摘要
目的比较急性心力衰竭(AHF)患者中左室射血分数下降的心衰(HF-REF)患者及左室射血分数保留的心衰(HF-PEF)患者的N末端脑钠肽原(NT-proBNP)水平,同时评估急性心衰患者NT-proBNP水平的影响因素及其与容量负荷及预后的相关性。方法研究对象为2013年12月至2014年4月急诊就诊诊断为急性心力衰竭的患者。根据射血分数分为HF-REF及HF-PEF两组。入组即刻行生化、NT-proBNP、超声心动图检查,观察患者预后,1年后随访患者急性心力衰竭复发情况。结果两组间Lg[NT-proBNP]值无显著性差异(P>0.05);Lg[NT-proBNP]与身体质量指数、肾小球滤过滤、左室射血分数呈显著负相关,与水潴留评分、Lg[肌酐]、尿素氮、左室舒张末内径呈显著正相关。存在慢性肾脏疾病的患者及透析患者Lg[NT-proBNP]值显著增高。NT-proBNP预测此次病死率曲线下面积为0.716,95%CI(0.528~0.904),P=0.043,截点为9451.5 pg/ml。结论经年龄及肾功能分层校正后的NTproBNP水平可作为良好的观察指标,对AHF患者进行诊断,并能指导治疗、判断预后。
Objective To compare the levels of N- terminal pro- brain natriuretic peptide（NT- proBNP） in patients with heart failure,patients with reduced left ventricular ejection fraction（HF- REF） and heart failure and patients with preserved left ventricular ejection fraction（HF- PEF）,in order to determine the factors influencing level of NT- proBNP in patients with acute heart failure,and to evaluate the correlation between level of NT- proBNP and prognosis of patients.Methods Patients with acute heart failure in the emergency department of this hospital during December 2013 to April 2014 were enrolled.All patients were divided into HF- REF and HF- PEF two groups according,to the left ventricular ejection fraction.Examination of biochemical indices,level of NT- proBNP and echocardiogram were taken at the moment of admission.Results There were 54 patients enrolled in HF- REF group,while 52 in HF- PEF group.There was no significant difference in Lg[NT- proBNP]（P 〉0.05） between these two groups.Lg[NT- proBNP]was negatively correlated with the index of body mass,glomerular filtration rate and left ventricular ejection fraction,while it was positively correlated with congestion scores,Lg[Creatinine],blood urea nitrogen,and left ventricular end diastolic diameter.Patients with chronic kidney disease and patients with hemodialysis had higher blood level of NT- proBNP,the AUC for prediction of the mortality was 0.716,with 95%CI（0.528 ~ 0.904）（P = 0.043）.The cut- off point of NT- proBNP was set at9451.5 pg/ml.Level of NT- proBNP cannot predict the recurrence of acute heart failure（P = 0.906）.Conclusion NT- proBNP can be used as a good indicator for diagnosis of acute heart failure and help its treatment,and evaluate the prognosis after adjustment of age and renal function.
出处
《临床和实验医学杂志》
2017年第2期163-166,共4页
Journal of Clinical and Experimental Medicine
关键词
急性心力衰竭
左室射血分数下降
左室射血分数保留
N末端脑钠肽原
容量负荷
预后
Acute heart failure
Reduced left ventricular ejection fraction
Preserved left ventricular ejection fraction
N-terminal pro-brain natriuretic peptide
Volume load
Prognosis
