BNP与老年心力衰竭患者LVEF、心功能分级及预后相关性研究

目的分析老年心力衰竭(心衰)患者血浆脑钠肽(BNP)水平与左室射血分数(LVEF)、6分钟步行试验距离(6MWT)、NYHA心功能分级及预后的相关性。方法选取2009年2月至2013年11月在上海市徐汇区中心医院老年病科治疗的老年心衰患者100例,男性48例,女性52例,年龄55~72岁,平均年龄(68.26±5.23)岁。根据血浆BNP水平分为4组,A组(8.0~93.9)pg/mL]22例;B组(94.0~349.9)pg/mL]30例;C组(350.0~988.9)pg/mL]21例;D组(989.0~5000.0)pg/mL]27例。检测患者血浆BNP水平,测量各组患者LVEF、6MWT、心功能分级以及随访出院2个月后不良心脏事件发生情况。结果与A组(135.13±32.24)pg/mL]比较,B组(323.14±52.37)pg/mL]、C组(568.47±132.13)pg/mL]、D组(1687.57±432.66)pg/mL]血浆BNP水平呈逐渐增高趋势,差异具有统计学意义(P均0.05)。与A组(49.56±8.63)%]比较,C组(42.24±4.41)%]、D组(35.03±3.87)%]下降,差异具有统计学意义(P均0.05)。随着血浆BNP水平升高,6MWT呈下降的趋势,差异具有统计学意义(P均0.05),心功能也逐渐下降,MACE发生率增加。老年心衰患者血浆BNP水平与LVEF呈负相关(r=-0.893,P0.05),与6MWT呈负相关(r=-0.913,P0.05),与心功能NYHA分级呈正相关(r=0.927,P0.05),与2个月MACE发生率呈正相关(r=0.909,P0.05)。结论老年心衰患者血浆BNP水平与LVEF、心功能分级、6MWT及预后密切相关,为临床诊断老年心衰以及评估心衰严重程度提供重要参考。

Correlation between BNP and LVEF,cardiac functional grading and prognosis in elderly patients with heart failure

Objective To analyze the relationship between level of brain natriuretic peptide （BNP） and left ventricular ejection fraction （LVEF）, 6-minute walk test （6MWT）, NYHA grading and prognosis in elderly patients with heart failure. Methods The elderly patients （male 48 and female 52）, aged from 55 to 72 and average age being （68.26±5.23）, were chosen from Feb. 2009 to Nov. 2013, and then divided, according to their BNP levels, into group A （8.0-93.9） pg/mL, n=22], group B （94.0-349.9） pg/mL, n=30], group C （350.0-988.9） pg/mL, n=21] and group D （989.0-5000.0） pg/mL, n=27]. The level of BNP, LVEF, 6MWT, NYHA grading and major adverse cardiac events （MACE） followed up for 2 m after discharged were detected in all groups. Results Compared with group A （135.13±32.24） pg/mL], BNP level increased gradually in group B （323.14±52.37） pg/mL], group C （568.47±132.13） pg/mL] and group D （1687.57±432.66） pg/mL, P〈0.05]. Compared with group A （49.56±8.63）%], LVEF decreased in group C （42.24±4.41）%] and group D （35.03±3.87）%, all P〈0.05]. As the increase of BNP level, 6MWT showed a decreasing trend （P〈0.05） and NYHA grading also decreased gradually. The level of BNP was negatively correlated to LVEF （r=-0.893, P〈0.05） and 6MWT （r=-0.913, P〈0.05）, and positively correlated to NYHA grading （r=0.927, P〈0.05） and MACE after 2 m （r=0.909, P〈0.05）. Conclusion The level of plasma BNP is closely correlated to LVEF, NYHA grading, 6MWT and prognosis in elderly patients with heart failure, which is important to clinical diagnosis of HF and reviewing of heart failure severe.