和肽素在慢性心力衰竭急性发作期治疗中的变化与预后的关系

目的 研究和肽素在慢性心力衰竭急性发作期治疗前后的变化,及其对病情评估、预后判断的价值.方法 选择慢性心力衰竭急性发作患者80例为心力衰竭组,健康对照组30例.心力衰竭组分别于入院即刻、治疗10 d后测定血浆和肽素、氮末端脑钠肽前体（NT-proBNP）水平,入院后24h内行心脏超声检查,测量左心室舒张末期内径（LVIDd）和左心室射血分数（LVEF）；出院后3个月时随访其是否发生心血管事件（包括心力衰竭、恶性心律失常、死亡等）.结果 心力衰竭组入院即刻和肽素、NT-proBNP水平均高于对照组（均为P＜0.01）；心力衰竭组治疗10 d后和肽素、NT-proBNP水平较入院时明显下降（均为P＜0.01）；出院后3个月时间内,与未发生心血管事件的患者相比,发生心血管事件患者的和肽素、NT-proBNP水平在治疗前后均较高（均为P＜0.01）；用全模型多元Logistic回归分析,入院时和肽素水平为慢性心力衰竭患者独立预后指标（P＜0.01）.结论 慢性心力衰竭急性发作期和肽素、NT-proBNP水平升高,治疗后其水平明显下降；监测和肽素浓度对心力衰竭患者的危险分层及预后判断有重要意义.

Clinical studies on level of copeptin in the treatment and prognosis of patients with acute attack of chronic heart failure

Objective To study the relationship of the level of copeptin and prognosis of patients with acute attack of chronic heart failure.Methods A total of 80 patients with acute attack of chronic heart failure as heart failure group,and 30 healthy counter-partners （no heart failure）were chosen as control group.Plasma levels of copeptin and NT-proBNP were detected by ELISA method before anti-cardiac failure treatment and 10 days after the treatment.All enrolled patients were followed up for 3 months after discharged,and cardiovascular events such as death,or readmission because of worsening of heart failure or severe arrhythmia were recorded.Results At admission,plasma copeptin,NT-proBNP levels in patients with acute attack of chronic heart failure were significandy increased compared with the control group （all P 〈 0.01）.Compared with baseline levels,plasma copeptin and NT-proBNP levels were significantly decreased on 10th day after admission and treatment （all P 〈0.01） in heart failure group.The levels of plasma copeptin and NT-proBNP levels significantly increased at all observational times in patients with cardiovascular events compared to the patients without events （all P〈0.01）.Multivariate Logistic regression analysis showed that plasma copeptin and NT-proBNP levels were independent prognostic factors for patients with chronic heart failure（all P 〈0.01）.Conclusions During acute onset of heart failure,plasma copeptin and NT-proBNP levels in patients with chronic heart failure can be lowered at 10th days after admission and treatment.Higher levels of plasma copeptin and NT-proBNP may have a certain association with worse prognosis in patient with chronic heart failure.