连续检测NT-proBNP和hs-cTnI评估心衰患者的预后

The application value of continuous detection of NT-proBNP and hs-cTnI in evaluating the prognosis of patients with heart failure

目的拟探讨连续检测N-端B型钠利尿肽(NT-proBNP)和超敏肌钙蛋白I(hs-cTnI)对心衰患者预后的诊断价值。方法采用回顾性研究的方法,选取符合条件的成年急性心衰患者作为研究对象,通过连续检测住院前5天的NT-proBNP和hs-cTnI的水平及其出院时的水平,采用ROC曲线计算最佳截断值,并分析ICU内610例急性心衰患者的死亡率及心衰相关的再住院率。采用生存图比较截断值对患者预后的价值。结果出院时NT-proBNP最佳截断值为350 ng/L(95%CI:0.551~0.741),hs-cTnI最佳截断值为24 ng/L(95%CI:0.562~0.751)。未再次入院患者存在稳定或降低的hs-cTnI和NT-proBNP浓度。与未再次入院患者相比,心衰相关再次入院患者存在显著性高浓度的hs-cTnI(>24 ng/L)和NT-proBNP(>350 ng/L)。60 d内心衰相关再住院患者存在显著性连续性高浓度的hs-cTnI和NT-proBNP,但住院后前5 d呈增多趋势的hs-cTnI和NT-proBNP并不显著性增加1年内心衰相关再住院的预后价值。结论出院时hs-cTnI和NT-proBNP浓度连续增高的患者60 d内发生心衰相关事件的风险增加。

Objective To investigate the application value of continuous detection of N-terminal proBNP(NT-proBNP)and high sensitive cardiac troponin I(hs-cTnI)in evaluating the prognosis of patients with heart failure(HF).Methods The clinical data of 610 patients with acute HF who were treated in our hospital were retrospectively analyzed.The levels of NT-proBNP and hs-cTnI at consecutive days before admission and in discharging from hospital were detected.Moreover the ROC curve was used to calculate the best cut-off value,and the death rate and readmission rate about the 610 patients in ICU were analyzed.Results The best cut-off value of NT-proBNP in discharging from hospital was 350ng/L(95%CI:0.551~0.741),and that of hs-cTn was 24ng/L(95%CI:0.562~0.751).The patients without readmission had relatively stable or decreased hs-cTnI and NT-proBNP levels.As compared with the patients without readmission,the hs-cTnI and NT-proBNP levels were significantly increased in the patients with readmission due to HF.Moreover the hs-cTnI and NT-proBNP levels were significantly increased in the patients with readmission due to HF within 60-day.However the increase of hs-cTnI and NT-proBNP levels at the first 5 days after admission did not increase the predictive value of HF-related within 1 year.Conclusion The research results demonstrate that the risk of 60-day HF-related events will increase in the patients with increase of hs-cTnI and NTproBNP levels in discharging from hospital.