摘要
目的:评价 B 型利钠肽(BNP)对左心衰竭患者的预后预测价值。方法:使用荧光免疫的方法测定心力衰竭患者的 BNP,并进行随访。主要临床终点为:心源性死亡和再入院。根据随访结果将患者分为无再发事件组(162例),心源性再入院组(47例),心源性死亡组(54例)。用 Kaplan-Meier 法计算生存率和无心脏事件生存率,多因素分析采用 COX 回归分析法。结果:300例患者平均随访(9.5±5.6)个月,心源性再入院组[482.0(227.0,793.0)pg/ml]及心源性死亡组[565.0(327.3,1192.5)pg/ml]的 BNP 水平均显著高于无再发事件组[146.5(51.7,374.3)pg/ml](P 均<0.001)。不论单因素还是多因素分析,包括年龄、性别、纽约心功能分级(NYHA)、超声心动图所测左心房前后径、左心室舒张末内径、左心室射血分数(LVEF)及 Log BNP,仅 Log BNP 与心源性死亡时间及心源性再入院时间独立相关。当分别引入 Log BNP,性别,年龄,NYHA,LVEF 和左心室舒张末内径及是否伴有心房颤动、心房扑动、室性心动过速、糖尿病共10个因素,单因素分析中:Log BNP、性别、NYHA、LVEF 和室性心动过速是心源性事件发生的预测因子。但进一步 COX 多元回归分析中,只有 Log BNP(回归系数:0.9898;P=0.002)和室性心动过速(回归系数:0.893;P=0.005)是独立相关影响因素。两者中,又以 Log BNP 的相关性最强。根据受试者工作特征曲线(ROC),BNP 288 pg/ml 为划分有无心源性事件发生的最佳阈值点。BNP≤288 pg/ml 患者的无心源性事件生存时间约是>288 pg/ml 患者的两倍(18.06个月 vs 9.94个月,P=0.000)。结论:BNP 对心力衰竭患者的预后预测价值好。Log BNP 和室性心动过速是心源性死亡、再入院事件独立相关影响因素。
Objective：To evaluate the clinical prognosis by blood level of B-type Natriuretic Peptide （BNP）in the patients with chronic heart failure （CHF）. Methods ： The blood level of BNP was examined by fluorescence immunoassay with the follow up study in CHF patients. The primary clinical end points were cardiac death and re-admission for CHF. The patients were divided into three groups according to the follow up result ： event free group （ n = 162 ）, cardiac re-admission group （ n = 47 ）, and cardiac death group （ n = 54 ）. Patients＇ survival rate and cardiac event-free survival rate were calculated by Kaplan-Meier method. Multivariate analysis was performed with Cox regression analysis. Results ：A total of 300 patients were followed up to 9. 5 ±5.6 months. The BNP level in cardiac death group[565.0（327.3, 1192.5 ） pg/ml ] and in cardiac re-admission group [ 482. 0 （ 227.0,793.0 ） pg/ml ] were both higher than in event free group [ 146.5 （51.7,374. 3 ） pg/ml ] （ P 〈 0. 001 ）. In both univariate analysis and multivariate regression analysis, among the factors of age, gender, NYHA classification, left atrial diameter, left ventricular ejection fraction （ LVEF ） , left ventrieular end-diastolic dimension（LVEDD） and Log BNP,only LogBNP was inversely correlated with the time to cardiac death and the time to cardiac readmission （P 〈 0.05 ）. In univariate Cox analysis, LogBNP, gender, LVEF and ventricular taehyeardia were associated with the adverse outcome and could be used as the predictors for cardiac events among ten individule factors of LogBNP, gender, age, NYHA, LVEF, LVEDD, atrial fibrillation, atrial flutter, ventrieular taehyeardia and diabetes. While in multivariate Cox analysis, only Log BNP（ r ：0. 9898 ;P = 0. 002 ） and ventricular tachycardia （ r ： 0. 893 ; P = 0. 005 ） remained as the significant predictors of cardiac events. Based on Roe analysis,the specific concentration of BNP of 288 pg/ml was chosen to be the cut off point for predicting the cardiac events. The cardiac event free survival time of CHF patients in BNP ≤ 288 pg/ml group （ 18.06 months） was about twice longer than that in BNP 〉288 pg/ml group（9.94 months） （P 〈0. 000）. Conelusion：BNP could be used as a prognostic indicator for CHF patients. LogBNP and ventrieular taehycardia were both significant independent risk factors of cardiac events.
出处
《中国循环杂志》
CSCD
北大核心
2008年第4期263-266,共4页
Chinese Circulation Journal
基金
北京市首都医学发展重点基金资助(2002-1029)
关键词
心力衰竭
B型利钠肽
预后
Heart failure
B-type natriuretic peptide
Prognosis
