心力衰竭患者的蛋白尿和B型钠尿肽对主要不良心脏事件的影响  

Effect of proteinuria and brain natriuretic peptide on major adverse cardiac events in heart failure patients

作　　者：卢维晟 刘斌 王一尘[2] 

机构地区：[1]上海市虹口区欧阳路街道社区卫生服务中心,200081 [2]上海交通大学医学院附属新华医院老年医学科

出　　处：《中华老年心脑血管病杂志》2016年第7期688-690,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的评价慢性心力衰竭（CHF）患者蛋白尿和B型钠尿肽（BNP）对主要不良心血管事件（MACE）的影响。方法选择382例CHF患者,分为无蛋白尿组231例和蛋白尿组151例。根据入院24h内试纸条法检测的蛋白尿结果判断蛋白尿,并分轻度和重度,免疫荧光法测定BNP。结果蛋白尿组与无蛋白尿组BNP比较有显著差异[（954.0±367.0）ng/L vs（865.0±401.0）ng/L,P=0.029]。蛋白尿组合并糖尿病及冠心病的比例较无蛋白尿组高（P〈0.01）,心功能分级（NYHA）更高（P=0.04）。蛋白尿组MACE发生率显著高于无蛋白尿组（19.21%vs6.93%,P〈0.01）。多因素logistic回归模型中,经年龄、合并症、BNP、血红蛋白和估计肾小球滤过率校正后,蛋白尿仍然是心源性休克（OR=1.98,95%CI：1.21～2.39,P〈0.01）及院内死亡（OR=2.56,95%CI：1.65～3.95,P〈0.01）的独立危险因素。与无蛋白尿组比较,蛋白尿组增加MACE中的心源性休克（OR=1.88,P=0.020）和院内死亡（OR=2.40,P=0.004）的风险。结论 CHF患者的蛋白尿与BNP相关,可能是预测发生MACE的危险因素。Objective To study the effect of proteinuria and brain natriuretic peptide（BNP）on major adverse cardiac events（MACE）in chronic heart failure（CHF）patients.Methods Three hundred and eighty-two CHF patients were divided into proteinuria-free group（n=231）and proteinuria group（n=151）.Their serum BNP level was measured by spectrophotometry.Results The serum BNP level was significantly higher in proteinuria group than in proteinuria-free group（954.0±367.0ng/L vs 865.0±401.0ng/L,P=0.029）.The ratio of CHF patients with DM and heart disease and the NYHA heart function classification were significantly higher in proteinuria proup than in proteinuria-free group（P〈0.01,P=0.004）.The incidence of MACE was significantly lower in proteinuria-free group than in proteinuria group（6.93%vs 19.21%,P〈0.01）.Multivariate logistic regression analysis showed that proteinuria was an independent risk factor for cardiogenic shock and hospital death after adjustment of age,compplications,BNP,HB and eGFR（OR=1.98,95%CI：1.21-239,P〈0.01;OR=2.56,95%CI：1.65-3.95,P〈0.01）.The risk of cardiac shock and hospital death was greater in proteinuria group than in proteinuria-free group（OR=1.88,95%CI：1.59-2.44,P=0.020;OR=2.40,95%CI：1.52-3.41,P=0.004）.ConclusionProteinuria associated with BNP is a major risk factor for MACE in HF patients.

关 键 词：心力衰竭 蛋白尿 利钠肽 脑 心血管疾病 

分 类 号：R541.6[医药卫生—心血管疾病]