血浆N-末端B型利钠肽原对慢性心力衰竭远期心脏事件的预测价值  

Value of N-ternimal pro-brain natriuretic peptide in prognosing long term cardiac incidence of chronic heart failure patients

作　　者：夏思良[1] 周建松[1] 嵇平[1] 孙红[1] 

机构地区：[1]东南大学附属南京江北人民医院心内科,江苏南京210048

出　　处：《海南医学院学报》2010年第5期548-551,560,共5页Journal of Hainan Medical University

基　　金：南京市医学科技发展项目(ZKM06062)~~

摘　　要：目的：评价慢性心力衰竭（CHF）患者入院时血浆N-末端B型利钠肽原水平（NT-proBNP）对远期心脏事件的预测价值。方法：连续检测122例住院的慢性心衰患者入院时血浆NT-proBNP浓度。随访2年,记录发生的心脏事件。结果：（1）共入选慢性心衰患者122例,随访时间平均（279±237）d,发生心脏事件50例,其中死亡17例,心衰失代偿再入院33例,72例随访期间无心脏事件发生,心脏事件组的NT-proBNP[5 059.00（965.80-27 793.00）pg/mL]明显高于非事件组[1 897.50（65.18-12928.00）pg/mL,P〈0.01）];（2）NT-proBNP〉2 917 ng/L组的死亡14例（21.21%）、再发心衰20例（30.30%）,NT-proBNP水平≤2 917ng/L组死亡3例（5.35%）、再发心衰13例（23.21%）;Chi-Square检验显示,〉2 917 ng/L组心脏事件发生率高于≤2 917 ng/L组,差异有统计学意义（P〈0.05）;NT-proBNP≤2 917 ng/L组的生存曲线高于NT-proBNP〉2 917 ng/L组,而且两条曲线在各时点都没有发生交叉,log-rank检验P=0.001,Chi-Square10.28;（3）根据是否发生心脏事件,做NT-proBNP对预后判定的ROC曲线,其曲线下面积为0.755（95%CI：0.671~0.839）（P=0.000）,对心衰患者心脏事件的阳性预测价值为75.5%,阴性预测值为24.5%;（4）COX回归分析表明,血浆NT-proBNP是慢性心衰患者再发心脏事件的独立预测因素（P〈0.01）。结论：血浆NT-proBNP可以用于对慢性心衰患者进行心衰后心脏事件再发的预后分析。Objective： To evaluate the value of N-ternimal pro-brain natriuretic peptide（NT-proBNP） in prognosing long term cardiac incidence of chronic heart failure（CHF） patients.Methods： A total of 122 CHF cases were selected,and the level of NT-proBNP was measured continuously,and two-year follow-up was carried out to record the cardiac incidence.Results： 50 cases had cardiac incidence,including 17 deaths and 33 cases with readmission due to heart failure.The level of NT-proBNP in cases with cardiac incidence was 5 059.00 pg/mL [（965.80-27 793.00） pg/mL],significantly higher than cases without incidence [1 897.50（65.18-12 928.00） pg/mL]（P〈0.01）.There were 14 deaths（21.21%） and 20 reoccurrence of heart failure（30.30%） in group with NT-proBNP2 917 ng/L;3 deaths（5.35%） and 13 reoccurrence of heart failure（23.21%） in group with NT-proBNP≤2 917 ng/L.Chi-Square test showed the incidence in group with NT-proBNP2 917 ng/L was significantly higher than group with NT-proBNP≤2 917 ng/L（P〈0.05）,while the survival curve was higher in group with NT-proBNP≤2 917 ng/L,without crossing with the curve of group with NT-proBNP2 917 ng/L（P=0.001,χ2=10.28）.The area of ROC curve was 0.7555（95% CI：0.671-0.839,P〈0.01）.The positive prediction of NT-proBNP was 75.5%,and the negative was 24.5%.COX regression analysis showed NT-proBNP was independent prognosis factor for reoccurrence of cardiac incidence（P〈0.01）.Conlusion： NT-pro BNP can be used as prediction index for prognosis of cardiac incidence in CHF patients

关 键 词：利钠肽 脑 心力衰竭 充血性 预后 

分 类 号：R541.6[医药卫生—心血管疾病]