慢性心力衰竭患者治疗后N端B型利尿钠肽前体水平变化的相关因素及其与1年预后的相关性

Related factors of changes in posttherapeutic N-terminal pro-B-type natriuretic peptide level and their correlation with 1-year prognosis in patients with chronic heart failure

目的探讨慢性心力衰竭(CHF)患者治疗后N端B型利尿钠肽前体(NT-proBNP)水平变化的相关因素及其与1年预后的相关性。方法选择100例CHF患者,均给予利尿、改善心功能等标准化西医治疗。根据治疗前后NT-proBNP下降程度将患者分为下降良好组(n=68)及下降一般组(n=32)。比较两组患者的一般资料,治疗前左心功能指标[左室射血分数(LVEF)、左室舒张末内径(LVEDD)及左室收缩末内径(LVESD)]及其治疗前后差值,采用多因素Logistic回归模型分析影响CHF患者治疗后NT-proBNP水平变化情况的相关因素。随访1年,比较两组患者主要心血管不良事件(MACE)的发生率。结果与下降一般组比较,下降良好组患者年龄更小,病程更短,治疗前后LVEF、LVEDD、LVESD的差值更大(均P<0.05)。多因素Logistic回归分析结果显示,高龄与治疗前后NT-proBNP下降一般有关(P<0.05),而治疗前后LVEDD、LVESD及LVEF差值较大与NT-proBNP下降良好有关(均P<0.05)。下降良好组患者的MACE发生率低于下降一般组(P<0.05)。结论CHF患者的年龄及治疗后的心功能改善程度与治疗前后NT-proBNP水平变化相关,且NT-proBNP下降良好者1年预后更好。

Objective To explore the related factors of changes in posttherapeutic N-terminal pro-B-type natriuretic peptide(NT-proBNP)level and their correlation with 1-year prognosis in patients with chronic heart failure(CHF).Methods One hundred CHF patients enrolled were given standardized western medicine treatment such as diuresis and improving cardiac function.Patients were divided into favorable decline group(n=68)and general decline group(n=32)according to the decline of NT-proBNP before and after treatment.The two groups were compared in terms of general data,pretherapeutic left ventricular indicators(left ventricular ejection fraction[LVEF],left ventricular end-diastolic dimension[LVEDD],and left ventricular end-systolic dimension[LVESD])and the differences between their pre and posttherapeutic values,the multivariate Logistic regression model was employed to analyse the related factors influencing the changes in NT-proBNP level in CHF patients after treatment.After one year of follow-up,the incidence rate of major adverse cardiovascular events(MACE)was compared between the two groups.Results Compared with the general decline group,the favorable decline group had younger cases,shorter duration of disease,and greater differences between pre and posttherapeutic LEVF,LVEDD,or LVESD(all P<0.05).The results of multivariate Logistic regression analysis revealed that advanced age generally correlated with NT-proBNP decline before and after treatment(P<0.05),whereas increased differences between pre and posttherapeutic LVEDD,LVESD,or LVEF correlated with favorable NT-proBNP decline(all P<0.05).The favorable decline group exhibited a lower incidence rate of MACE than the general decline group(P<0.05).Conclusion In CHF patients age and improvements in posttherapeutic cardiac function are related to changes in NT-proBNP level before and after treatment,and those with favorable NT-proBNP decline have better 1-year prognosis.