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目的评价血浆脑钠肽(BNP)动态变化对急性左心衰患者院内预后的预测价值。方法选取50例急性左心衰患者,分别于急诊入院即刻、入院24、72h测量血浆BNP,并计算72 h内血浆BNP变化率(RATE)。超声检测左室舒张末内径(LVEDD)和左室射血分数(LVEF)。根据患者出院时预后分为预后良好组(出院时NYHA级别改善≥Ⅱ级者),疗效不良组(出院时NYHA级别改善≤Ⅰ级者)及死亡组,比较分析三组患者的各项观察指标,logistic回归对病例预后进行多因素分析。结果 3个时间点的血浆BNP组间分别比较,差异均有统计学意义。预后良好的患者各个时间点血浆BNP水平分别比较,均有统计学差异;随着预后的恶化,血浆BNP的下降趋势越不明显。回归分析显示只有LVEF、RATE2个变量对住院期间预后影响具有统计学意义,且RATE对预后的影响强于LVEF。结论连续、多个时间点观察血浆BNP水平结合超声心功能指标LVEF对评价急性左心衰患者的院内治疗有重要意义,是重要的预后指标,且BNP下降率的影响力要强于传统的LVEF值。
Objective To evaluate the predictive value of dynamic changes of plasma brain natriuretic peptide (BNP) in patients with acute left heart failure. Methods Fifty patients with acute left heart failure were enrolled in this study. Plasma BNP was measured at 24 and 72 hours after admission, and the rate of plasma BNP was calculated within 72 hours. The left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured by ultrasound. According to the prognosis of patients discharged into good prognosis group (discharged NYHA level improved ≥ Ⅱ grade), poor efficacy group (discharge grade NYHA grade ≤ Ⅰ) and death group, comparative analysis of the three groups of patients with various indicators Logistic regression was used to analyze the prognosis of the patients by multivariate analysis. Results The plasma BNP levels at 3 time points were compared respectively, the differences were statistically significant. Patients with good prognosis at all time points plasma BNP levels were compared, were statistically significant; as the prognosis deteriorated, the decline of plasma BNP less obvious. Regression analysis showed that only LVEF, RATE2 variables on the prognosis of hospitalization was statistically significant, and RATE on prognosis than LVEF. Conclusions The observation of plasma BNP level and echocardiographic index LVEF in continuous and multiple time points is of great significance in the evaluation of hospital treatment of patients with acute left heart failure and is an important prognostic indicator with the influence of BNP decline rate being stronger than the traditional LVEF .