陈旧性广泛前壁心肌梗死合并慢性心力衰竭急性加重期血B型利钠肽正常的临床意义

目的 探讨陈旧性广泛前壁心肌梗死合并慢性充血性心力衰竭(chronic heart failure,CHF)急性加重期患者出现血B型利钠肽(B-type natriuretic peptide,BNP)水平正常的临床意义.方法 采用前瞻性对照研究的方法观察陈旧性广泛前壁心肌梗死合并CHF急性加重期[纽约心功能分级(NYHA)Ⅲ～Ⅳ级]患者62例.血BNP水平正常的18例为研究组(BNP＜100 pg/L),血BNP水平明显升高的 44例为对照组(BNP＞100 pg/L).分析两组患者的临床特点和预后,从而得出陈旧性广泛前壁心肌梗死合并CHF急性加重期血BNP正常的临床意义.结果 两组患者的基线情况差异无统计学意义.研究组的左心室舒张期末内经(left veiltricular end diastolic diameter,LVEDd)大于对照组,(65.44±2.04) mm vs (63.48±2.50) mm(P＜0.05).研究组的左心室射血分数(left ventricular ejection fraction,LVEF)低于对照组,(21.06±3.45)％ vs(32.25±4.05)％(P＜0.05).研究组的平均住院日长于对照组,(22.56±3.29)d vs (15.43±2.42)d(P＜0.05).研究组服用美托洛尔的最大耐受剂量低于对照组,(12.50±4.79) mg vs(24.94±6.80) mg(P＜0.05).随访2年期间研究组因心源性死亡15例,对照组因心源性死亡6例(P ＜0.01).两组在LVEDd、LVEF、住院时间、美托洛尔耐受最大剂量、随访2年心源性病死率方面比较差异有统计学意义(P＜0.01).Logistic回归分析显示:血BNP降低为预测陈旧性广泛前壁心肌梗死合并慢性心衰急性加重期的独立危险因素(r =4.266,OR=71.208,95％CI=1.200～4224.226,P＜0.05).结论 陈旧性广泛前壁心肌梗死合并CHF急性加重期(NYHAⅢ～Ⅳ级)血BNP正常的患者心力衰竭程度更严重,预后更差.

Clinic significance of old extensive anterior myocardial infarction complicated with chronic heart failure patients with normal blood B-type natriuretic peptide at acute stages

Objective To investigate the clinic significance of normal blood B-type natriuretic peptide（BNP） at acute stages in old extensive anterior myocardial infarction complicated with chronic heart failure patients. Methods Sixty-two patients of old extensiv6 anterior myocardial infarction complicated with chronic heart failure at acute stages （New York Heart Class III-IV ） were included in this prospective control study. The research group included 18 patients with normal BNP（BNP〈100 pg/L） and the comparison group included 44 patients with increased BNP （BNP〉100 pg/L）. Clinic feature and prognosis of the two groups were analyzed to get conclusion of normal blood BNP at acute stages in old extensive anterior myocardial infarction complicated with chronic heart failure patients. The baseline clinical characteristics of two groups were comparable. Results Left ventricular end diastolic diameter （LVEDd） of research group was larger than that of comparison group, （65.44 ± 2.04） mm vs （63.48 ± 2.50） mm（ P 〈 0.05）, left ventricular ejection fraction（LVEF） of research group was lower than that of comparison group, （21.06 ± 3.45） % vs （32.25 ± 4.05）% （ P 〈0.05）. Average days of hospital stay in research group were longer than those of comparison group, （22.56 ± 3.29） d vs （15.43 ± 2.42） d （ P 〈0.05）. The tolerated dose of metoprolol of research group was smaller than that of comparison group, （12.50 ±4.79） mg vs （24.94 ±6.80） mg（ P 〈0.05）. In the 2 years of follow-- up study,cardiac factors-death accounted for 15 patients in research group and 6 patients in comparison group（ P 〈 0.01）. The two groups showed statistic significance in LVEDd, LVEF, hospitalization days, largest tolerated dose of metoprolol, cariac factors-death during 2-year follow-up（ P 〈0.01）. The binary logistic regression analysis showed that normal BNP was an independent predictor of old extensive anterior myocardial infarction complicated with chronic heart failure patients at acute stages （ OR = 71. 208,95% CI = 1. 200-4224. 226, P 〈 0.05）. Conclusion Normal blood BNP at acute stages（NYHA III-/V） in patients of old extensive anterior myocardial infarction complicated with chronic heart failure suggest severe chronic heart failure and poor prognosis.