B型利钠肽与慢性心力衰竭短期预后的关系

目的探讨B型利钠肽(BNP)能否反映慢性心力衰竭患者心功能的变化,以及比较它与生存质量、白介素-6(IL-6)、肌钙蛋白I(cTnI)对慢性心衰患者短期预后的影响。方法从2002年9月至2003年3月所有入住中山大学附属一院心血管内科的慢性心衰NYHA分级II—Ⅳ的患者共96例。入院第2天抽血检查BNP、IL-6、cTnI,入院1天内自行填写明苏达慢性心功能不全患者生存质量量表。3个月后重复测量BNP的水平并再次填写生存质量量表。结果BNP随着慢性心衰的严重程度升高而升高。躯体方面及总的生存质量得分都与慢性心衰的严重程度相关(P<0.05)。3个月后,好转的患者BNP水平下降了(P<0.05),恶化的患者BNP水平升高了(P<0.05)。以150ng/L为分割点用Kaplan-meier的方法分析得出高水平BNP患者的生存曲线明显高于低水平BNP的患者(P<0.01)。在单因素的logistic回归分析中纽约心功能分级、BNP、左室射血分数、左室舒张末直径、心脏增大、IL-6、生存质量总得分、躯体方面得分及精神方面得分都是有意义的短期预后因子,而在多因素回归分析中,只有BNP及生存质量精神方面得分是独立的短期预后因子。结论BNP水平的变化能反映慢性心衰的治疗效果。BNP及生存质量是慢性心衰两个主要的短期预后因子。

Prognostic potential of B-type natriuretic peptide and quality of life in patients with chronic heart failure

Objectives To study whether change of B type natriuretic peptide(BNP) levels reflect change of cardiac function and to compare the short term prognostic potential of IL 6,cTnI,BNP and QOL in patients with CHF Methods Ninety six consecutive patients admitted with CHF between September 2002 and January 2003 were studied,upon entry the study,patients were measured BNP levels,IL 6,cTnI and administered the disease specific QOL questionnaire Minnesota living with heart failure questionnaire (LiHFe) within 1 day BNP levels and administering LiHFe were repeated three months later Results BNP levels increased proportional to the severity of cardiac function Physical domain and total score of LiHFe were significantly correlated to the severity of CHF(P< 0 05) BNP levels decreased in improving group (P=0 032) In deteriorating group BNP levels increased (P=0 043) Kaplan meier analysis according to BNP level cutoff point 150 ng/l,the life curve of higher BNP level group was significantly lower than the lower group (P=0 001) In univariate logistic regression,NYHA class,BNP,LVEF,LVEDD,heart size,IL 6,total score of LiHFe,physical domain of LiHFe and the emotional domain of LiHFe were all significant prognostic factors of CHF (P< 0 05 for all) While in multiple regression,only BNP level (P=0 036) and the emotional domain of LiHFe (P=0 025) were independent prognostic factors Conclusion Change of BNP reflect the treatment efficacy of CHF BNP and QOL are the two major short time prognostic factors of the chronic heart failure patients