CAJ | 학술논문

目的探讨氨基末端B型利钠肽前体（ NT-proBNP ）测定对老年收缩性心力衰竭诊断及预后的应用价值。方法510例患者，根据年龄、临床资料及心脏超声心动图分为老年收缩性心力衰竭组（老年心力衰竭组）、老年非心力衰竭组及对照组，测定并比较3组患者NT-proBNP水平，评价NT-proBNP对老年收缩性心力衰竭诊断的价值；同时对老年心力衰竭组患者随访，观察心力衰竭患者心源性再住院及死亡等事件，评价NT-proBNP对预后判定的价值。结果老年心力衰竭组患者为172例，老年非心力衰竭组患者为168例，对照组为170例，三组患者 NT-proBNP 水平有显著差异[（6986.6±104.6） pg/ml vs．（824.2±6.2）pg/ml vs．（266.4±9.4）pg/ml，P＜0.01]。其中老年心力衰竭组中158例患者平均随访（166.0±38.6）d，心源性再住院组及心源性死亡组的NT-proBNP水平显著高于无再发事件组，分别为（5281.6±70.2） pg/ml、（7886.2±146.3）pg/ml及（2646.8±58.4）pg/ml（P＜0.01），差异有非常显著统计学意义。 COX多元回归分析显示logNT-proBNP（回归系数：0.992；P ＝0.005）、治疗后 NT-proBNP 下降速率（回归系数：0.966；P ＝0.002）和心房颤动（回归系数：0.884；P＝0.005）、室性心动过速（回归系数：0.924；P＝0.005）是心源性死亡、再住院患者独立相关因素。结论 NT-proBNP检测对老年收缩性心力衰竭的诊断和鉴别诊断有显著的临床价值，NT-proBNP对老年收缩性心力衰竭的预后预测价值好。 log NT-proBNP、治疗后NT-proBNP下降速率、心房颤动、室性心动过速是老年心力衰竭患者心源性死亡、再住院事件的独立相关因素。
목적탐토안기말단B형리납태전체（ NT-proBNP ）측정대노년수축성심력쇠갈진단급예후적응용개치。방법510례환자，근거년령、림상자료급심장초성심동도분위노년수축성심력쇠갈조（노년심력쇠갈조）、노년비심력쇠갈조급대조조，측정병비교3조환자NT-proBNP수평，평개NT-proBNP대노년수축성심력쇠갈진단적개치；동시대노년심력쇠갈조환자수방，관찰심력쇠갈환자심원성재주원급사망등사건，평개NT-proBNP대예후판정적개치。결과노년심력쇠갈조환자위172례，노년비심력쇠갈조환자위168례，대조조위170례，삼조환자 NT-proBNP 수평유현저차이[（6986.6±104.6） pg/ml vs．（824.2±6.2）pg/ml vs．（266.4±9.4）pg/ml，P＜0.01]。기중노년심력쇠갈조중158례환자평균수방（166.0±38.6）d，심원성재주원조급심원성사망조적NT-proBNP수평현저고우무재발사건조，분별위（5281.6±70.2） pg/ml、（7886.2±146.3）pg/ml급（2646.8±58.4）pg/ml（P＜0.01），차이유비상현저통계학의의。 COX다원회귀분석현시logNT-proBNP（회귀계수：0.992；P ＝0.005）、치료후 NT-proBNP 하강속솔（회귀계수：0.966；P ＝0.002）화심방전동（회귀계수：0.884；P＝0.005）、실성심동과속（회귀계수：0.924；P＝0.005）시심원성사망、재주원환자독립상관인소。결론 NT-proBNP검측대노년수축성심력쇠갈적진단화감별진단유현저적림상개치，NT-proBNP대노년수축성심력쇠갈적예후예측개치호。 log NT-proBNP、치료후NT-proBNP하강속솔、심방전동、실성심동과속시노년심력쇠갈환자심원성사망、재주원사건적독립상관인소。
Objective To study the diagnostic and predictive value of amino-terminal pro-B-type natriuretic peptide( NT-proBNP) testing in elderly patients presenting with heart failure .Methods A total of 510 patients were evaluated in this study .According to the clinical characteristic and echocardiography results ,the patients were divided into three groups:Elderly patients with systolic heart failure group ( ESHF group ) , elderly patients without systolic heart failure(Non-ESHF Group)and control group.NT-proBNP levels were tested in all patients .The diagnostic value of NT-proBNP was evaluated in these patients .The predictive value of NT-proBNP was evaluated in ESHF Group with the follow up study .The clinical end points were cardiac death and re-admission .Results There were 172 ESHF patients and 168 Non-ESHF patients and 170 control patients , and NT-proBNP levels were significant different in three groups[(6986.6 ±104.6)pg/ml vs.(824.2 ±6.2)pg/ml vs.(266.4 ±9.4)pg/ml,P<0.01].A total of 158 ESHF patients were follow up to (166.0 ±38.6) d.The NT-proBNP levels in cardiac re-admission group[(5281.6 ±70.2)pg/ml]and in death group [(7886.2 ±146.3 )pg/ml]were both higher than in event free group [(2646.8 ±58.4)pg/ml](P<0.01).In multivariate Cox analysis,log NT-proBNP(r=0.992,P=0.005),drop rate of NT-proBNP after treatment(r=0.966,P=0.002)and atrial fibrillation(r=0.884,P=0.005),ventricular tachycardia (r=0.924,P=0.005)were the significant predictors of cardiac events .Conclusion Routine NT-proBNP testing should be useful to triage elderly patients with systolic heart failure quickly .NT-proBNP could used as a good prognostic indicator of ESHF patients .log NT-proBNP,Drop rate of NT-proBNP after treatment and atrial fibrillation , ventricular tachycardia were significant independent risk factors of cardiac events .