NT-proBNP和超声二尖瓣早期舒张期血流峰速度与二尖瓣环舒张早期速度比值预测心力衰竭患者预后价值研究  

Prognostic value of NT-proBNP and E/e’in the prognosis evaluation of patients with heart failure

作　　者：程慧 杨文娟[2] 范卫泽[3] 王生池 耿静 沈晓辉 CHENG Hui;YANG Wenjuan;FAN Weize(Department of Intensive Care Unit,The People’s Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050031,China;不详)

机构地区：[1]河北省石家庄市人民医院重症医学科,050031 [2]河北省血液中心成分制备室 [3]河北医科大学第二医院心内科

出　　处：《河北医药》2020年第21期3238-3241,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展计划(编号:161460733);首都特色应用研究专项基金(编号:Z181100001718026)。

摘　　要：目的探讨心力衰竭患者出院时N末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)和超声二尖瓣早期舒张期血流峰速度与二尖瓣环舒张早期速度比值(the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus,E/e’),评估其对此类患者的预后价值。方法选取经治疗好转出院时的成年急、慢性左心力衰竭患者210例,收集其临床资料,出院时检测血NT-proBNP和超声E/e’,应用二元Logistic回归模型分析心力衰竭出院患者预后的影响因素(因变量为60 d再住院率和1年全因病死率,协变量为出院时NT-proBNP和E/e’),评价心力衰竭出院患者预后相关的危险因素。应用Spearman回归分析心力衰竭患者出院时NT-proBNP>339 ng/L、NT-proBNP≤339 ng/L和E/e’>9.76、E/e’≤9.76与60 d再住院率和1年全因病死率的相关性,同时做NT-proBNP>374 ng/L、NT-proBNP≤374 ng/L和E/e’>10.2、E/e’≤10.2与60 d再住院率和1年全因病死率的相关性进行分析。结果随访1年,心力衰竭出院210例患者60 d再住院率为30.95%,1年病死率20.48%。二元Logistic回归模型分析心力衰竭出院患者(因变量为60 d再住院率和1年全因病死率,协变量为出院时NT-proBNP和E/e’)显示,出院时NT-proBNP[Exp(B)1.008,95%CI 1.005~1.012,P=0.000]、E/e’[Exp(B)1.565,95%CI 1.285~1.907,P=0.000]是心力衰竭出院患者60 d再住院率的独立影响因素。出院时NT-proBNP[Exp(B)1.009,95%CI 1.004~1.013,P=0.000]、E/e’[Exp(B)1.634,95%CI 1.299~1.056,P=0.000]是心力衰竭出院患者1年全因病死率的独立影响因素。相关性分析显示,以心力衰竭患者出院时NT-proBNP>339 ng/L、NT-proBNP≤339 ng/L与60 d再住院率呈正相关(r=0.311,P=0.000)。E/e’>9.76、E/e’≤9.76与60 d再住院率呈正相关(r=0.324,P=0.000)。NT-proBNP>374 ng/L、NT-proBNP≤374 ng/L与1年全因病死率呈正相关(r=0.295,P=0.000)。E/e’>10.02、E/e’≤10.02与1年全因病死率呈正相关(r=Objective To investigate the prognostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP)and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus(E/e’)in patients with heart failure(HF).Methods A total of 210 adult patients with acute or chronic HF were enrolled in the study.The NT-proBNP and E/e’were detected in discharging from hospital.The influencing factors of the prognosis of patients including 1-year all cause mortality and 60-day readmission rate were analyzed by means of binary Logistic regression model.Moreove the correlation between NT-proBNP levels and 60-day readmission rate as well as 1-year all cause mortality was analyzed by Spearmanregression analysis.Results After 1-year follow up,the 60-day readmission rate in the 210 patients with HF after discharging from hospital was 30.95%,and 1-year mortality was 20.48%.Binary Logistic Analysis showed that both E/e’[Exp(B)1.565,95%CI 1.285~1.907]and NT-proBNP[Exp(B)1.008,95%CI 1.005~1.012]were independent risk factors of 60-day readmission(P<0.01).And E/e[Exp(B)1.634,95%CI 1.299~1.056]and NT-proBNP[Exp(B)1.009,95%CI 1.004~1.013]were independent risk factors of 1-year mortality(P<0.01).Speaman regression analysis showed that NT-proBNP>339ng/L and NT-proBNP≤339ng/L were significantly positive correlated with 60-day readmission rate(P<0.01),and E/e’>9.76 and E/e’≤9.76 were significantly positive correlated with 60-day readmission rate(P<0.01).Moreover NT-proBNP>374ng/L and NT-proBNP≤374ng/L were significantly positive correlated with 1-year mortality(P<0.01),and E/e’>10.02 and E/e’≤10.02 were significantly positive correlated with 1-year mortality(P<0.01).There was a significant difference in the 60-day readmission rate between E/e’>9.76 group and E/e’≤9.76 group(P<0.01).Conclusion The prognostic value of NT-proBNP and E/e’in the prognosis evaluation of patients with heart failure is equally important,which can provide objective indexes and specific data for the interven

关 键 词：心力衰竭 N末端脑利钠肽前体 早期舒张期血流峰速度与二尖瓣环舒张早期速度比值 再住院率 

分 类 号：R541.61[医药卫生—心血管疾病]