Objective To investigate the evaluation value of plasma N-terminal natriuretic peptide levels and change rate for the severity and prognosis of patients with acute heart failure.Methods A total of 160 patients with acute heart failure who were diagnosed and treated in our hospital from December 2015 to December 2016 were enrolled in the study. According to the cardiac function classification (NYHA),these patients were divided into four groups. Immediately after admission,the levels of plasma N-terminal natriuretic peptide (NT-proBNP) and high sensitivity C reactive protein (hs-CRP) and cardiac troponin(cTnI) were detected,moreover,the left ventricular ejection fraction(EF) was measured by ultrasoundcardiogram.In addition the ratio of mitral early diastolic peak velocity of mitral annulus velocity/root ratio(E/Ea) was detected by blood flow and tissue Doppler echocardiography,and the correlation between the plasma BNP and EF,E/Ea was analyzed by Pearson correlation analysis.Moreover the plasma levels of NT-proBNP were detected immediately after admission,at 24h,48h and 72h after hospitalization,and the dynamic change rate of plasma NT-proBNP levels at 24h,48h and 72h was calculated by NT-proBNPd 24h,NT-proBNPd 48h,NT-proBNPd 72h.According to the state of diuretic resistance,these patients were divided into diuretic resistance group and diuretic reaction group.The differences of the immediate plasma natriuretic peptide levels and the 24h plasma NT-proBNP levels were compared between the two groups.The receiver operating characteristic curve (ROC) was used to analyze its predictive value for diuretic resistance in patients. According to the prognosis state of patients within 14 days after hospitalization,these patients were divided into survival group and death group,the changes of plasma NT-proBNP levels on admission at 24h,48h, 72h,96h were observed and compared between two groups.Finally,the prognosis evaluation value of plasma N-terminal natriuretic peptide levels changes within 72h after admission was analyzed by ROC analysis. Results The plasma levels of NT-proBNP,hs-CRP and cTnI were increased gradually in the patients with cardiac function NYHA grade I,II,III and IV,there were significant differences among groups (P<0.05).The plasma NT-proBNP was negatively correlated with EF value (r=-0.783,P<0.05),however,which was positively correlated with the ratio of E/Ea(r=0.851,P<0.05).There were no significant differences in immediate levels of plasma NT-proBNP between diuretic resistant group and diuretic response group (P>0.05). However there was significant difference in change rate of plasma NT-proBNP levels within 24 hour between two groups (P<0.05).The change rate of plasma NT-proBNP levels within 24 hours after admission had a good predictive value for patients with diuretic resistance (AUC=0.806).When the change rate of plasma NT-proBNP levels was 34.5%,the sensitivity was 78.13% and specificity was 81.90%.After admission,the plasma levels of NT-proBNP in death group showed a trend of continuous increase,however, the plasma levels of NT-proBNP were decreased rapidly in survival group.The change rate of plasma NT-proBNP levels on 72h after admission had a better diagnostic value (AUC=0.894).When the change rate of plasma NT-proBNP levele in 72h was 65%,the sensitivity of the diagnosis was 76.47% and the specificity was 87.18%.Conclusion The plasma levels of NT-proBNP are related with the severity of patients with acute heart failure,and the levels can reflect the extent of cardiac systolic and diastolic dysfunction.The change rate of plasma NT-proBNP levels within 24 hours on admission can predict the incidence of diuretic resistance in patients,moreover the change rate of plasma levels of NT-proBNP within 72h after admission has better predictive value for prognosis of patients.%目的 探讨血浆氨基末端钠尿肽水平与变化率对急性心力衰竭患者病情严重性与预后判断价值.方法 选择2015年12月至2016年12月诊断急性心力衰竭患者160例,依据患者NYHA心功能分级分为4组.入院后即时检测血浆氨基末端钠尿肽(NT-proBNP)、血清高敏C-反应蛋白(hs-CRP)与肌钙蛋白(cTnI)水平,超声心动图测量左心室射血分数(LVEF)、血流与组织多普勒超声检测二尖瓣舒张早期血流速度峰值/二尖瓣环根部运动速度峰值比(E/Ea),Pearson相关分析血浆BNP与EF、E/Ea之间相关性.入院后即时、24 h、48 h、72 h,分别检测血浆NT-proBNP水平,计算24 h、48 h、72 h内血浆NT-proBNP水平动态变化率NT-proBNPd 24 h、NT-proBNPd 48 h、NT-proBNPd 72 h.依据患者是否伴有利尿剂抵抗分为利尿剂抵抗组与利尿剂反应组,比较2组患者入院即时血浆钠尿肽水平与24 h血浆NT-proBNP水平变化率差异.受试者工作特征曲线(ROC)分析其对于患者发生利尿剂抵抗的预测价值.依据患者入院14 d内预后情况分为存活组与病死组,连续观察入院即时、24 h、48 h、72 h、96 h 2组患者血浆 NT-proBNP水平变化,ROC分析入院72 h 内血浆 NT-proBNP 水平变化率对于患者预后的预测价值.结果 心功能NYHA分级Ⅰ级、Ⅱ级、Ⅲ级与Ⅳ级组患者血浆NT-proBNP、hs-CRP、cTnI水平逐渐升高,总组间以及两两组间比较差异有统计学意义(P<0.05).血浆NT-proBNP与EF值呈直线负相关(r=-0.783,P<0.05),与E/Ea比值呈直线正相关(r=0.851,P<0.05).利尿剂抵抗组与利尿剂反应组患者入院即时血浆NT-proBNP水平比较差异无统计学意义(P>0.05).2组患者24 h内血浆NT-proBNP水平变化率比较差异有统计学意义(P<0.03).入院后24 h内血浆NT-proBNP水平变化率对于患者发生利尿剂抵抗有较好预测价值(AUC=0.806).当血浆NT-proBNP水平变化率=34.5%时,其敏感度为78.13%,特异度为81.90%.入院后病死组患者血浆NT-proBNP水平呈持续升高趋势,而存活组患者血浆NT-proBNP水平呈迅速下降变化.入院72 h内血浆NT-proBNP水平变化率对于患者预后具有较好诊断价值(AUC=0.894).当72 h内血浆NT-proBNP水平变化率为65%时,诊断患者病死预后敏感度为76.47%,特异度为87.18%.结论 血浆NT-proBNP水平与急性心力衰竭患者病情严重性相关,其水平高低能够反映患者心脏收缩与舒张功能受损程度.入院24 h内血浆NT-proBNP水平变化率可以预测患者利尿剂抵抗发生.入院后72 h内血浆NT-proBNP水平变化率对于患者预后具有较好预测价值.
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