钠尿肽和肌酐及体质量指数对慢性心力衰竭远期心脏事件的预测价值

Predictive value of natriuretic peptide,serum creatinine and BMI for long-term cardiac events in patients with chronic heart failure

目的探讨临床中预测慢性心力衰竭(心衰)长期预后指标的应用价值。方法选取2015年8月至2018年8月安徽省第二人民医院心内科及合肥市第三人民医院心内科住院的慢性心衰患者120例,根据36个月随访结果分为死亡组40例,生存组80例。比较2组临床资料,用多因素logistic回归分析慢性心衰的危险因素,ROC曲线评估相关指标对慢性心衰死亡风险的预测价值。结果与死亡组比较,生存组舒张压、体质量指数(BMI)更高,心率、肌酐、钠尿肽水平更低(P<0.05,P<0.01)。多因素logistic回归分析显示,钠尿肽、BMI、肌酐是慢性心衰患者随访36个月死亡的独立危险因素(P<0.01)。ROC曲线分析显示,钠尿肽、BMI、肌酐对慢性心衰随访36个月全因死亡事件预测的曲线下面积(AUC)为0.794(95%CI:0.703~0.885,P<0.01)、0.674(95%CI:0.574~0.774,P<0.01)、0.792(95%CI:0.704~0.879,P<0.01),钠尿肽+BMI+肌酐三者联合的AUC为0.899(95%CI:0.845~0.953,P<0.01),预后价值优于单一指标(P<0.01)。结论钠尿肽、BMI、肌酐是慢性心衰长期预后的独立影响因素,钠尿肽、肌酐对慢性心衰远期病死率具有整体的不良影响,BMI有利于慢性心衰患者的长期预后。

Objective To investigate the application value of clinical indicators in predicting long-term prognosis of chronic HF.Methods A total of 120 patients with chronic HF hospitalized in the cardiology departments of the Second People’s Hospital of Anhui Province and Third People’s Hospital of Hefei from August 2015 to August 2018 were enrolled in this study.According to the outcomes of 36 months’follow-up,they were divided into a death group of 40 cases and a survival group of 80 cases.The clinical data were compared between two groups.The risk factors of chronic HF were screened by multivariate logistic regression analysis.ROC curve was drawn to evaluate the predictive value of related indicators on the risk of death in the patients.Results Compared with the death group,diastolic blood pressure and BMI were significantly higher,while heart rate,creatinine and natriuretic peptide levels were obviously lower in the survival group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that natriuretic peptide,BMI,and creatinine were independent risk factors for death in patients with chronic HF after 36 months of follow-up(P<0.01).ROC curve analysis indicated that the AUC of natriuretic peptide,BMI,and creatinine for the prediction of all-cause mortality for chronic HF patients in 36-month follow-up were 0.794(95%CI:0.703-0.885,P<0.01),0.674(95%CI:0.574-0.774,P<0.01),0.792(95%CI:0.704-0.879,P<0.01),and the AUC of their combination was 0.899(95%CI:0.845-0.953,P<0.01),with its prognostic value better than a single index(P<0.01).Conclusion Natriuretic peptide,BMI and creatinine are independent influencing factors of long-term prognosis in chronic HF patients.Natriuretic peptide and creatinine have an overall adverse effect on the long-term mortality,and BMI is beneficial to the long-term prognosis in the patients with chronic HF.