慢性心力衰竭急性发作患者N端前脑钠素水平的变化  

Clinical studies on level of Nterminal portion of brain natriuretic in the treatment and prognosis of Chinese patients with chronic left heart failure

作　　者：汪芳[1] 王莉[1] 边文彦[1] 顼志敏[1] 李一石[1] 

机构地区：[1]中国医学科学院阜外心血管病医院临床药理中心,卫生部心血管药物临床研究重点实验室,北京卫生部北京医院心内科100037

出　　处：《中国危重病急救医学》2006年第4期195-198,共4页Chinese Critical Care Medicine

基　　金：国家"863"计划"十五"重大科技专项课题基金资助项目(2002AA2Z341A)

摘　　要：目的 探讨N端前脑钠素（NT-ProBNP）水平变化对慢性心力衰竭（心衰）急性发作患者病情评估、疗效判定及长期预后的临床价值.方法 选择2003年4月-2004年7月我院急诊及住院的慢性心衰急性发作患者44例,年龄18～80岁.于急诊就诊即刻或住院开始抗心衰治疗前以及治疗后3～5 d和5～7 d时,分别测定NTProBNP水平及肾素-血管紧张素-醛固酮系统（RAAS）激素水平;出院后定期随访,随访期限为2年,了解是否发生心血管事件（如死亡、心肌梗死、心衰加重、严重心律失常等）.结果 与入院即刻比较,治疗后3～5 d及5～7 d的NT-ProBNP水平均明显下降（P均〈0.05）,但治疗后两个时相间差异无显著性;与随访期间未发生心血管事件的患者比较,发生心血管事件患者的NT-ProBNP水平在各时相均较高（P均〈0.05）.RAAS激素血管紧张素原（AO）、血浆肾素活性（PRA）、血管紧张素Ⅱ（ATⅡ）及醛固酮（ALD）的血浆水平变化均不显著.结论慢性心衰急性发作患者早期NT-ProBNP水平即明显下降;就诊时监测NT-ProBNP水平对判定患者病情和危险分层有一定的价值.Objective To study the relationship of the level of N -terminal portion of brain natriuretic （NT - ProBNP） with the treatment and prognosis of patients with acute attack of chronic left heart failure. Methods Patients （age range 18 -80 years） with decompensated heart failure treated in the emergency department in Fuwai Hospital were included in this study. Dynamic changes of plasma levels of NT - ProBNP, angiotensin （AO）, renin activity （PRA）, angiotensin Ⅱ （ATⅡ） and aldosterone （ALD） were detected by enzyme linked immunoadsorbent assay （ELISA） before anti-cardiac failure treatment and 3 - 5, 5 - 7 days after the treatment. All enrolled patients were followed up for 2 years after leaving hospital, and cardiovascular events such as death, myocardial infarction, worsening of heart failure, severe arrhythmia or delayed discharge from hospital were recorded. Results Compared with baseline level at admission, plasma NT - ProBNP levels were lowered on 3rd - 5th day and 5th - 7th day after admission and treatment （both P〈0. 05） in 44 patients with chronic left heart failure, but there was no difference in NT- ProBNP levels between the 3rd - 5th and 5th - 7th day after treatment. The levels of plasma NT - ProBNP increased much higher at all observation times in patients with cardiovascular events than without the events （all P〈 0. 05）, but the changes in AO, PRA, AT Ⅱ and ALD showed no significant difference between two groups （all P〉0. 05）. Conclusion During acute onset, plasma NT - ProBNP levels in patients with chronic left heart failure can be lowered at 3 - 7 days after admission and treatment. Higher baseline levels of plasma NT- ProBNP may have certain predictive values for long term prognosis in patients with chronic left heart failure.

关 键 词：心力衰竭 慢性 急性发作 N端前脑钠素 肾素血管紧张素-醛固酮系统 心血管事件 病情评估 

分 类 号：R541.6[医药卫生—心血管疾病] R725.622.5[医药卫生—内科学]