血浆脑钠肽水平与肝硬化失代偿期患者预后的相关性分析  

Relation of B-type natriuretic peptide and prognosis of patients in decompensated cirrhosis stage

作　　者：石玲燕[1] 张培趁[1] 林春景[1] 董乐妹[1] 吴建胜[1] 

机构地区：[1]温州医科大学附属第一医院消化科,浙江温州325000

出　　处：《中国临床药理学杂志》2015年第12期1091-1094,共4页The Chinese Journal of Clinical Pharmacology

基　　金：温州市科技局基金资助项目(Y20120209)

摘　　要：目的探讨血浆脑钠肽(BNP)水平与肝硬化失代偿期患者预后的关系。方法选取2010年1月至2012年3月我院住院的60例肝硬化失代偿期患者,设为试验组,对照组为2010年6月至2011年3月间我院住院的58例非肝硬化肝病患者。用酶联免疫分析(ELISA)法检测2组的血浆BNP水平,用COX多因素回归分析影响肝硬化患者预后的独立因素,进行生存曲线分析,随访观察患者出院后3个月的死亡率。结果试验组血浆BNP(189.01±33.20)pg·m L-1明显高于对照组(32.41±72.43)pg·m L-1(P<0.05),其水平与肝功能ChildPugh分级呈正相关。BNP水平与肝硬化门脉高压的4项指标之间也呈一定的相关性(P<0.05),BNP水平越高,脾静脉及食道静脉越粗,侧枝循环越明显,腹水也越易出现。肝硬化合并上消化道出血的患者血浆BNP水平明显高于未出血者(P<0.05)。COX回归显示,影响肝硬化患者预后的独立因素有3个:BNP水平、食道静脉曲张、腹水。Kaplan-Meier生存曲线提示,BNP>157.3pg·m L-1的患者较BNP≤157.3 pg·m L-1的患者3个月生存率明显下降(P<0.05)。结论肝硬化患者血浆BNP水平显著升高,临床上检测肝硬化患者血浆BNP可作为肝功能评价参考指标之一,且其对肝硬化失代偿期患者的预后有一定的应用价值。Objective To determine whether B-type natriuretic pep-tide （ BNP） level was related with the stage of decompensated cirrhosis as a prognostic marker of cirrhosis.Methods A total of 60 patients with cirrhosis selected from January 2010 to March 2012 as treatment group and 58 patients with non-liver sclerosis were selected from June 2010 to March 2011 as control group.At admission, BNP measurements were performed by ELISA method in both groups. The association of independent variables with time to clinical outcome was assessed by Cox regression.The survival curve was evaluated by Kaplan-Meier analysis at 3 months of follow-up.The occurrence of death within 3 months were followed after patients were discharged.Results The BNP level of the treatment group was （ 189.01 ±33.20 ） pg· mL-1 , significantly higher than that in the control group（P〈0.05）, and it was positively correlated with Child -Pugh score, the grade of esophagus varices, splenic vein, collateral circulation and presence of ascites with significant difference （ P 〈0.05 ） .The BNP levels in the patients with upper digestive hemorrhage were significantly higher than those without bleeding （ P〈0.05 ） .Through univariate and multivariate COX regression analysis, the data of BNP level, esophageal varices, and large/medium volume ascites were related with the prognosis of patients with cirrhosis. Kaplan-Meier analysis showed that BNP levels above median 157.3 pg· mL-1 were associated with an increased occurrence of death within 3 months of discharge （P〈0.05）.Conclusion Plasma BNP level of patients with cirrho-sis is correlated significantly with the stage of cirrhosis.It can be used as one of the indexes of liver function, and it was a significant predictor for 3-month prognosis.

关 键 词：脑钠肽 肝硬化 预后 

分 类 号：R657.31[医药卫生—外科学] R331[医药卫生—临床医学]