N末端脑钠肽和大内皮素-1对心衰的预后价值

摘要

Objective This study was prospectively desigued to investigate the prognostic factors for chronic heart failure and the prognostic ability of N-terminal pro-brain natriuretic peptide (NT-proBNP) and big endothelin-l (Big ET-1) in patients with chronic heart failure. Methods To study 143 consecutive patients hospitalized for chronic heart failure. Serum concentration of NT-proBNP,cTnI,CKMB and plasma Big ET-1 as well as left ventricular ejection fraction (LVEF) and NYHA class I to IV on admission were measured. Cardiac events were found by patients to discharge after 360~480 days, prospectively. Results During a median follow-up period of 380 days,the endpoint of recurrence for cardiac events was reached in 57 patients with 143 heart failure. Patients with endpoint events were older (82 vs 52,P = 0. 000),in a higher functional class (3 vs l,P=0. 000),had higher levels of NT-proBNP (3 802 pmol/L vs 891 pmol/L,P=0. 000) and Big ET-1 (5.13 pmol/L vs 3. 53 pmol/L,P = 0. 000) compared with those without endpoint events. On a Cox proportional hazards regression models analyses, age NT-proBNP and Big ET-1 were found to be the independent predictors of cardiac events. Risk ratio (RR) were 1.175,3. 987 and 2. 691,respectively. Logistic regression models analyses,NT-proBNP and Big ET-1 were found independent predictors of death. Odd ratio (OR) were 2.515 and 1. 978,respectively. Conclusion Measurement of NT-proBNP and Big ET-1 in patients with chronic heart failure could help to identify patients at higher risk for cardiac events and patients for prognosis.%目的 通过对心衰患者的随访研究,探讨N末端脑钠肽(NT-proBNP)和大内皮素-1(Big ET-1)对心衰患者的预后价值.方法 研究143例心衰住院患者,检测入院时NT-proBNP,Big ET-1,肌钙蛋白I,CK-MB和左室射血分数以及NYHA分级.并随访观察患者出院后360~480 d的心血管事件再发生情况.结果 143例心衰患者的中位随访380 d,发生心脏事件57例.发生与未发生终点事件组相比,患者的年龄(82比52,P=0.000)、NYHA分级(3比1,P=0.000)、NT-proBNP(3 802 pmol/L比891 pmol/L,P=0.000)和Big ET-1(5.13 pmol/L比3.53 pmol/L,P=0.000)中位数水平都明显偏高.Cox比例风险模型分析显示,年龄和NT-proBNP及Big ET-1是独立的心脏事件再发生的预后因素,风险比分别为1.175,3.987和2.691.logistic回归显示,NT-proBNP和Big ET-1是独立的心源性死亡的危险因素,优势比分别为2.515和1.978.结论 检测NT-proBNP和Big ET-1可对心衰患者进行心脏事件再发生的危险分层和预后分析.