B型利钠肽和肺毛细血管嵌压对心力衰竭远期心脏事件的预测价值  

Predictive value for long term cardiac events by admission B-type natriuretic peptide and pulmonary capillary wedge pressure in patients with chronic heart failure

作　　者：胡咏梅[1] 王勉[1] 赵思勤[1] 李秋[1] 聂晓莉[1] 吴涛[1] 刘小蓉[1] 张文勇[1] 

机构地区：[1]成都市第二人民医院心内科,610017

出　　处：《中华心血管病杂志》2008年第9期786-789,共4页Chinese Journal of Cardiology

摘　　要：目的研究血浆B型利钠肽（BNP）和肺毛细血管嵌压（PCWP）对慢性心力衰竭（心衰）患者远期心脏事件的预测价值。方法入选134例心衰患者，经Swan—Ganz导管测定PCWP，双抗体夹心免疫荧光法测定血浆BNP浓度。随访3年，记录发生的心脏事件。结果（1）心脏事件组的心胸比率、PCWP、BNP较非心脏事件组显著升高（P〈0．01）。（2）多元Logistic回归分析PCWP和BNP为心衰患者远期心脏事件独立的预测因子。（3）BNP、PCWP预测心原性死亡ROC曲线下面积分别为0．846和0．762。BNP取值720．5ng／L、PCWP取值19．5mmHg（1mmHg=0．133kPa）预测心原性死亡的敏感度和特异度达最高。（4）血浆BNP≤702．5ng／L组心衰患者的生存率高于BNP〉702．5ng／L组，PCWP≤19．5mmHg组心衰患者的生存率高于PCWP〉19．5mmHg组；Log—Rank检验说明，不同PCWP和BNP两组生存时间之间差异有统计学意义（P〈0．05）。结论BNP和PCWP是影响慢性心衰患者远期心脏事件的独立预测因素。Objective To evaluate the predictive value of admission plasma B-type natriuretie peptide （BNP） and pulmonary capillary wedge pressure （PCWP） for long term cardiovascular events in patients with chronic heart failure （CHF）. Methods A total of 134 patients [ 70 males and 64 females, mean age （71.28 ±8.22） years] with CHF were included in this study. PCWP was measured with a Swan- Ganz catheterization and plasma BNP level was determined by a rapid immunofluoreseence assay （Triage, Biosite, USA） in all patients on admission day. Left ventricular end diastolic diameter （LVEDD） and cardiothoracic ratio （CRT） were measured within 24 hours before or after catheterization. All CHF patients received conventional therapy and the rates of cardiac death and rehospitalization were used as end points during 3-year follow up. Results （1） LVEDD, CRT, PCWP and BNP were increased in patients with cardiac events compared with patients without cardiac events （P 〈 0. 01 ）. （2） Multivariant logistic analysis showed that PCWP （ OR = 1. 423,95% CI 1. 163 - 1. 741 ） and BNP （ OR = 1. 005,95% CI 1. 002 - 1. 007 ） were the independent factors for cardiac events. （3） The area under the receiver operating curve （ROC） of BNP and PCWP to predict cardiac death was 0. 846 （95% CI 0. 771 -0. 922） and 0. 762 （95% CI 0. 666 - 0. 875）, respectively. The sensitivity was 76. 5% and the specificity was 75.2% with BNP cutoff point of 720. 5 ng/L, and the sensitivity was 68. 1% and the specificity was 76.2% with PCWP cutoff point of 19.5 mm Hg（ 1 mm Hg =0. 133 kPa） for predicting cardiac deaths. （4） The survival rate of patients with BNP≤ 702. 5 ng/L and PCWP≤ 19. 5 mm Hg were significantly higher than that in patients with BNP 〉702. 5 ng/L （ OR =4.383, 95% CI 1.407 - 13.650） and PCWP 〉 19.5 mm Hg （OR = 2.843, 95% CI 1.013 - 8.854）. Conclusion Both plasma BNP and PCWP on admission day are independent predictors for long term cardiac events in patients with CHF.

关 键 词：心力衰竭 充血性 利钠肽 脑 血液动力学 预后 

分 类 号：R686[医药卫生—骨科学]