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目的:分析高海拔地区充血性心力衰竭(CHF)患者氨基末端脑钠肽前体(NT-proBNP)和血尿酸水平,充分评价其临床分层和预后,从而积极预防包括死亡在内的心血管事件。方法:选择生活在海拔2 500m～3 000m,临床上明确诊断为充血性心力衰竭患者80例,男41例,女39例,平均年龄(61.3±9.5)岁;另选择同等海拔地区正常人群80例作为对照测定NT-proBNP。观察、随访CHF患者住院期间与出院后12个月内不良心脏事件(心力衰竭恶化、心绞痛或心肌梗死)或因不良心脏事件的再住院率以及病死率(心力衰竭恶化死亡、猝死)。所有患者均行心功能评价,测定NT-proBNP和血尿酸(UA)浓度。结果:心功能Ⅱ、Ⅲ和Ⅳ级患者NT-proBNP分别为(520.13±97.45)ng/L、(2173.18±296.18)ng/L、(4 523.16±401.72)ng/L,三者比较差异有统计学意义(P<0.01);其血尿酸分别为(316±113)mmol/L、(360±140)mmol/L、(456±137)μmol/L。血尿酸≥420mmol/L在心功能Ⅲ、Ⅳ级患者检出率较Ⅱ级者高(P<0.05),差异有统计学意义。血尿酸≥420mmol/L及(或)NT-proB-NP≥900 ng/L的患者,无论是住院期间或是出院12个月内不良心脏事件发生率均高于血尿酸<420mmol/L及NT-proBNP<900 ng/L的患者(P<0.05),差异有统计学意义。结论:增高的NT-proBNP和血尿酸可被视为充血性心力衰竭患者独立的心血管事件的预测因子。这两种标志物的同时增高与随访过程中心血管事件发生率的增高呈正相关。
OBJECTIVE: To analyze the levels of NT-proBNP and serum uric acid in patients with congestive heart failure (CHF) at high altitudes to fully assess their clinical stratification and prognosis so as to actively prevent cardiovascular death, including death event. Methods: Eighty patients (41 males and 39 females, mean age (61.3 ± 9.5) years old) were diagnosed clinically as being diagnosed congestive heart failure at an altitude of 2 500 m -3 000 m. Another 80 Example as a control NT-proBNP. Follow-up CHF patients were hospitalized within 12 months after discharge from adverse cardiac events (worsening heart failure, angina pectoris or myocardial infarction) or rehospitalization due to adverse cardiac events and mortality (worsening of heart failure death, sudden death). All patients underwent cardiac function evaluation, determination of NT-proBNP and serum uric acid (UA) concentrations. Results: NT-proBNP was (520.13 ± 97.45) ng / L, (2173.18 ± 296.18) ng / L, and (4 523.16 ± 401.72) ng / L respectively in patients with grades Ⅱ, Ⅲ and Ⅳ of cardiac function. (316 ± 113) mmol / L, (360 ± 140) mmol / L and (456 ± 137) μmol / L, respectively. Serum uric acid ≥ 420mmol / L in patients with heart function Ⅲ, Ⅳ grade detection rate was higher than those in grade Ⅱ (P <0.05), the difference was statistically significant. Serum uric acid ≥ 420mmol / L and / or NT-proB-NP ≥ 900 ng / L in patients with either hospitalization or discharge within 12 months of adverse cardiac events were higher than the serum uric acid <420mmol / L and NT -proBNP <900 ng / L (P <0.05), the difference was statistically significant. Conclusions: Elevated NT-proBNP and uric acid may be considered as predictors of independent cardiovascular events in patients with congestive heart failure. The simultaneous increase of these two markers was positively correlated with the increased incidence of cardiovascular events during follow-up.