短期动态血压变异性与心力衰竭患者预后的关系

Relationship between Short-term Ambulatory Blood Pressure Variability and Prognosis of Patients with Heart Failure

目的探讨短期动态血压变异性(blood pressure variability,BPV)与心力衰竭患者预后的关系。方法收集2019年1月至2021年1月在南通市海门区人民医院确诊为心力衰竭的患者共160例作为研究对象,采用24 h动态血压监测仪获取患者白天(d),夜间(n)和全天24 h收缩压变异性(systolic blood pressure variability,SBPV)和舒张压变异性(diastolic blood pressure variability,DBPV),根据发病后90 d随访结果分为预后良好组(120例)和预后不良组(40例),比较两组患者的一般临床资料和BPV的差异,分析BPV与患者预后的关系。结果预后不良组患者的超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)、脑钠肽(brain natriuretic peptide,BNP)、白细胞介素(interleukin,IL)-6、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血管紧张素转化酶(angiotensin converting enzyme,ACE)、血管紧张素(angiotensin,Ang)Ⅱ浓度显著高于预后良好组,左心室射血分数(left ventricular ejection fraction,LVEF)明显低于预后良好组,差异有统计学意义(P<0.05)。预后良好组患者的24 h SBPV、24 h DBPV、d SBPV、d DBPV、n SBPV、n DBPV均低于预后不良组,其中24 h SBPV、24 h DBPV、d SBPV、d DBPV、n DBPV两组比较差异具有统计学意义(P<0.05)。Logistic回归分析显示24 h SBPV是心力衰竭患者不良预后的独立危险因素,受试者工作特征曲线(receiver operating characteristic curve,ROC)的曲线下面积为0.844(95%CI:0.640~1.048),灵敏度为79.8%,特异度为82.3%,截断值为13.45。结论BPV越大,心力衰竭患者预后相对不佳,24 h SBPV是心力衰竭患者近期预后的独立危险因素并具有一定的诊断价值。

Objectives To study the relationship between short-term ambulatory blood pressure variability(BPV)and prognosis of patients with heart failure.Methods A total of 160 patients with heart failure diagnosed in Nantong Haimen District People′s Hospital from January 2019 to January 2021 were collected as the research objects.The 24-hour ambu⁃latory blood pressure monitor was used to obtain the systolic BPV(SBPV)and diastolic BPV(DBPV)during the day(d),night(n)and all day.According to the follow-up results 90 days after onset,the patients were divided into good prognosis group and poor prognosis group.The differences of general clinical data and BPV between the two groups were compared.The relationship between BPV and prognosis was analyzed.Results Concentrations of high sensitivity C-reac⁃tive protein(hs-CRP),brain natriuretic peptide(BNP),interleukin(IL)-6,N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensin converting enzyme(ACE)and angiotensin(Ang)Ⅱin poor prognosis group were significantly higher than those in good prognosis group,left ventricular ejection fraction(LVEF)was significantly lower than that in good prognosis group(P<0.05).Twenty-four h SBPV,24 h DBPV,d SBPV,d DBPV,n SBPV and n DBPV in good prognosis group were significantly lower than those in poor prognosis group(P<0.05).Logistic regression analysis showed that 24 h SBPV was an independent risk factor for poor prognosis in patients with heart failure.The area under curve(AUC)of receiver operating characteristic curve(ROC)was 0.844(95%CI:0.640-1.048),the sensitivity was 79.8%,the specificity was 82.3%,and the cut-off value was 13.45.Conclusions The greater the variability of blood pressure is,the poorer the prognosis of patients with heart failure is.Twenty-four h SBPV is an independent risk factor for the short-term prognosis of patients with heart failure and has certain diagnostic value.