急性心力衰竭患者血浆BNP水平变化与心功能及预后的关系

摘要

Objective: To explore assessment value of change of brain natriuretic peptide (BNP) level for cardiac function and prognosis judgment in patients with acute heart failure (AHF).Methods: After standard medicinal treatment, according to whether BNP level after treatment reduced <30% or rose compared with at hospitalization, a total of 91 AHF inpatients were divided into BNP reduction ≥30% group (n=67) and BNP reduction <30% or rise group (n=24).Left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDd) and 6min walking distance (6MWD) at discharge were compared between two groups.All patients were followed up for 12 months.Multi-factor Logistic regression analysis was used to analyze risk factors for cardiogenic death.and adverse cardiac events were recorded.Results: Compared with BNP reduction ≥30% group, there were significant reductions in LVEF [(46.00±5.46)% vs.(34.54±5.32)%] and 6MWD [(392.64±153.02)m vs.(136.75±56.25)m], and significant rise in LVEDd [(56.33±4.40)mm vs.(65.96±6.13)mm] in BNP reduction <30% group, P<0.01 all.Multi-factor Logistic regression analysis indicated BNP reduction <30% or rise was the only one independent risk factor for cardiogenic death (OR=2.714, P=0.039).Compared with BNP reduction ≥30% group, there was significant rise in incidence rate of adverse cardiac events (40.3% vs.62.5%) in BNP<30% group, and the Log-rank value was 30.264 (P=0.001).Conclusion: Change of plasma BNP level can be used as an important reference index for the evaluation of cardiac function and prognosis in patients with acute heart failure.%目的:探讨脑钠肽(BNP)水平变化评估急性心力衰竭(AHF)患者心功能及判断预后的价值.方法:选择AHF住院患者91例,经内科标准治疗后,按治疗后BNP测值是否较入院时降低<30%或较入院时升高,分为BNP降低≥30%组(67例)和BNP降低<30%(或升高)组(24例).比较两组出院时的左室射血分数(LVEF)、左室舒张末期内径(LVEDd),6min步行距离(6MWD)差异.随访12个月,记录心脏不良事件.并采用多元Logistic回归分析心源性死亡的危险因素.结果:与BNP降低≥30%组相比,BNP降低<30%组LVEF[(46.00±5.46)%比(34.54±5.32)%]明显降低、6MWD[(392.64±153.02)m比(136.75±56.25)m]明显减小,LVEDd[(56.33±4.40)mm比(65.96±6.13)mm]明显增加(P均<0.01).经多因素Logistic回归分析显示,BNP降幅<30%或升高是心源性死亡的唯一独立危险因素(OR=2.714,P=0.039).与BNP降低≥30%组相比,BNP降低<30%组患者出现心脏不良事件概率显著更高(40.3%比62.5%),Log-rank 值为30.264(P=0.001).结论:血浆脑钠肽水平的变化可作为判定急性心力衰竭患者心脏功能和预后的重要参考指标.