氨基末端B型利钠肽前体监测对老年心衰患者的预后评估价值

目的动态监测氨基末端B型利钠肽前体(NT-proBNP)水平,探讨其对老年充血性心力衰竭患者的预后评估价值。方法前瞻性选取186例老年心衰患者,分别于入院时、出院时、出院后4周测定血浆NT-proBNP(NT-proBNP1、NT-proBNP2、NT-proBNP3)水平,观察心衰患者心源性再住院及死亡等事件,评价NT-proBNP对老年充血性心衰患者预后判定的价值。结果 186例患者平均随访(261±23.6)d,心源性再发组及非再发组的NT-proBNP1及NT-proBNP3水平无明显差异。再发组NT-proBNP2水平显著高于非再发组(均P<0.01),心源性死亡组NT-proBNP2水平也显著高于心衰再入院组(均P<0.01),再发组NT-proBNP变化指数显著低于非再发组(P<0.01)。Cox多元回归分析显示,NT-proBNP2、住院期间NT-proBNP变化指数、患者的年龄、既往心衰史、贫血、入院时NYHA分级、合并心房颤动、室性心动过速是反映老年心力衰竭患者心源性死亡、再住院的独立的相关因素。结论动态监测入院时及出院时NT-proBNP,计算NT-proBNP变化指数,有利于对老年心力衰竭患者预后做出评估。

Value of prognosis evaluation of NT-proBNP in elderly patients with heart failure

Objective To detect the level of N-terminal pro-brain natriuretic peptide(NT-proBNP) and analyze its value of prognosis evaluation in elderly patients with heart failure.Methods The data of 186 elderly patients with heart failure were analyzed prospectively.NT-proBNP(NT-proBNP 1,NT-proBNP 2 and NT-proBNP 3) levels were assayed when they admitted in hospital,discharged from hospital and after one month in order to evaluate the predictive value of NT-proBNP for prognosis of heart failure.The cardiogenic re-admission and death events were observed.Results Heart patients were followed up for average(261±23.6) d.Compared patients with cardiovascular events and patients without cardiovascular events,there were no statistical differences in NT-proBNP1 and NT-proBNP3.NT-proBNP2 were higher in patients with cardiovascular events than without cardiovascular events group(P<0.01).NT-proBNP2 were also higher in death group than re-admission group(P<0.01).Variability index of NT-proBNP1 were lower in patients with cardiovascular events than in patients without cardiovascular events(P<0.01).Cox proportional hazard regression model analysis showed that NT-proBNP2,changes in NT-proBNP during hospitalization,advance age,previous history of heart failure,anemia,NYHA class,atrial fibrillation and ventricular tachycardia were determinants for patients’cardiogenic death and re-admission.Conclusion Monitoring NT-proBNP in elderly patients at the time of hospitalization and leave hospital could predict the prognosis of patient s with heart failure.