慢性心力衰竭心源性猝死影响因素分析及基线QRS波群时限联合基线血浆NT-proBNP对其预测价值  

Analysis of the Influencing Factors of Sudden Cardiac Death in Patients with Chronic Heart Failure and the predictive value of Baseline QRS Wave Duration Combined with Plasma NT-proBNP Level

作　　者：程龙 程蓉 尚艳妍 CHENG Long;CHENG Rong;SHANG Yan-yan(Department of Cardiovascular Medicine,the Third Clinical Medical College of China Three Gorges University Gezhouba Central Hospital of Sinopharm,Yichang,Hubei 443002,China;Department of Nephrology,the Third Clinical Medical College of China Three Gorges University Gezhouba Central Hospital of Sinopharm,Yichang,Hubei 443002,China)

机构地区：[1]三峡大学第三临床医学院国药葛洲坝中心医院心血管内科,湖北宜昌443002 [2]三峡大学第三临床医学院国药葛洲坝中心医院肾内科,湖北宜昌443002

出　　处：《临床误诊误治》2022年第12期21-25,共5页Clinical Misdiagnosis & Mistherapy

基　　金：湖北省科技计划项目(2019CFB125)。

摘　　要：目的探讨慢性心力衰竭心源性猝死影响因素及基线QRS波群时限联合基线血浆N-末端B型脑钠肽前体(NT-proBNP)对其预测价值。方法回顾性分析2012年1月—2018年10月收治的慢性心力衰竭189例的临床资料,统计心源性猝死发生情况,采用单因素和多因素Logistic回归分析探讨影响慢性心力衰竭心源性猝死的因素,绘制受试者工作特征(ROC)曲线探讨基线QRS波群时限、基线血浆NT-proBNP及二者联合对慢性心力衰竭心源性猝死的预测价值。结果慢性心力衰竭189例中68例(35.98%)发生心源性猝死。多因素Logistic回归分析结果显示,年龄>60岁、合并2型糖尿病、合并高脂血症、心律失常、伴肺栓塞、心功能Ⅲ级、心功能Ⅳ级、基线QRS波群时限、基线左室射血分数(LVEF)和基线血浆NT-proBNP均是慢性心力衰竭心源性猝死的危险因素,联合用药是慢性心力衰竭心源性猝死的保护因素(P<0.01)。ROC曲线分析结果显示,基线QRS波群时限和基线血浆NT-proBNP二者联合预测慢性心力衰竭心源性猝死的曲线下面积和敏感度、特异度均高于单独预测(P<0.01)。结论年龄>60岁、合并2型糖尿病、合并高脂血症、心律失常、伴肺栓塞、心功能Ⅲ级、心功能Ⅳ级、基线QRS波群时限、基线LVEF和基线血浆NT-proBNP均是慢性心力衰竭心源性猝死的危险因素,基线QRS波群时限联合基线血浆NT-proBNP对慢性心力衰竭心源性猝死预测价值较高。Objective To explore the influencing factors of sudden cardiac death in patients with chronic heart failure(CHF)and the predictive value of baseline QRS wave duration combined with plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)level.Methods The clinical data of 189 patients with CHF admitted from January 2012 to October 2018 were retrospectively analyzed.The occurrence of sudden cardiac death was calculated.The influencing factors of sudden cardiac death in patients with CHF were analyzed using univariate and multivariate Logistic regression analyses.The receiver operating characteristic(ROC)curve was drawn to explore the predictive role of QRS wave duration alone,plasma NT-proBNP level alone and the combination of the two in sudden cardiac death in patients with CHF.Results Of 189 patients,there were 68(35.98%)patients had sudden cardiac death in this group.Multivariate Logistic regression analysis showed that age>60 years,combined type 2 diabetes mellitus(T2DM),combined hyperlipidemia,arrhythmia,pulmonary embolism,cardiac function gradeⅢand gradeⅣ,baseline QRS wave duration,baseline left ventricular ejection fraction(LVEF)and baseline plasma NT-proBNP were all risk factors for sudden cardiac death,while combined drug use was a protective factor for sudden cardiac death in patients with CHF.The ROC curve results showed that the area under the ROC curve(AUC),the sensitivity and specificity of baseline QRS wave duration combined with baseline plasma NT-proBNP in predicting sudden cardiac death in patients with CHF were higher than those of single prediction(P<0.01).Conclusion Age>60 years,combined T2DM,combined hyperlipidemia,arrhythmia,pulmonary embolism,cardiac function gradeⅢand gradeⅣ,baseline QRS wave duration,baseline LVEF and baseline plasma NT-proBNP are all risk factors for sudden cardiac death in patients with CHF,and baseline QRS wave duration combined with plasma NT-proBNP level has a higher predictive value for sudden cardiac death in patients with CHF.

关 键 词：心力衰竭 猝死 影响因素分析 QRS波群时限 N-末端B型脑钠肽前体 

分 类 号：R541.6[医药卫生—心血管疾病]