CAJ | 학술논문

目的探讨不同B型利钠肽(BNP)水平对慢性心力衰竭(CHF)患者预后的影响.方法 162例CHF患者初次入院后测定血液BNP水平,并行常规超声心动图和组织多普勒检查.根据BNP水平高低分为高BNP组(BNP＞1500 ng/L)和低BNP组(BNP≤1500ng/L).对两组患者的一般临床资料、心脏超声和组织多普勒数据及2年内心血管事件发生率进行分析.再按随访2年内是否发生心血管事件分为事件组与非事件组,并对相关数据进行统计学分析.结果高BNP组和低BNP组左心室射血分数(LVEF)分别为(40.9±5.6)％和(44.0±5.9)％(P＜0.01).高BNP组和低BNP组总心血管事件发生率分别为49.1％和21.0％ (P ＜0.01)、心原性病死率分别为25.5％和9.0％(P＜0.01).事件组和非事件组BNP水平分别为(2875.4±325.7) ng/L和(1136.9±298.6)ng/L(P＜0.000).事件组BNP水平与组织多普勒心肌做功指数(TDI-Tei)呈正相关(r=0.793,P＜0.001),与LVEF呈负相关(r=-0.57,P＜0.001).多因素logistic回归分析显示BNP、LVEF、TDI-Tei和β受体阻滞剂的应用是预测心血管事件发生的危险因素.BNP水平预测事件组CHF患者2年内发生死亡的ROC曲线下面积为0.795,以事件组患者BNP水平均数1910ng/L作为分组的界值,通过Kaplan-Meier法作BNP不同水平患者在随访期间心血管事件发生率曲线,计算Log-rank为 24.11(P=0.000).结论 BNP水平是CHF患者心血管事件发生的独立危险因素,不同BNP水平对CHF患者的预后影响不同,界值超过1910ng/L的患者预后较差.
목적 탐토불동B형리납태(BNP)수평대만성심력쇠갈(CHF)환자예후적영향.방법 162례CHF환자초차입원후측정혈액BNP수평,병행상규초성심동도화조직다보륵검사.근거BNP수평고저분위고BNP조(BNP＞1500 ng/L)화저BNP조(BNP≤1500ng/L).대량조환자적일반림상자료、심장초성화조직다보륵수거급2년내심혈관사건발생솔진행분석.재안수방2년내시부발생심혈관사건분위사건조여비사건조,병대상관수거진행통계학분석.결과 고BNP조화저BNP조좌심실사혈분수(LVEF)분별위(40.9±5.6)％화(44.0±5.9)％(P＜0.01).고BNP조화저BNP조총심혈관사건발생솔분별위49.1％화21.0％ (P ＜0.01)、심원성병사솔분별위25.5％화9.0％(P＜0.01).사건조화비사건조BNP수평분별위(2875.4±325.7) ng/L화(1136.9±298.6)ng/L(P＜0.000).사건조BNP수평여조직다보륵심기주공지수(TDI-Tei)정정상관(r=0.793,P＜0.001),여LVEF정부상관(r=-0.57,P＜0.001).다인소logistic회귀분석현시BNP、LVEF、TDI-Tei화β수체조체제적응용시예측심혈관사건발생적위험인소.BNP수평예측사건조CHF환자2년내발생사망적ROC곡선하면적위0.795,이사건조환자BNP수평균수1910ng/L작위분조적계치,통과Kaplan-Meier법작BNP불동수평환자재수방기간심혈관사건발생솔곡선,계산Log-rank위 24.11(P=0.000).결론 BNP수평시CHF환자심혈관사건발생적독립위험인소,불동BNP수평대CHF환자적예후영향불동,계치초과1910ng/L적환자예후교차.
Objective To observe the prognostic value of admission B-type natriuretic peptide (BNP) on outcome for patients with congestive heart failure (CHF).Methods Blood BNP levels,routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [95 male,mean age:(71.8 ±3.7 ) years] at admission.Patients were divided into high BNP ( BNP ＞ 1500 ng/L,n =104) and low BNP (BNP≤ 1500 ng/L,n =58 ) groups.All patients were followed up for 2 years and clinical characteristics,echocardiography including Doppler image and cardiovascular events results were analyzed.Data were also compared between patients with ( n =48 ) or without ( n =107 ) cardiovascular events.Results Left ventricular ejection fractions (LVEF) was significantly lower [ (40.9 ±5.6)％ vs.(44.0 ±5.9)％,P ＜0.01 ] while the total cardiovascular events rate (49.1％ vs.21.0％,P ＜0.01 ) and cardiac mortality rate (25.5％ vs.9.0％,P＜0.01) were significantly higher in high BNP group than in low BNP group.BNP level at admission in event group was significantly higher than in event-free group [ (2875.4 ±325.7) ng/Lvs.(1136.9±298.6) ng/L,P＜0.000].BNP level was positively related to Tei-index (r=0.793,P＜0.001 ) and negatively correlated with LVEF ( r =-0.57,P ＜0.001 ).Multiple logistic regression analysis demonstrated that BNP,LVEF,Tei-index and β-blocker use were independent risk factors for cardiovascular events.The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0.795 (95％ CI 0.693 - 0.935,sensitivity:72.31％ and specificity:84.62％,cut-off BNP value:1910 ng/L).The event risk was 2.17 times higher in CHF patients with admission BNP ＞ 1910 ng/Lcompared CHF patients with admission BNP ≤ 1910 ng/L ( 95％ CI:1.852 - 2.954,P =0.000 ).Conclusion Admission BNP level,LVEF,Tei-index and β-blocker use are independent risk factors for cardiovascular events in patients with CHF.Patients with higher admission BNP level ( ＞ 1910 ng/L) is linked with worse prognosis in this patient cohort.