NT-proBNP水平对急性心力衰竭患者近期预后的评估价值

摘要

目的 探讨N末端脑钠肽前体(NT-proBNP)水平对急性心力衰竭(简称急性心衰)患者近期预后的评估价值.方法 选取2015年1-12月接受治疗的急性心衰患者122例作为研究对象.行常规治疗,出院后行30 d随访,将发生心源性再住院及死亡情况的患者纳入事件组,将其余患者纳入无事件组.比较两组患者在一般资料、临床表现与体征方面的差异,行多因素Logistic回归分析,观察影响患者预后的危险因素.结果 随访30 d后,122例患者中40例发生了终点事件.40例患者纳入事件组,82例患者纳入无事件组.两组患者在年龄、性别、体质量指数、高血压史、糖尿病史、心肌梗死史、冠心病史、房颤史方面比较,差异无统计学意义(P＞0.05).无事件组患者心脏功能NYHA分级Ⅲ级占81.71％,明显高于事件组的40.00％;Ⅳ级占18.29％,明显低于事件组的60.00％ (P＜0.05).两组患者在夜间呼吸困难、主动脉瓣反流、舒张压、心率方面比较,差异无统计学意义(P＞0.05).事件组下肢水肿、肺部哆音、二尖瓣反流百分比明显高于无事件组(P＜0.05).事件组LVEDD、NT-proBNP水平明显高于无事件组,LVEF、收缩压明显低于无事件组(P＜0.05).经Logistic回归分析,NT-proBNP水平过高是急性心衰患者近期预后不良的显著独立危险因素(OR=3.522,P=0.021,95％CI为1.080～4.361).结论 较高的NT-proBNP水平是急性心衰患者近期预后不良的显著危险因素.%Objective To explore the evaluation value of N terminal brain natriuretic peptide(NT-proBNP) level on the short term prognosis in the patients with acute heart failure.Methods One hundred and twenty-two patients with acute heart failure receiving the therapy in our hospital from January to december 2015 were selected as the research subjects.All cases were treated by the routine therapy and followed up for 30 d.The cases of re-hospitalization due to cardiac shock and death were included in the event group and the other cases were included in the non-event group.The differences in the aspects of general data,clinical manifestations and body signs were compared between the two groups.The multivariate Logistic regression analysis was performed to observe the risk factors influencing the prognosis of the patients.Results Among 122 cases,the terminal event after 30 d follow up occurred in 40 cases.So these 40 cases were included in the event group and 82 cases were included in the non-event group.There were no statistically significant differences in the aspects of age,sex,body mass index,history of hypertension,history of myocardial infarction,coronary heart disease and atrial fibrillation between the two groups(P＞0.05).The cardiac function NYHA grade Ⅲ in the non-event group accounted for 81.71 ％,which was significantly higher than 40.00 ％ in the event group,grade Ⅳ accounted for 18.29％,which was significantly lower than 60.00％ in the event group(P＜0.05).There were no statistically significant differences in the aspects of dyspnea,aortic regurgitation,diastolic pressure and heart rate between the two groups(P＞0.05).The proportions of lower extremity edema,pulmonary rales and mitral regurgitation in the event group were significantly higher than those in the non-event group(P＜0.05).The LVEDD value and NT-proBNP level of the event group were significantly higher than those of the non-event group,while the LVEF value and systolic pressure were significantly lower than those of non-event group(P＜ 0.05).By the Logistic regression analysis,NT-proBNP level too high was a significant independent risk factor for short term adverse prognosis in the patients with acute heart failure (OR =3.522,P=0.021,95 ％ CI was 1.080-4.361).Conclusion Higher NT-proBNP level is a significant risk factor for poor short term prognosis in the patients with acute heart failure.