论文部分内容阅读
目的探讨住院期间监测氨基末端脑钠肽前体(NT-proBNP)对心力衰竭患者的预后价值。方法选择连续住院治疗的171例心力衰竭患者[男103名、女68名,年龄(70.4±13.3)岁]为研究对象,采用自动化电化学发光免疫分析仪,测定入院时及出院前血浆NT-proBNP水平,根据住院期间NT-proBNP变化比值分为下降明显组(NT-proBNP下降≥30%,n=106),升高明显组(NT-proBNP升高≥30%,n=31),变化不明显组(NT-proBNP变化<30%,n=34);根据出院前NT-proBNP中位数,分为NT-proBNP≤2016.0ng/L组(n=86)和NT-proBNP水平>2016.0ng/L组(n=85),平均随访371(90～540)d。以心血管事件再发组(心源性死亡或心力衰竭失代偿再入院)为观察结果。结果随访期间,76例患者心血管事件再发(26例心源性死亡,50例心力衰竭失代偿再入院)。心血管事件再发组与非再发组入院时NT-proBNP无统计学差异。再发组出院前NT-proBNP显著高于非再发组(3872.0比1306.0ng/L,P<0.01),再发组住院期间NT-proBNP下降不明显,表现为NT-proBNP变化比值(入院时NT-proBNP水平-治疗后NT-proBNP水平/入院时NT-proBNP水平)显著低于非再发组(18.7%比69.2%,P<0.01);Cox比例风险回归模型分析显示,NT-proBNP变化比值分组、出院前NT-proBNP是反映心力衰竭患者预后的重要预测因子;Kaplan-Meier法分析显示,下降明显组较变化不明显组以及升高明显组生存几率明显较高,出院前NT-proBNP≤2016.0ng/L组较NT-proBNP>2016.0ng/L组生存几率高。结论重复检测NT-proBNP,尤其是出院前NT-proBNP,可能有助于提高心力衰竭患者的预后生存率。
Objective To investigate the prognostic value of monitoring NT-proBNP during heart failure in patients with heart failure. Methods A total of 171 patients with heart failure (103 males and 68 females, aged 70.4 ± 13.3 years) who underwent continuous hospitalization were enrolled in this study. The automated electrochemiluminescence immunoassay was used to determine the plasma levels of NT- proBNP levels were significantly decreased (NT-proBNP ≥30%, n = 106) and significantly elevated NT-proBNP (≥30% NT-proBNP, n = 31) NT-proBNP≤2016.0 ng / L group (n = 86) and NT-proBNP level> 2016.0 according to the median of NT-proBNP before discharge ng / L group (n = 85), the average follow-up of 371 (90 ~ 540) d. Recurrence of cardiovascular events group (cardiac death or heart failure decompensation and admission) as the observation. Results During the follow-up period, 76 patients had recurrent cardiovascular events (26 cases of cardiac death and 50 cases of heart failure decompensated). There was no significant difference in NT-proBNP between admissions of recurrent and non-recurrent cardiovascular events. The NT-proBNP level was significantly higher in the recurrent group than that in the non-recurrent group (3872.0 vs. 1306.0 ng / L, P <0.01). The NT-proBNP did not decrease significantly in the recurrent group NT-proBNP level-NT-proBNP level after treatment / NT-proBNP level at admission) was significantly lower than that of non-recurrence group (18.7% vs 69.2%, P <0.01); Cox proportional hazards regression analysis showed that the NT-proBNP level NT-proBNP before discharge was an important predictor of the prognosis of patients with heart failure. Kaplan-Meier analysis showed that there was a significantly higher risk of survival in the group of decreased significantly compared with the group without obvious change and the group of obvious increase. The pre-discharge NT-proBNP ≤2016.0ng / L group than NT-proBNP> 2016.0ng / L group of high survival probability. Conclusions Repeated detection of NT-proBNP, especially pre-discharge NT-proBNP, may help to improve the prognosis of patients with heart failure survival.