B型利钠肽测定对充血性心力衰竭患者预后评估的研究  

Prognosis evaluation of B type natriuretic peptide in patients with congestive heart failure

作　　者：羊镇宇[1] 王如兴[1] 李肖蓉[1] 刘志华[2] 

机构地区：[1]南京医科大学附属无锡市第一人民医院,江苏无锡214002 [2]苏州大学附属第一医院,江苏苏州215006

出　　处：《中国心血管杂志》2005年第3期201-203,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨B型利钠肽(BNP)对充血性心力衰竭(CHF)患者预后评估的价值。方法对343例因CHF住院的患者,入院时测定BNP,同时测定左心室射血分数(LVEF)、左心室舒张末内径(LVDD),胸片测定心胸比率(CTR)。出院前复查一次,随访观察患者3个月内的病死率、再住院率,作为终末事件。结果①心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者的BNP水平分别为(157±15)pg/ml、(341±22)pg/ml、(597±33)pg/ml、(1245±38)pg/ml。心功能越差,BNP越高,不同的NYHA心功能分级,BNP差异有显著性(P<0.001)。②BNP水平与LVEF呈明显负相关(r=-0.8,P<0.05)。③343例患者,住院期间死亡5例,3月内再次入院22例。事件组27例,其BNP水平为(1683±124)pg/ml,非事件组316例,其BNP水平为(468±48)pg/ml。两组差异有显著性(P<0.001)。4.将出院前BNP>1500pg/ml作为评估终末事件的界值,其预测预后的敏感性为96.3%,特异性为92.7%。5.对CHF患者的性别、年龄、LVEF、LVDD、BNP、病因等进行多元逐步回归分析,BNP与预后关系最密切。结论本文提示BNP较LVEF评价CHF更确切可靠,动态观察BNP变化水平是CHF患者有效的预后判断指标。Objective To investigate the prognosis evaluation in patients with congestive heart failure (CHF) by B type natriuretic peptide (BNP) assay.Methods 343 patients were admitted to hospital for CHF.BNP levels,left ventricular ejection fraction (LVEF),left ventricular end diastolic diameters(LVDD),cardiacthoracic ratio (CRT) were performed respectively in admission and before discharge.The rates of fatality and re-hospitalization were as end points during 3-month follow-up.Results 1.BNP levels were significantly different in different heart function classes according to NYHA (P<0.001).The levels of BNP in patients with heart function class Ⅰ,Ⅱ,Ⅲ and Ⅳ were (157±15) pg/ml, (341±22) pg/ml,(597±33) pg/ml and (1245±38) pg/ml,respectively. 2.There was a significant negative correlation between BNP levels and LVEF (r=-0.8,P<0.05).3.BNP level of 27 patients including 5 death and 22 re-hospitalization was (1683±124)pg/ml,however,BNP level of 316 patients in non-episode group was (468±348) pg/ml(P<0.001).4.Sensitivity and specialty were 96.3% and 92.7% when BNP>1500 pg/ml was as cut-off point before discharge. 5.Results of multiple factors step-wise regression analysis about gender,year,LVEF,LVDD,BNP and etiology etc showed that there was a most significant correlation between BNP and prognosis.Conclusion BNP level was more exact than LVEF in evaluating prognosis of CHF.Dynamic changes of BNP levels were effective marker in evaluating prognosis of CHF.

关 键 词：B型利钠肽 充血性心力衰竭 预后 

分 类 号：R541.6[医药卫生—心血管疾病]