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目的评价血浆N-端B型钠尿肽原(NT-proBNP)水平对心力衰竭患者近期死亡风险的预测价值。方法连续收集2006年4月~2006年7月在我院门诊或住院的心血管病患者117例,根据心功能级别分为NYHAⅠ、Ⅱ、Ⅲ、Ⅳ组。同期收集我院健康体检者20例作为对照组。测定血浆NT-proBNP浓度,心脏超声测量左室舒张未内径(LVDD)、左室短轴缩短率(LVFS)、左室射血分数(LVEF)等指标。电话随访3个月,终点为心血管事件死亡。结果血浆NT-proBNP浓度随NYHA分级增加而增高,且均高于对照组(P<0.01)。对照组、NYHAⅠ、Ⅱ组间的LVDD、LVFS和LVEF差异无统计学意义(P>0.05)。NYHA分级与NT-proBNP及LVDD呈正相关,与LVFS和LVEF呈负相关,其中与NT-proBNP相关程度最高。血浆NT-proBNP浓度>20000pg/ml的患者3个月病死率为40%,死亡的相对危险性是<20000pg/ml组的48.8倍,后者3个月病死率为0.8%。结论血浆NT-proBNP浓度是反映心力衰竭严重程度的理想指标;血浆NT-proBNP浓度明显升高者近期死亡危险性明显增加。
Objective To evaluate the predictive value of plasma N-terminal B-type natriuretic peptide (NT-proBNP) in the risk of death in patients with heart failure. Methods A total of 117 cardiovascular patients were enrolled or hospitalized in our hospital from April 2006 to July 2006. The patients were divided into NYHAⅠ, Ⅱ, Ⅲ and Ⅳ groups according to their cardiac function. In the same period collected 20 cases of healthy physical examination in our hospital as a control group. Plasma concentrations of NT-proBNP, left ventricular diastolic diameter (LVDD), left ventricular fractional shortening (LVFS) and left ventricular ejection fraction (LVEF) were measured. The phone was followed up for 3 months and died of a cardiovascular event. Results The plasma concentration of NT-proBNP increased with the increase of NYHA classification, and were higher than those of the control group (P <0.01). There was no significant difference in LVDD, LVFS and LVEF between NYHA Ⅰ and Ⅱ in the control group (P> 0.05). The NYHA classification was positively correlated with NT-proBNP and LVDD, negatively correlated with LVFS and LVEF, with the highest correlation with NT-proBNP. Patients with plasma NT-proBNP concentrations> 20,000 pg / ml had a 3-month mortality of 40% and a relative risk of death of 48.8-fold in the <20,000 pg / ml group, with a 3-month case-fatality rate of 0.8%. Conclusion The plasma NT-proBNP concentration is an ideal indicator of the severity of heart failure. The plasma NT-proBNP concentration significantly increased the risk of death in the recent significant increase.