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目的探讨血浆脑钠肽(BNP)水平与肝硬化失代偿期患者预后的关系。方法选取2010年1月至2012年3月我院住院的60例肝硬化失代偿期患者,设为试验组,对照组为2010年6月至2011年3月间我院住院的58例非肝硬化肝病患者。用酶联免疫分析(ELISA)法检测2组的血浆BNP水平,用COX多因素回归分析影响肝硬化患者预后的独立因素,进行生存曲线分析,随访观察患者出院后3个月的死亡率。结果试验组血浆BNP(189.01±33.20)pg·m L-1明显高于对照组(32.41±72.43)pg·m L-1(P<0.05),其水平与肝功能ChildPugh分级呈正相关。BNP水平与肝硬化门脉高压的4项指标之间也呈一定的相关性(P<0.05),BNP水平越高,脾静脉及食道静脉越粗,侧枝循环越明显,腹水也越易出现。肝硬化合并上消化道出血的患者血浆BNP水平明显高于未出血者(P<0.05)。COX回归显示,影响肝硬化患者预后的独立因素有3个:BNP水平、食道静脉曲张、腹水。Kaplan-Meier生存曲线提示,BNP>157.3pg·m L-1的患者较BNP≤157.3 pg·m L-1的患者3个月生存率明显下降(P<0.05)。结论肝硬化患者血浆BNP水平显著升高,临床上检测肝硬化患者血浆BNP可作为肝功能评价参考指标之一,且其对肝硬化失代偿期患者的预后有一定的应用价值。
Objective To investigate the relationship between plasma brain natriuretic peptide (BNP) and the prognosis of patients with decompensated liver cirrhosis. Methods Sixty patients with decompensated liver cirrhosis who were hospitalized in our hospital from January 2010 to March 2012 were selected as the experimental group and the control group were 58 patients hospitalized in our hospital from June 2010 to March 2011 Liver cirrhosis patients. Plasma BNP levels in two groups were detected by enzyme-linked immunosorbent assay (ELISA). Independent variables influencing the prognosis of patients with cirrhosis were analyzed by COX multiple regression analysis. Survival curves were analyzed. Mortality rates at 3 months after discharge were observed. Results Plasma BNP level (189.01 ± 33.20) pg · m L-1 in the experimental group was significantly higher than that in the control group (32.41 ± 72.43) pg · m L-1 (P <0.05). The level of BNP was positively correlated with Child Pugh classification. There was also a correlation between BNP level and 4 indexes of cirrhotic portal hypertension (P <0.05). The higher BNP level, the more thick splenic vein and esophageal vein, the more obvious collateral circulation and the more prone to ascites. Plasma BNP levels in cirrhotic patients with upper gastrointestinal bleeding were significantly higher than those without bleeding (P <0.05). COX regression showed that there were three independent factors affecting the prognosis of cirrhotic patients: BNP level, esophageal varices, ascites. Kaplan-Meier survival curves suggested that patients with BNP> 157.3pg · m L-1 had a significantly lower 3-month survival rate than patients with BNP ≤157.3 pg · m L-1 (P <0.05). Conclusions Plasma BNP level is significantly elevated in patients with cirrhosis. Detecting plasma BNP level in patients with cirrhosis can be used as a reference index for the evaluation of liver function in patients with cirrhosis, and it has a certain value in the prognosis of patients with cirrhosis.