血浆N端B型钠尿肽原对老年慢性心力衰竭病情评估及预后判断价值的研究  

Values of plasma N-terminal pro-B-type natriuretic peptide in severity assessment and prognostic prediction for chronic heart failure in the elderly

作　　者：杨倩红[1] 陆有为[1] 陆洁[1] 孙珏[1] 许佳毅[1] 

机构地区：[1]上海市闵行区中心医院复旦大学附属闵行医院老年科

出　　处：《中华老年多器官疾病杂志》2016年第9期683-687,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的：探讨血浆 N 端B 型钠尿肽原（ NT-proBNP ）对老年慢性心力衰竭患者病情评估及预后判断的价值。方法入选2013年1月至2015年6月在复旦大学附属闵行医院老年科住院的慢性心功能不全患者122例，根据美国纽约心脏病联合会（NYHA）分级标准将所有患者分为3组：NYHAⅡ组（n＝30），NYHA Ⅲ组（n＝36）和NYHA Ⅳ组（n＝56）。另选正常对照组50例。在NYHAⅣ组进行亚组分析：死亡组（ n＝14）和非死亡组（ n＝42）。比较各组基线资料，考察左心室射血分数（LVEF）和左心室舒张末期内径（LVEDd）与NT-proBNP的相关性。比较3组患者治疗前、治疗7 d后及治疗14 d后NT-proBNP浓度的变化情况。出院后随访6～12个月，随访期间密切监测NT-proBNP水平。结果随着NYHA分级的递增，年龄、LVEDd及NT-proBNP均呈递增趋势，LVEF呈递减趋势。 LVEF与NT-proBNP呈中度负相关（r＝－0．79，P＜0．05），而LVEDd与NT-proBNP呈高度正相关（r＝0．96，P＜0．05）。治疗7 d后，各组患者的NT-proBNP 水平较治疗前也显著降低（P＜0．05），治疗14 d后较治疗7 d后的NT-proBNP水平也有进一步降低，其中NYHAⅢ组和NYHAⅣ非死亡组治疗14 d后与治疗7 d后的差异具有统计学意义（P＜0．05）。与非死亡组相比，死亡组在治疗前、治疗7 d后以及末次监测时的NT-proBNP水平均显著增高（P＜0．05）。在非死亡组中，随时间推移，NT-proBNP水平有进一步降低趋势（P＜0．05）。在死亡组中，治疗前与治疗7 d后的NT-proBNP水平间无明显差异（P＞0．05），且截至随访末次监测时（死亡前）的NT-proBNP水平显著增高（ P＜0．05）。结论 NT-proBNP水平与心功能密切相关，是诊断心力衰竭、评价治疗效果和预后评估的重要指标。Objective To investigate the values of serum N-terminal pro-B-type natriuretic peptide （ NT-proBNP ） in severity assessment and prognostic prediction in the elderly patients with chronic heart failure.Methods A total of 122 elderly patients with chronic heart failure admitted in our hospital from January 2013 to June 2015 were enrolled into the study.According to New York Heart Association （NYHA） classification, the patients were divided into 3 group, that is, NYHAⅡgroup （n=30）, NYHAⅢgroup （n=36）, and NYHAⅣgroup （n=56）.Another 50 healthy individuals served as normal controls.The patients of NYHAⅣ group were further assigned into death subgroup （n=14） and non-death subgroup （n=42）.The relationship of serum NT-proBNP level with left ventricular ejection fraction （ LVEF） and left ventricular end diastolic diameter （ LVEDd） was analyzed.The change of NT-proBNP level was compared among the 3 groups before and in 7 and 14 d after treatment.The serum level of NT-proBNP was monitored during the follow-up of 6 to 12 months.Results With the increase of NYHA classification, the age, LVEDd and NT-proBNP level were increased, while LVEF was decreased in the subjects.Serum NT-proBNP level was positively correlated with LVEDd （ r =0.96, P〈0.05） and negatively correlated with LVEF （r=-0.79, P〈0.05）.The level of NT-proBNP was significantly decreased in the patients from the 3 groups in 7 d after treatment （ P〈0.05） , and further reduced after 14 days’ treatment, but significant difference was only found in NYHAⅢgroup and NYHAⅣnon-death subgroup between the levels of 2 time points （P〈0.05）.Compared with the non-death subgroup, the level was remarkably higher in the death subgroup before, in 7 d after treatment and at the last time of detection （P〈0.05）.In the non-death subgroup, the level was in a trend of reducing （P〈0.05）.But in the death subgroup, there＆amp;nbsp;was no statistical difference in the level before and in 7 d after treatment （

关 键 词：N端B型钠尿肽原 心力衰竭 危险分层 预后 

分 类 号：R592[医药卫生—老年医学] R541[医药卫生—内科学]