脑钠肽对心血管病患者近期心源性死亡的预测价值

目的脑钠肽(BNP)主要由心室分泌的一种多肽类激素,其对国人心血管病患者近期预后评估的价值尚未确定,本研究旨在探讨脑钠肽对国人心血管病患者近期发生心源性死亡的预测价值.方法使用BIOSITE Triage脑钠肽干氏快速检测方法对107例住院心血管病患者入院1～3 d的脑钠肽水平进行测量,随访1月,分为存活组和死亡组.结果①存活组和死亡组脑钠肽水平差异有极显著统计学意义(U=148,P＜0.000 5);②血脑钠肽浓度与心率、左室舒张末期内径、心力衰竭史和心肌梗死史呈正相关(r=0.28,P=0.000 4;r=0.49,P＜0.000 5;r=0.39,P＜0.000 5;r=0.21,P=0.03),与左室射血分数呈负相关(r=-0.63,P＜0.000 5);③脑钠肽预测1月内心源性死亡的ROC曲线下面积为0.89,95%可信区间为0.79～0.98,P＜0.000 5;Logistic逐步回归分析表明,惟有血脑钠肽浓度大于755pg/mL是近期心源性死亡的独立预测因子(OR=17.6,95%可信区间为8.7～66.5,P＜0.000 5).结论脑钠肽对心血管病患者1月内心源性死亡的发生有极高的预测价值.

The Value of Brain Natriuretic Peptide to Predict Short-term Cardiac Death in Patients with Cardiovascular Disease

Objective Brain natriuretic peptide(BNP) is released from the cardiac ventricles in response to increased wall tension. The prognostic significance of blood brain natriuretic peptide in Chinese patients with cardiovascular disease has not been established. The purpose of this study was to investigate the value of brain natriuretic peptide for predictin g cardiac death within 1 month in Chinese patients with cardiovascular disease. Methods One hundred and seven inpatients with cardiovascular disease, whose blood brain natriuretic peptide concentration were measured within 1 - 3 days of admission, using triage BNP test, were divided into 2 groups: the survival and the non-survival, according to the results of 1was positively correlated with heart rate, left ventricular end-diastolic dimension, history of heart failure and old myocardial infarction (r=0.28, P=0. 000 4; r=0.49, P＜0. 000 5; r=0.39, P＜0. 000 5; r=Area under the curve of the receiver-operating-characteristic(ROC) of brain natriuretic peptide to predict cardiac death at 1 month in patients with cardiovascular disease was 0.89%, 95% confidence interval 0.79-0. 98, P＜0. 000 5; stepwise logistic regression analysis indicated that brain natriuretic peptide (≥755pg/mL) was the only independent predictor of cardiac death at 1 month in patients with cardiovascular disease (OR= 17.6, 95 % confidence interval, 8.7- 66.5, P＜0. 000 5 ). Conclusion Brain natriuretic peptide might predict cardiac death at 1 month in patients with cardiovascular disease.