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论著:动态脑钠肽水平改变对充血性心力衰竭患者近期预后的预测价值
Prognosis Value of Sequential B-type Natriuretic Peptide Measurements for Patients Hospitalized with Chronic Congestive Heart Failure
洪斌 金雪娟 罗勇 周兰珠 蔡前芳 葛均波
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作者单位:上海市青浦区中心医院心内科
中文关键字:脑钠肽;充血性心力衰竭;预后
英文关键字:Brain natriuretic peptide; Congestive heart failure; Prognosis
中文摘要:目的:动态观察血浆脑钠肽(brain natriuretic peptide, BNP)水平的改变对不同程度充血性心力衰竭(congestive heart failure,CHF)患者的近期预后的影响。方法:采用前瞻性研究方法,观察2006年3月—2007年4月心内科住院的CHF患者BNP水平,评价其与近期预后的关系。在入选标准中,排除同时合并其它组织器官疾病的患者。将不同程度的CHF患者依次按纽约心脏协会分级(NYAH)和CHF临床评分级别分组,动态观察BNP水平的改变,比较BNP水平与NYAH分级的相关性;以及比较BNP水平与患者住院时间、出院12个月内再入院率、病死率的关系。结果:共入组患者99例,其中男性55例(55.6%),女性44例(44.4%);年龄71.9±11.4岁。入院时和出院时BNP水平中位数 (25th分位数, 75th 分位数) 分别为 285 pg·mL-1 (177 pg·mL-1, 571 pg·mL-1) 和 253 pg·mL-1(134 pg·mL-1,448 pg·mL-1)。经过标准治疗后,BNP明显下降,下降值为37.5 pg·mL-1 (253 pg·mL-1, 122 pg·mL-1;P<0.001)。入院时BNP水平与 NYHA呈相关 (r=0.4593,P<0.05),但没有发现出院BNP水平与NYHA有统计学差异。入院时 BNP水平 >571 pg·mL-1 (75th分位数)者平均住院时间显著长于入院BNP水平 <571pg·mL-1者(12.2 d对 8.7 d, P< 0.001)。在出院后12个月的随访中,有6例(6.0%)患者死亡,30例(30.3%)患者再入院治疗。第1次入院时BNP水平与1年再住院率显著相关,风险比和95%可信限(HR,95%CI)为3.724(1.795~7.727),但没有发现与1年内的病死率相关。治疗后BNP水平对预后没有预测价值。结论:血浆BNP水平与CHF严重程度成正相关,治疗前BNP水平对住院时间有预测价值。
英文摘要:Objective: To investigate the potential prognostic value of serial measurement of plasma B-type natriuretic peptide (BNP) levels in patients with congestive heart failure (CHF). Methods:A cohort of 99 patients in cardiac ward of our hospital was prospectively enrolled from March 2006 to April 2007, among which 67 (67.7%) were in New York Heart Association class(NYHA) III-IV heart failure patients. Plasma BNP levels were measured at baseline, discharge and the one month after discharge. Pearson′s correlations were used to describe the relation among BNP and NYHA and clinical scores. All patients were followed 12 months after first discharge. Primary end points were death, length of stay, and re-hospitalization. Results: There were ninety-nine patients((71.9±11.4 years, 55.6% males) were enrolled in this prospective cohort study. The median (25th percentile, 75th percentile) BNP levels were 285 pg/ml (177 pg/ml, 571 pg/ml) at study enrollment and 253 pg/ml (134 pg/ml,448 pg/ml) at discharge. BNP decreased after standardized treatment for CHF, the median BNP level decreased by 37.5 pg/ml (-253 pg/ml, 122 pg/ml; P<0.001). Baseline plasma BNP levels were positive correlated with NYHA (r=0.4593,P<0.05). However, BNP level after treatment did not related with NYHA. Patients with baseline BNP levels >571 pg/ml (upper quartile) had longer length of stay than patients with BNP levels <571pg/ml (12.2 vs 8.7 days, P< 0.001). During one year follow-up after discharge, 6(6.0%) patient died, while 30(30.3%) patients were re-hospitalization. The hazard ratio(HR) and 95% confidence interval (95%CI) for the baseline BNP level <571pg/ml and 1 year re-hospitalization rate was 3.724(1.795-7.727). But no statistical significant difference was found between BNP level and 1 year mortality rate (P>0.05). The BNP levels after treatment was no longer with prognostic values. Conclusion:The data suggest that plasma BNP is an ideal biomarker for evaluation the severity of CHF.
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