心率变异性和NT-proBNP对慢性心力衰竭患者病情评估及预后的临床应用价值

目的探讨心率变异性（HRV）和血浆N末端脑钠肽前体（NT-proBNP）水平对慢性心力衰竭（CHF）患者病情评估及预后的临床应用价值。 方法选取2016年9月至2017年12月在六安市第二人民医院住院的177例CHF患者为研究对象。根据患者心功能分级，将其分为心功能Ⅱ~Ⅲ级组和心功能Ⅳ级组：心功能Ⅱ~Ⅲ级组包括心功能Ⅱ级患者28例，心功能Ⅲ级患者63例，共91例；心功能Ⅳ级组均为心功能Ⅳ级患者，共86例。对两组患者性别、伴发疾病情况的比较采用χ²检验；对两组患者年龄、血浆NT-proBNP水平，以及HRV时域指标SDNN、RMSSD、PNN50和三角指数的比较采用独立样本t检验。 结果心功能Ⅱ~Ⅲ级组CHF患者血浆NT-proBNP水平显著低于心功能Ⅳ级组，差异有统计学意义［（1545.2±147.5）ng/L vs（4012.6±983.2）ng/L，t=49.510，P<0.001］；心功能Ⅱ~Ⅲ级组CHF患者HRV时域指标SDNN、RMSSD、PNN50和三角指数均显著高于心功能Ⅳ级组患者，差异有统计学意义［（95.56±15.16）ms vs（68.74±12.58）ms，t=15.294，P<0.001；（19.04±7.62）ms vs（15.23±5.29）ms，t=9.275，P=0.001；（5.59±2.23）% vs（4.48±2.65）%，t=5.601，P=0.002；（13.22±6.82）vs（10.69±4.53），t=2.748，P=0.011］。心功能Ⅱ~Ⅲ级组房性心律失常、心血管事件、房性心律失常伴心血管事件的发生率均明显低于心功能Ⅳ级组，差异有统计学意义［27例（29.7%）vs 40例（46.5%），χ²=15.130，P<0.001；9例（9.9%）vs 14例（16.3%），χ²=11.577，P<0.001；4例（4.4%）vs 8例（9.3%），χ²=10.836，P=0.001］。 结论血NT-proBNP水平和HRV各项时域指标均对CHF患者诊断、治疗及预后具有重要临床应用价值。

Clinical value of NT-proBNP and heart rate variability in disease severity and prognosis assessment in patients with chronic heart failure

ObjectiveTo investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and heart rate variability in disease severity and prognosis assessment in patients with chronic heart failure. MethodsA total of 177 hospitalized patients with chronic heart failure treated at the Lu′an Second People′s Hospital from September 2016 to December 2017 were included. According to cardiac function classification, the patients were divided into a levelⅡ-Ⅲ cardiac function group (n=91) or a levelⅣ group (n=86). The distribution of gender and concomitant diseases were compared by chi-square test between the two groups. Age, NT-proBNP, and heart rate variability (HRV) measures SDNN, RMSSD, PNN50, and HRV triangle index were compared by the independent samples t-test between the two groups. ResultsThe level of plasma NT-proBNP in the levelⅡ-Ⅲ group was significantly lower than that of the levelⅣ group (1545.2±147.5) ng/L vs (4012.6±983.2) ng/L, t=49.510, P<0.001]. The HRV measures SDNN, RMSSD, PNN50, and HRV triangle index in the level Ⅱ-Ⅲ group were significantly higher than those of the level Ⅳ group (95.56±15.16) ms vs (68.74±12.58) ms, t=15.294, P<0.001; (19.04±7.62) ms vs (15.23±5.29) ms, t=9.275, P=0.001; (5.59±2.23)% vs (4.48±2.65)%, t=5.601, P=0.002; (13.22±6.82) vs (10.69±4.53), t=2.748, P=0.011]. The rates of sinus arrhythmia, cardiovascular events, and sinus arrhythmia with cardiovascular events were significantly lower in the level Ⅱ-Ⅲ group than that of the level Ⅳ group 27 cases (29.7%) vs 40 cases (46.5%), χ²=15.130, P<0.001; 9 cases (9.9%) vs 14 cases (16.3%), χ²=11.577, P<0.001; 4 cases (4.4%) vs 8 cases (9.3%), χ²=10.836, P=0.001]. ConclusionPlasma NT-proBNP level and HRV indexes are of great significance in the diagnosis, treatment, and prognosis assessment in patients with chronic heart failure.