Objective To explore the predictive value of cTnI and BNP on prognosis of patients with acute heart failure. Methods From February 2011 to January 2014,a total of 147 patients with acute heart failure were selected as observation group in the People′s Hospital of Yutai County,Jining,there into 86 cases with Ⅲ - grade NYHA cardiac functional grading were served as A group,others 61 cases with Ⅳ - grade NYHA cardiac functional grading were served as B group,101 cases with good prognosis were served as C group,46 cases with poor prognosis were served as D group;meanwhile a total of 30 healthy people admitted to this hospital for physical examination were selected as control group. Serum levels of cTnI,BNP,CK and CK-MB at admission,LVEF,LVEDd and LAD within 24 hours after admission were compared among A group,B group and control group,meanwhile serum levels of cTnI and BNP at admisson were compared between C group and D group;of patients with acute heart failure,correlations between serum level of cTnI,of BNP and index of cardiac function,prognosis were analyzed,and ROC curve was drawn to evaluate the predictive value of serum levels of cTnI and BNP on death in patients with acute heart failure. Results Serum levels of cTnI and BNP of A group and B group were statistically significantly higher than those of control group at admission(P < 0. 05),while no statistically significant differences of serum level of CK or CK-MB was found among A group,B group and C group( P > 0. 05);serum levels of cTnI and BNP of A group were statistically significantly lower than those of control group at admission(P < 0. 05). Within 24 hours after admission,LVEF of A group and B group was statistically significantly lower than that of control group,respectively,while LVEDd and LAD of A group and B group were statistically significantly higher than those of control group ( P < 0. 05 );LVEF of A group was statistically significantly higher than that of B group,while LVEDd and LAD of A group were statistically significantly lower than those of B group(P < 0. 05). Of patients with acute heart failure,serum cTnI level at admission was negatively correlated with LVEF(r= - 0. 527,P < 0. 05),was positively correlated with LVEDd and LAD,respectively(r = 0. 443,0. 406,P < 0. 05);serum BNP level at admission was negatively correlated with LVEF(r = - 0. 542,P < 0. 05),was positively correlated with LVEDd and LAD,respectively ( r = 0. 416,0. 372,P < 0. 05 ). Serum levels of cTnI and BNP of C group were statistically significantly lower than those of D group at admission(P < 0. 05). The AUC of serum cTnI level at admission in predicting death in patients with acute heart failure was 0. 814 〔 95% CI( 0. 614,0. 862 )〕,when it was 0. 4 μg/ L,the sensitivity was 55. 72% ,the specificity was 88. 96% ,the diagnosis index was 1. 447;the AUC of serum BNP level at admission in predicting death in patients with acute heart failure was 0. 869〔95% CI(0. 733,0. 931)〕,when it was 1 600 ng/ L,the sensitivity was 69. 15% ,the specificity was 85. 30% ,the diagnosis index was 1. 545. Conclusion Serum levels of cTnI and BNP are closely correlated with the disease severity,cardiac function and prognosis of patients with acute heart failure,both of them have certain predictive value on the prognosis.%目的：探讨心肌肌钙蛋白 I（cTnI）、利钠肽（BNP）对急性心力衰竭（AHF）患者预后的预测价值。方法选取2011年2月—2014年1月济宁市鱼台县人民医院收治的 AHF 患者147例作为 AHF 组，根据美国纽约心脏病学会（NYHA）心功能分级标准分为Ⅲ级组86例，Ⅳ级组61例；根据患者转归情况分为预后良好组101例，预后不良组46例。另选取同期在本院体检健康者30例作为对照组。比较Ⅲ级组、Ⅳ级组及对照组受试者入院时血清 cTnI、BNP、肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）水平及入院24 h 内心功能指标〔左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）、左心房内径（LAD）〕，比较预后良好组与预后不良组患者入院时血清 cTnI、BNP 水平；分析入院时血清 cTnI、BNP 水平与 AHF 患者心功能指标、预后的关系，并绘制 ROC 曲线评价入院时血清 cTnI、BNP水平对 AHF 患者死亡的预测价值。结果Ⅲ级、Ⅳ级组患者入院时血清 cTnI、BNP 水平高于对照组（P <0.05）；Ⅲ级、Ⅳ级组及对照组受试者入院时血清 CK、CK-MB水平比较，差异无统计学意义（ P >0.05）；Ⅲ级组患者入院时血清 cTnI、BNP 水平低于Ⅳ级组（P <0.05）。Ⅲ级、Ⅳ级组患者入院24 h 内 LVEF 低于对照组，LVEDd、LAD 高于对照组（P <0.05）；Ⅲ级组患者入院24 h 内 LVEF 高于Ⅳ级组，LVEDd、LAD 低于Ⅳ级组（P <0.05）。AHF 组患者入院时血清 cTnI 水平与 LVEF 呈负相关（r =-0.527，P <0.05），与 LVEDd、LAD 呈正相关（r 值分别为0.443、0.406， P <0.05）；血清 BNP 水平与 LVEF 呈负相关（r =-0.542，P <0.05），与 LVEDd、LAD 呈正相关（r 值分别为0.416、0.372，P <0.05）。预后良好组患者入院时血清 cTnI、BNP 水平低于预后不良组（P <0.05）。入院时血清 cTnI 水平预测 AHF 患者死亡的 ROC 曲线下面积为0.814〔95% CI（0.614，0.862）〕，当其为0.4 μg/ L 时，灵敏度为55.72%，特异度为88.96%，诊断指数为1.447；入院时血清 BNP 水平预测 AHF 患者死亡的 ROC 曲线下面积为0.869〔95% CI （0.733，0.931）〕，当其为1 600 ng/ L 时，灵敏度为69.15%，特异度为85.30%，诊断指数为1.545。结论血清cTnI、BNP 水平与 AHF 患者病情严重程度、心功能及预后有关，且血清 cTnI、BNP 水平对 AHF 患者预后具有一定的预测价值。
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