NT-proBNP、HRV应用于冠心病心力衰竭患者的预后判断研究

Study on the application of NT-proBNP and HRV in prognosis judgement for patients with coronary heart disease and heart failure

目的探讨NT-proBNP、HRV在冠心病心力衰竭患者的预后判断的价值。方法选择2017年1月—2018年6月本院治疗的40例冠心病心力衰竭、40例单纯冠心病及同期40名健康体检者作为研究对象。将40例冠心病心力衰竭作为观察组A;40例单纯冠心病作为观察组B,同期40名健康体检者作为对照组,共三组。观察三组的NT-proBNP水平和24 h内HRV指标的变化,并分析其对冠心病心力衰竭患者预后判断的价值。结果A、B两组的NT-proBNP水平明显高于对照组,A组显著高于B组,三组互相比较差异均有统计学意义(P<0.05)。A、B两组在24 h内HRV指标明显低于对照组,A组显著低于B组,三组互相比较差异均有统计学意义(P<0.05)。血浆NT-proBNP水平随着心功能级别的增加而增高,而HRV各项指标随着心功能级别的增加而降低。心功能分级中的Ⅱ级、Ⅲ级、Ⅳ级之间相互比较均有显著性差异(P<0.05),对三组患者进行为期一年的随访,随访期间均无失访者,单纯冠心病和健康者组均无患者死亡病例,其中,冠心病伴心力衰竭组有9例患者心源性死亡,有7例患者在急性症状开始60 min内死亡。死亡者和存活者血浆NT-ProBNP和转化BNP浓度比较,并无统计学差异(P>0.05)。结论NT-proBNP水平升高,HRV降低的程度则可反映冠心病心力衰竭患者的心衰程度,NT-proBNP、HRV均能有效检测心脑血管疾病,具有重要的临床研究价值。

Objective To analyze the value of NT-proBNP combined with HRV in prognosis judgement for patients with coronary heart disease and heart failure.Methods From January2017 to June 2018,40 patients with coronary heart disease and heart failure,40 patients with coronary heart disease,and 40 people received healthy physical examination in our hospital were selected as research subjects.Th 40 patients with coronary heart disease and heart failure were enrolled in observation group A,the 40 patients with coronary heart disease were enrolled in the observation group B,and the 40 people received healthy physical examination were enrolled in the control group.The levels of NT-proBNP and the change of HRV index within 24 hours of the three groups were observed,the value of the in prognosis judgement for patients with coronary heart disease and heart failure was analyzed.Results The levels of NT-proBNP in group A and group B were significantly higher than that in control group,the level of Group A was significantly higher than that of group B,the differencesamong the three groups were statistically significant(P<0.05).The HRV index in group A and groupBwere significantly lower than that in the control group within 24 hours,and that in the groupA was significantly lower than the groupB,the differencesamong the three groups were statistically significant(P<0.05).Plasma NT-proBNP levels increased with the increasing cardiac function levels,while HRV indicators decreased with increasing cardiac function levels.There were statisticallysignificant differences among grade II,grade III and grade IV in cardiac function grading(P<0.05).Three groups of patients were followed up for one year.There were no cases of loss of follow-up during the follow-up period.There were no deaths in patients with coronary heart disease and healthy subjects.Among patients with coronary heart disease and heart failure,9 dead of cardiac death.Seven patients died within 60 minutes of the onset of acute symptoms.There was no significant difference in plasma NT-ProBNP and transformed BNP between the dead and the survivors(P>0.05).Conclusions The increase of NT-proBNP,and the degree of HRV reduction could reflect the degree of heart failure in patients with coronary heart disease.Both NT-proBNP and HRV could effectively detect cardiovascular and cerebrovascular diseases,and have important clinical research value.