慢性心力衰竭患者血浆脑钠肽水平与左室重构的关系和预后价值  

Relationship between plasma brain natriuretic peptide level and left ventricular remodeling and prognostic value in chronic heart failure patients

作　　者：吴波[1] 张书富[1] 马瑾[1] 陈德[1] 张斌[1] 王加红[1] 

机构地区：[1]上海市杨浦区中心医院心内科,200090

出　　处：《临床内科杂志》2008年第12期818-820,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨慢性心力衰竭（CHF）患者血浆脑钠肽水平与左室重构的关系及其预后价值。方法入选126例CHF患者，测定血浆脑钠肽（BNP）浓度，随访住院期间、30天和6个月的主要心脏不良事件（即心血管病死亡、新发心衰／心衰恶化再人院）。结果随BNP水平分级递增，左室重量指数（LVMI）、左室舒张末内径指数（LVIDdI）明显增高，左室射血分数（LVEF）明显减低，各组心脏不良事件发生率明显增加。通过多变量的logistic回归分析，BNP是独立于年龄、LVMI、LVIDdI、LVEF等危险因素的CHF预后因素，可预测30天和6个月心脏不良事件发生（r分别为0．769，0．831，P〈0．01）。BNP预测6个月心脏不良事件发生的ROC曲线下面积为0．851（95％CI：0．778～0．924，P〈0．01）。结论BNP水平与CHF患者左室重构有一定相关性，能很好地对CHF患者进行危险分层，是CHF患者近期临床预后的较好指标。Objective To investigate the relationship between brain natriuretic peptide （BNP） level and left ventricular remodeling and prognostic value in chronic heart failure （CHF） patients. Methods The plasma BNP concentrations of 126 CHF patients were measured quickly by luminoimmunoassay. The main adverse cardiac events（ MACE,including cardiavarscular death, recurrent heart failure/readmission for HF worsening） were analyzed at inhospital and 30 days and 6 months. Results With the higher BNP values in CHF group gradually, LVMI and LVIDdI increasing, and LVEF decreasing distinctly with the higher incidence of MACE. After adjustment for clinical prognostic factors, such as ages, LVMI, LVIDdI, and LYEF in CHF groups, BNP level remained significantly independent predictor for MACE at 30 days （ r = 0. 769, P 〈 0.01 ） and 6 months （ r = 0.831, P 〈 0.01 ） by multivariate logistic regression analysis. The Area under receiver operating characteristic （ROC） curve was 0.851 （95% CI 0. 778 - 0. 924, P 〈 0.01 ） for incidence of MACE at 6 months. Conclusion Plasma BNP level is related with left ventricular remodeling, and it is a significantly independent predictor for MACE in patients with CHF.

关 键 词：充血性心力衰竭 B型利钠肽 脑钠肽 

分 类 号：R541.61[医药卫生—心血管疾病]