血清cTnI和NT—proBNP对稳定性慢性心衰病人的预测价值

目的：探讨血清心肌肌钙蛋白（cTnI）和N末端B型利钠肽前体（NT-proBNP）与稳定性慢性心衰病人心脏主要终点事件的相关性。方法：本研究从2010年2月至2011年2月共入选了95名心功能Ⅲ-Ⅳ级的患者。根据患者cTnI和NT—proBNP的水平分为cTnI阴性组（60例）和cTnI阳性组（35例）；NT—proBNP阴性组（40例）和NT—proBNP阳性组（55例），随访2年，主要终点事件是心源性猝死和心衰再次急性加重住院。结果：和阴性组比较，cTnI阳性组发生终点事件的风险比（HR）为2．69，可信区间（CI）1．54～4．72，P=0．002；NT—proB—NP阳性组的HR为2．54，CI1．35～4．78，P=0．002；进一步组间交叉分析发现，当病人cTnI和NT—proBNP均为阳性组，发生心脏终点事件的风险比最高（HR=6．34，CI2．26～17．9，P〈0．001）。结论：在慢性稳定性心衰的病人，血清心肌肌钙蛋白和N末端B型利钠肽前体水平的升高是反映心衰病人预后的重要预测指标。

Predictive value of serum cTnI and NT-proBNP for patients with chronic stable heart failure

Objective： To explore the correlation among serum cardiac troponin I （cTnI）, N terminal pro brain natri- uretic peptide （NT-proBNP） and main endpoint events of heart in patients with chronic stable heart failure. Methods： The present study enrolled 95 patients with NYHA cardiac function class Ⅲ-Ⅳ from Feb 2010 to Feb 2011. According to levels of cTnI and NT-proBNP, the patients were divided into cTnI negative group （n = 60） and cTnI positive group （n = 35）; NT-proBNP negative group （n = 40） and NT-proBNP positive group （n = 55）, all patients were followed up for two years, and the main endpoint events were cardiogenic sudden death and rehospitalization caused by acute aggravation of heart failure. Results： Compared with negative group, the hazard ratio （HR） of endpoint events was 2.69 and confidence interval （CI） was 1.54~4.72, P = 0. 002 in cTnI positive group; HR was 2.54 and CI was 1.35~4.78, P = 0. 003 in NT-proBNP positive group; further interclass crossover analysis found that, when patients cTnI and NT-proBNP were both positive, the hazard ratio of cardiac endpoint events was the highest （HR= 6.34, CI 2.26~17.9, P〈0. 001）. Conclusion： In patients with chronic stable heart failure, serum elevated levels of cardiac troponin I and N terminal pro brain natriuretic peptide are important predictors reflecting prognosis of patients with heart failure.