心电图参数联合血浆NT-proBNP水平对慢性心力衰竭患者预后的评估价值  

Prognostic value of electrocardiogram parameters combined with plasma NT-proBNP level in patients with chronic heart failure

作　　者：袁永杰 张永军 鲁其乐 程陶玲 杨涛 方平 YUAN Yong-jie;ZHANG Yong-jun;LU Qi-le;CHENG Tao-ling;YANG Tao;FANG Ping(Department of Electrophysiology,Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China;Department of Cardiovascular,Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院·弋矶山医院电生理科,安徽芜湖241001 [2]皖南医学院第一附属医院·弋矶山医院心血管内科,安徽芜湖241001

出　　处：《川北医学院学报》2024年第7期916-919,共4页Journal of North Sichuan Medical College

基　　金：安徽省卫生健康科研项目(AHWJ2022b090)。

摘　　要：目的:探究心电图参数联合血浆N-末端前体脑钠肽(NT-proBNP)水平对慢性心力衰竭(CHF)患者预后的评估价值。方法:选取108例CHF患者为研究对象,按随访12个月内是否发生心血管不良事件(MACE)将患者分为MACE组(n=30)与预后良好组(n=78)。收集并比较两组患者相关资料,包括一般资料、左室射血分数(LVEF)、生化指标[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、白细胞计数(WBC)、血浆N-末端前体脑钠肽(NT-proBNP)]水平及心电图参数(QRS波时限、额面QRS-T夹角)。采用多因素Logistic回归分析CHF发生MACE的危险因素。使用受试者工作特征(ROC)曲线分析相关指标对MACE的预测价值。结果:与预后良好组相比,MACE组的年龄更大,LVEF更低,NYHA分级、QRS波时限、额面QRS-T夹角及血浆NT-proBNP水平均更高(P<0.05)。多因素Logistic回归分析显示,NYHA分级(OR=1.137)、LVEF(OR=1.335)、QRS波时限(OR=1.228)、额面QRS-T夹角(OR=1.200)及NT-proBNP(OR=1.081)均是CHF患者发生MACE的独立危险因素(P<0.05)。ROC曲线分析显示,QRS波时限、额面QRS-T夹角及NT-proBNP均可预测CHF发生MACE(P<0.05),曲线下面积(AUC)分别为0.658、0.924、0.842,三者联合预测AUC为0.959,敏感度、特异度分别为90.00%、93.59%,预测效能最高(P<0.05)。结论:QRS波时限长、额面QRS-T夹角大、血浆NT-proBNP水平高是CHF患者发生MACE的独立危险因素,三者均可预测患者预后不良,且三者联合预测效能最佳。Objective:To explore the value of electrocardiogram parameters combined with plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)level in evaluating the prognosis of patients with chronic heart failure(CHF).Methods:108 patients with CHF were selected as the research subjects.They were divided into MACE group(n=30)and good prognosis group(n=78)according to the occurrence of cardiovascular adverse events(MACE)within 12 months of follow-up.The relevant data of two groups were collected and compared,including general data,left ventricular ejection fraction(LVEF),biochemical indicators[total cholesterol(TC),Low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),white blood cell count(WBC),plasma N-terminal precursor brain natriuretic peptide(NT-proBNP)]and electrocardiogram parameters(QRS wave duration,frontal QRS-T angle).Multiple Logistic regression analysis was used to identify the risk factors for MACE in CHF,the predictive value of relevant indicators on MACE was analyzed by Receiver Operating Characteristic(ROC)curves.Results:Compared with the good prognosis group,the MACE group had older age,lower LVEF,higher NYHA classification,QRS wave duration,frontal QRS-T angle and plasma NT-proBNP level(P<0.05).Multivariate Logistic regression analysis showed that NYHA classification(OR=1.137),LVEF(OR=1.335),QRS wave duration(OR=1.228),frontal QRS-T angle(OR=1.200)and NT-proBNP(OR=1.081)were independent risk factors for MACE in CHF patients(P<0.05).ROC curve analysis showed that QRS duration,frontal QRS-T angle and NT-proBNP could predict the occurrence of MACE in CHF(P<0.05).The area under the curve(AUC)was 0.658,0.924 and 0.842,respectively.The combination of the three had the highest predictive efficacy(AUC=0.959),and the sensitivity and specificity were 90.00%and 93.59%,respectively(P<0.05).Conclusion:Long QRS duration,large frontal QRS-T angle and high plasma NT-proBNP level are independent risk factors for MACE in CHF patients.All three can predict poor prognosis of patients,and the combination

关 键 词：心电图 N-末端前体脑钠肽 慢性心力衰竭 QRS波时限 额面QRS-T夹角 预后 

分 类 号：R54[医药卫生—心血管疾病]