血浆N末端原脑利钠肽水平对慢性心力衰竭患者长期预后的预测价值

目的探讨N末端原脑利钠肽（Nt-proBNP）水平对慢性心力衰竭（心衰）患者长期预后的临床价值。方法选择慢性心衰患者,以纽约心脏病心功能分级方法评估心功能,采用双抗体夹心免疫荧光法测定血浆Nt-proBNP水平;并随访2年。结果（1）135例慢性心衰患者平均随访（6404-100）d,发现发生心血管事件组比不发生事件组的Nt-proBNP基线水平明显为高。（2）全模型多元logistic回归分析显示,Nt-proBNP和是否发生事件明显相关,Log Nt-proBNP每变化1个单位,风险增加14倍;Nt-proBNP≤1246ng／L组的生存曲线高于Nt-proBNP〉1246ng／L组。（3）Nt-proBNP水平对预后判定的ROC曲线下面积为0．885,其对心血管事件的阳性预测价值为88．5％,阴性预测价值为11．5％。结论（1）慢性心衰患者中Nt-proBNP水平明显增高,且随着心功能不全级别的增高相应递增;（2）血浆Nt-proBNP水平升高的程度对慢性心衰患者发生心血管事件或死亡的预测具有一定的价值。

Prognostic value of N-terminal-pro-brain natriuretic peptide on admission in patients with chronic heart failure

OBJECTIVE: Heart failure is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (Nt-proBNP) on predicting death or hospital readmission after hospital discharge in patients with chronic heart failure (CHF). METHODS: From March 2003 to April 2005, 135 consecutive patients (97 male and 38 female, mean age 60.7 years +/- 13.1 years) with chronic heart failure dilated cardiomyopathy (44%) and coronary heart disease (35%)] were included in this study. Plasma concentrations of the Nt-proBNP were measured by ELISA on admission. All patients received conventional therapy and were followed up for 24 months. The primary end point was death or readmission. RESULTS: (1) During the follow up period (640 days +/- 100 days), 11 patients died and 39 patients rehospitalized, the median Nt-proBNP level on admission was significantly higher in patients died during the follow up period (5908 ng/L) than that of rehospitalized patients (2768 ng/L, P = 0.038). Plasma Nt-proBNP level on admission were significantly higher in primary end point group (n = 50, 2947 ng/L) than that in non-primary end point group (n = 85, 917 ng/L, P < 0.01). (2) Variables associated with an increased hazard of death and/or rehospitalization were Nt-proBNP and NYHA degree when analyzed by logistic regression models. Increased Log Nt-proBNP was the strongest independent predictor of an adverse outcome of CHF (odds ratio 13.8, 95% confidence interval 2.29 to 2.78, P < 0.01). (3) Area under the curve for Nt-proBNP in evaluating prognosis of CHF patients was 0.885 (positive predictive value 88.5%, negative predictive value 11.5%). CONCLUSION: Nt-proBNP level on admission is a strong predictor of rehospitalization and death within 24 months after hospital discharge in patients with chronic heart failure.