蛋白尿和血清氨基末端脑钠肽前体水平对慢性心力衰竭患者预后的影响研究  

Influence of Proteinuria and Serum NT-proBNP Level on Prognosis in Patients with Chronic Heart Failure

作　　者：姚峰[1] 刘波[1] 庄红[1] 尹俊[1] 张苏川[1] 

机构地区：[1]江汉大学附属医院(武汉市第六医院)心血管内科,湖北省武汉市430015

出　　处：《实用心脑肺血管病杂志》2017年第3期19-23,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨蛋白尿和血清氨基末端脑钠肽前体(NT-proBNP)水平对慢性心力衰竭患者预后的影响。方法选取2012—2015年江汉大学附属医院(武汉市第六医院)收治的慢性心力衰竭患者104例,其中有蛋白尿者41例,无蛋白尿者63例;预后良好者86例,预后不良者18例。比较有无蛋白尿、不同预后患者临床资料,慢性心力衰竭患者预后不良的影响因素分析采用多因素Logistic回归分析。结果有无蛋白尿患者年龄、性别、吸烟率、高血压发生率、脑卒中发生率、收缩压、舒张压、血肌酐水平、血尿酸水平、心率及使用利尿剂、洋地黄类药物、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)者所占比例比较,差异均无统计学意义(P>0.05);有蛋白尿者糖尿病发生率、冠心病发生率及血清NT-proBNP水平高于无蛋白尿者,美国纽约心脏病协会(NYHA)分级劣于无蛋白尿者,左心室舒张末期内径(LVEDD)大于无蛋白尿者,左心室射血分数(LVEF)和使用β-受体阻滞剂者所占比例低于无蛋白尿者(P<0.05)。不同预后患者性别、吸烟率、糖尿病发生率、冠心病发生率、高血压发生率、脑卒中发生率、舒张压、血肌酐水平、血尿酸水平、心率及使用利尿剂、洋地黄类药物、ACEI/ARB者所占比例比较,差异均无统计学意义(P>0.05);预后不良者年龄和LVEDD大于预后良好者,收缩压、蛋白尿发生率、血清NT-proBNP水平及NYHA分级Ⅳ级者所占比例高于预后良好者,LVEF、使用β-受体阻滞剂者所占比例低于预后良好者(P<0.05)。多因素Logistic回归分析结果显示,蛋白尿[OR=1.317,95%CI(1.219,1.578)]、血清NT-proBNP水平[OR=8.020,95%CI(1.592,9.863)]、NYHA分级Ⅳ级[OR=2.795,95%CI(1.164,4.917)]及LVEDD[OR=2.481,95%CI(1.153,2.578)]是慢性心力衰竭患者预后不良的独立危险因素,而LVEF[OR=0.166,95%CI(0.029,0.954)]是慢性心力衰竭患者预后不良的独立保护因素(P<0.05)。结�Objective To explore the influence of proteinuria and serum NT - proBNP level on prognosis in patients with chronic heart failure. Methods A total of 104 patients with chronic heart failure were selected in the Affiliated Hospital of Jianghan University （ the Sixth Hospital of Wuhan） from 2012 to 2015, thereinto 41 patients with proteinuria were served as A! group, other 63 patients without proteinufia were served as A2 group; 86 patients with good prognosis were served as BI group, other 18 patients with poor prognosis were served as B2 group. Clinical data was compared between AI group and A2 group, between B1 group and B2 group, influencing factors of poor prognosis in patients with chronic heart failure were analyzed by multivariate Logistic regression analysis. Results No statistically significant differences of age, gender, smoking rate,incidence of hypertension or stroke, SBP, DBP, Ser, BUA, heart rate, proportion of patients received diuretic, digitalis drugs or ACEI/ARB was found between A1 group and A2 group （P 〉0. 05） ; incidence of diabetes and coronary heart disease, and serum NT-proBNP level of AI group were statistically significantly higher than those of A2 group, NYHA grading of AI group was statistically significantly worse than that of A2 group, LVEDD of A1 group was statistically significantly larger than that of A2 group, while LVEF and proportion of patients received β - receptor blockers of AI grouP were statistically significantly lower than those of A2 group （P 〈0. 05）. No statistically significant differences of gender, smoking rate, incidence of diabetes, coronary heart disease, hypertension or stroke, DBP, Scr, BUA, heart rate, proportion of patients received diuretic, digitalis drugs or ACEI/ARB was found between B1 group and B2 gruop （ P 〉0. 05 ） ; age of B2 group was statistically significantly older than that of BI group, LYEDD of B2 group was statistically significantly larger than that of BI group, SBP, incidence of proteinuria, serum NT-proBNP level and pr

关 键 词：心力衰竭 蛋白尿 氨基末端脑钠肽前体 预后 

分 类 号：R541.6[医药卫生—心血管疾病]