <0.01 all. Multifactor Logistic regression indicated that plasma BNP level was independent risk factor for SMAE events in HFmEF and HFrEF patients (OR=1.006,1.001, P <0.05 both). ROC analysis indicated that AUC of plasma BNP predicting SMAE in CHF patients was 0.818,cutoff point was 1415pg/ml,and sensitivity and specificity was 82.6% and 72.7% respectively. There was no significant difference in rehospitalization rate and mortality during hospitalization and within 12-month follow-up after discharge among three groups, P =0.328. Conclusion: Plasma BNP possesses good predictive value for short-term rehospitalization and death events in HFmEF and HFrEF patients,but it can′t predict endpoint events of HFpEF patients.