NT-proBNP、hsTropT、hsCRP及其他相关功能指标与急性心衰病人预后的相关性研究

摘要

目的 探讨N末端B型利钠肽前体(NT-proBNP)、肌钙蛋白-T(hsTropT)、高敏C-反应蛋白(hsCRP)及其他相关功能指标与急性心衰病人预后的相关性.方法 选取2011年1月-2014年12月湖北省汉川市人民医院收治的急性心力衰竭病人274例,采集病人入院时的一般临床资料,回顾性分析病人的病历资料,包括年龄、性别、身高、体重、体重指数(BMI)、伴发病、吸烟、饮酒、缺血性心衰、血红蛋白量、hsCRP、谷丙转氨酶、谷草转氨酶、肌酐、白蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、三酰甘油、载脂蛋白A、载脂蛋白B、初始NT-proBNP、48 h NT-proBNP、hsTropT、舒张期左心室内径、收缩期左心室内径、左心室射血分数 、美国纽约心脏协会(NYHA)心功能分级、不良事件、死亡例数等信息,并进行统计分析.结果 获得HF-REF组226例和HF-PEF组48例,HF-REF组和HF-PEF组病人的年龄、糖尿病、高血压、初始NT-proBNP、48 h NT-proBNP、hsTropT、舒张期左心室内径、收缩期左心室内径、左心室射血分数 、NYHA心功能分级、死亡例数差异具有统计学意义(P<0.05).不良事件共有 90例 (32.8%),其中死亡33 例(12%),心衰症状不断恶化18例和发展为难治性心衰 (NYHA分级Ⅲ或 Ⅳ级) 39例 .获得不良事件组病人90例和非不良事件组病人184例,不良事件组和非不良事件组的年龄、糖尿病、hsCRP、初始NT-proBNP、48 h NT-proBNP、NYHA心功能分级、随访时间比较,差异具有统计学意义(P<0.05).多因素Logistic回归分析结果表明,初始NT-proBNP(OR=5.16,95%CI1.67~44.46,P=0.004)、48 h NT-proBNP(OR=4.27,95%CI1.96~37.43,P=0.016)和NYHA分级OR=3.22,95%CI1.37~7.52,P=0.039)是影响急性心力衰竭病人预后的独立危险因素.结论 初始NT-proBNP和48 h NT-proBNP可有助于急性心力衰竭病人的治疗选择和病人预后改善.%Objective To investigate the correlation between N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity Troponin T (hsTropT), high sensitivity C-reactive protein (hsCRP),other related functional parameters and the prognosis in patients with acute heart failure (AHF).Methods Two hundreds and seventy-four patients with AHF were treated in our hospital from January 2011 to December 2014.The general clinical data and medical records were analyzed when they were admitted to hospital.The clinical data were analyzed including age,sex,height,weight, body mass index (BMI),smoking,drinking,ischemic heart failure,hemoglobin,hsCRP,alanine aminotransferase, aspartate aminotransferase,creatinine,albumin,total cholesterol,high density lipoprotein,low density lipoprotein,triglyceride,apolipoprotein A,apolipoprotein B,initial NT-proBNP,48 hours NT-proBNP,hsTropT,left ventricular diastolic diameter,left ventricular systolic diameter,left ventricular ejection fraction,American New York Heart Association (NYHA) information heart function classification,adverse events and death cases.Results There were 226 cases in HF-REF group and 48 cases in HF-PEF group.Comparison between the age,diabetes,hypertension,initial NT-proBNP,48 hours NT-proBNP,hsTropT,diastolic left ventricular diameter,left ventricular systolic diameter,left ventricular ejection fraction, NYHA heart function classification and death cases of two group,the differences was statistically significant (P<0.05).Patients with adverse events were 90 cases (32.8%),including 33 cases of death (the total mortality rate of 12%),18 cases of heart failure continue to deteriorate and 39 cases of developing refractory heart failure (NYHA grade Ⅲ or IV grade).There were 184 patients in the adverse event group and 90 in the non adverse event group.Comparison between the age,diabetes,hsCRP,initial NT-proBNP,48 hours NT-proBNP, NYHA heart function classification,follow-up time of two group,the difference was statistically significant (P<0.05).The results of multivariate logistic regression analysis showed that the initial NT-proBNP(OR=5.16,95% CI:1.67 to 44.46,P=0.004), 48 hours NT-proBNP (OR=4.27,95% CI:1.96 to 37.43,P=0.016) and NYHA (OR=3.22,95% CI:1.37 to 7.52,P=0.039 classification) were independent prognostic factors of patients with AHF.Conclusion The initial NT-proBNP and 48 h NT-proBNP showed an obvious correlation,which can be used as an important indicator for clinical diagnosis and prognosis evaluation.