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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 prognostic value of B-type natriuretic peptide (BNP) in patients with left ventricular failure. Methods: BNP levels in patients with heart failure were measured by fluorescence immunoassay and followed up. The main clinical endpoints were cardiac death and re-admission. According to the follow-up results, patients were divided into non-recurrence group (162 cases), cardigenic rehospitalization group (47 cases) and cardiac death group (54 cases). Survival and no cardiac event survival were calculated using the Kaplan-Meier method, and multivariate analysis using COX regression analysis. RESULTS: The mean follow-up of 300 patients (9.5 ± 5.6) months was significantly higher in the cardigenic rehospitalization group (482.0 (227.0, 793.0) pg / ml) and in the cardiac death group (565.0 (327.3, 1192.5) pg / BNP levels were significantly higher than those without recurrence [146.5 (51.7, 374.3) pg / ml] (all P <0.001). Regardless of univariate or multivariate analysis, including age, gender, New York Heart Association grading (NYHA), echocardiographic left anteroposterior diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction (LVEF) and Log BNP, only Log BNP was independently associated with cardiac death and cardiological readmission. Log BNP, gender, age, NYHA, LVEF, end-diastolic diameter of left ventricular end-diastolic diameter, and whether or not there were atrial fibrillation, atrial flutter, ventricular tachycardia and diabetes were all introduced into the study. Sex, NYHA, LVEF and ventricular tachycardia were predictors of cardiac events. However, for further COX multiple regression analysis, only Log BNP (regression coefficient: 0.9898; P = 0.002) and ventricular tachycardia (regression coefficient: 0.893; P = 0.005) were independently associated risk factors. In both cases, the strongest association was Log BNP. According to the receiver operating characteristic curve (ROC), BNP 288 pg / ml is the best threshold for the occurrence of episodes of no cardiogenic events. Patients with BNP ≤288 pg / ml had a life-span of approximately twice as long as patients with> 288 pg / ml (18.06 months vs 9.94 months, P = 0.000). Conclusion: The predictive value of BNP in patients with heart failure is good. Log BNP and ventricular tachycardia are independent determinants of cardiac death and rehospitalization.