和肽素联合N末端B型利钠肽原对慢性心力衰竭急性发作失代偿患者预后的预测价值

Predictive value of copeptin combined with N-terminal pro-B-type natriuretic peptide on the prognosis of patients with decompensated acute attack of chronic heart failure

目的探究和肽素和N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)与慢性心力衰竭急性发作失代偿(decompensated acute attack of chronic heart failure,DAACHF)患者病情的关系及二者联合对DAACHF患者预后的预测价值。方法纳入2015年1月至2019年4月西安交通大学第一附属医院诊治的DAACHF患者作为研究对象,将30 d内发生心源性死亡或心力衰竭加重患者纳入心脏事件组(45例),经治疗好转的DAACHF患者纳入好转组(55例)。检测并记录两组患者治疗前后NT-proBNP与和肽素水平,对上述标志物水平与纽约心脏协会(New York Heart Association,NYHA)心功能分级进行相关性分析,并通过受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评估NT-proBNP联合和肽素对DAACHF患者预后的预测价值。结果NYHA心功能分级Ⅲ级的DAACHF患者血清NT-proBNP、和肽素水平均显著低于NYHA心功能分级Ⅳ级患者(均P<0.05)。相关性分析显示,患者血清NT-proBNP及和肽素水平与NYHA心功能分级均呈正相关(均P<0.05)。心脏事件组患者入院当天、治疗后3 d、治疗后7 d的血清NT-proBNP、和肽素水平均显著高于好转组(均P<0.01)。ROC曲线显示,血清NT-proBNP联合和肽素水平对DAACHF患者预后的预测效能高于NT-proBNP及和肽素单独检测。结论血清NT-proBNP及和肽素水平与DAACHF患者病情严重程度关系密切,二者联合检测对DAACHF患者30 d预后的预测效能较高,临床可加强监测。

Objective To explore the relationship between copeptin and N-terminal pro-B-type natriuretic peptide(NT-proBNP)and the condition of patients with decompensated acute attack of chronic heart failure(DAACHF)and their combined predictive value for prognosis.Method DAACHF patients treated in the First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to April 2019 were included as study subjects.Patients with cardiac death or exacerbation of heart failure within 30 days were included in cardiac event group(45 cases),and DAACHF patients who improved after treatment were included in improved group(55 cases).The levels of NT-proBNP and copeptin were detected and recorded before and after treatment in the two groups of patients,and the correlation analysis was conducted between the above markers and New York Heart Association(NYHA)grade,and the predictive value of NT-proBNP and copeptin on the prognosis of DAACHF patients was evaluated through receiver operating characteristic curve(ROC curve).Result Serum NT-proBNP and copeptin levels of DAACHF patients with NYHA gradeⅢwere significantly lower than those of NYHA gradeⅣ(all P<0.05).Correlation analysis showed that serum NT-proBNP and copeptin levels were positively correlated with NYHA grade of cardiac function(all P<0.05).The serum NT-proBNP and copeptin levels of patients in cardiac event group on the day of admission,3 days after treatment,and 7 days after treatment were significantly higher than those in improved group(all P<0.05).The ROC curve showed that the combination of serum NT-proBNP and copeptin levels are more effective in predicting the prognosis of DAACHF patients than NT-proBNP and copeptin alone.Conclusion Serum NT-proBNP and copeptin levels are closely related to the severity of DAACHF patients.The combined detection of the two indicators has a high predictive effect on the 30 days prognosis of DAACHF patients,and clinical monitoring can be strengthened.