CAJ | 학술논문

目的：探讨联合尿酸和NT-proBNP对急性心力衰竭（AHF）患者短期不良预后的预测价值。方法连续入选2011年10月至2014年1月在高新区人民医院内科住院并诊断为AHF的患者193例，分别测定血尿酸（UA）和N-端脑利钠钛（NT-ProBNP）水平，随访6个月，记录期间发生的心血管事件，定义为心源性死亡和/或因心力衰竭而再住院。结果193例患者中，有23例死亡（11.9%），20例（10.4%）在随访期内因心力衰竭（HF）再住院。单因素回归分析显示，短期心血管不良事件发生的预测因素包括高水平的UA和NT-proBNP、低肾小球滤过率、未使用血管紧张素转换酶抑制剂或血管紧张素受体阻断剂及高龄等。多因素Cox回归分析表明，UA水平与心血管事件的发生率增加独立相关（HR=1.115；95%CI：1.006~1.235；P=0.037）。Kaplan-Meier生存分析显示，UA水平＞8.0 mg/dL及NT-ProBNP＞4210 pg/mL的患者发生心血管事件的风险最高（P=0.01）。结论对于AHF患者，UA和NT-ProBNP水平联合可作为短期不良预后的独立预测因素，且比其中单用一种标志物更有效。
목적：탐토연합뇨산화NT-proBNP대급성심력쇠갈（AHF）환자단기불량예후적예측개치。방법련속입선2011년10월지2014년1월재고신구인민의원내과주원병진단위AHF적환자193례，분별측정혈뇨산（UA）화N-단뇌리납태（NT-ProBNP）수평，수방6개월，기록기간발생적심혈관사건，정의위심원성사망화/혹인심력쇠갈이재주원。결과193례환자중，유23례사망（11.9%），20례（10.4%）재수방기내인심력쇠갈（HF）재주원。단인소회귀분석현시，단기심혈관불량사건발생적예측인소포괄고수평적UA화NT-proBNP、저신소구려과솔、미사용혈관긴장소전환매억제제혹혈관긴장소수체조단제급고령등。다인소Cox회귀분석표명，UA수평여심혈관사건적발생솔증가독립상관（HR=1.115；95%CI：1.006~1.235；P=0.037）。Kaplan-Meier생존분석현시，UA수평＞8.0 mg/dL급NT-ProBNP＞4210 pg/mL적환자발생심혈관사건적풍험최고（P=0.01）。결론대우AHF환자，UA화NT-ProBNP수평연합가작위단기불량예후적독립예측인소，차비기중단용일충표지물경유효。
Objective To discuss the predictive value of uric acid (UA) combining N-terminal pro brain natriuretic peptide (NT-proBNP) to short-term poor prognosis in patients with acute heart failure (AHF). Methods AHF patients (n=193) were chosen from Oct. 2011 to Jan. 2014, and their levels of UA and NT-ProBNP were detected and followed up for 6 m. The major adverse cardiovascular events (MACE) and rehospitalized cases due to cardiac death and/or heart failure were recorded. Results Of 193 patients, there were 23 (11.9%) died and 20 (10.4%) rehospitalized due to AHF. Single-factor regression analysis showed that predictive factors of short-term MACE risk included high levels of UA and NT-proBNP, lower glomerular filtration rate, angiotensin converting enzyme inhibitor, angiotensin receptor blocker and elderly age. Multi-factor Cox regression analysis showed that UA level was independently correlated to increase of MACE incidence (HR=1.115;95%CI:1.006~1.235;P=0.037). Kaplan-Meier survival analysis showed that risk of MACE was the highest in patients with UA>8.0 mg/dL and NT-ProBNP>4210 pg/mL (P=0.01). Conclusion UA combining NT-ProBNP can be taken as an independent predictive factor for short-term poor prognosis in AHF patients, which is more effective than any single one of them.