CAJ | 학술논문

目的：通过对慢性心力衰竭（CHF）患者心肌型脂肪酸结合蛋白（H-FABP）和脑钠肽（BNP）联合检测及随访研究，探讨影响CHF的预后因素，并对患者进行危险分层分析。方法连续入选2009年1月~2012年12月间于牡丹江医学院红旗医院确诊为CHF患者184例，其中男性109例，女性75例，年龄25~92岁，平均年龄（67±12）岁。按照是否发生不良心血管事件分为未发生组（141例）与发生组（43例）。入院时测定H-FABP和BNP水平，随访出院后6个月不良心血管事件的发生情况。应用受试者工作特征曲线（ROC）确定H-FABP和BNP水平cut-off值，根据两者水平cut-off值将患者危险分层，分为正常组（67例）、低危组1（30例）、低危组2（33例）和高危组（54例）。结果与未发生组比较，发生组年龄增加，NYHA分级IV级比例增加，BNP和H-FABP水平升高，差异有统计学意义（P均＜0.05）。H-FABP的cut-off值为4.3 ng/ml时，特异性和敏感性分别为62.1%和84.0%；BNP的cut-off值为200 pg/ml时，特异性和敏感性分别为61.9%和70.2%。H-FABP＞4.3 ng/ml（RR=5.415，95%CI：2.201~13.324）和BNP＞200pg/ml（RR=2.412，95%CI：1.016~5.731）是不良心血管事件的危险因素。发生不良心血管事件正常组为4例（6.0%）、低危组1为3例（10.0%）、低危组2为8例（24.2%）、高危组为28例（51.9%），高危组不良心血管事件发生率较正常组升高，差异有统计学意义（P＜0.01）。结论H-FABP和BNP联合检测是判定CHF患者预后和危险分层较可靠的指标。
목적：통과대만성심력쇠갈（CHF）환자심기형지방산결합단백（H-FABP）화뇌납태（BNP）연합검측급수방연구，탐토영향CHF적예후인소，병대환자진행위험분층분석。방법련속입선2009년1월~2012년12월간우모단강의학원홍기의원학진위CHF환자184례，기중남성109례，녀성75례，년령25~92세，평균년령（67±12）세。안조시부발생불양심혈관사건분위미발생조（141례）여발생조（43례）。입원시측정H-FABP화BNP수평，수방출원후6개월불양심혈관사건적발생정황。응용수시자공작특정곡선（ROC）학정H-FABP화BNP수평cut-off치，근거량자수평cut-off치장환자위험분층，분위정상조（67례）、저위조1（30례）、저위조2（33례）화고위조（54례）。결과여미발생조비교，발생조년령증가，NYHA분급IV급비례증가，BNP화H-FABP수평승고，차이유통계학의의（P균＜0.05）。H-FABP적cut-off치위4.3 ng/ml시，특이성화민감성분별위62.1%화84.0%；BNP적cut-off치위200 pg/ml시，특이성화민감성분별위61.9%화70.2%。H-FABP＞4.3 ng/ml（RR=5.415，95%CI：2.201~13.324）화BNP＞200pg/ml（RR=2.412，95%CI：1.016~5.731）시불양심혈관사건적위험인소。발생불양심혈관사건정상조위4례（6.0%）、저위조1위3례（10.0%）、저위조2위8례（24.2%）、고위조위28례（51.9%），고위조불양심혈관사건발생솔교정상조승고，차이유통계학의의（P＜0.01）。결론H-FABP화BNP연합검측시판정CHF환자예후화위험분층교가고적지표。
Objective To investigate the prognostic factors affecting chronic heart failure (CHF) and risk stratification through joint detection of heart-type fatty acid binding protein (H-FABP) and brain natriuretic peptide (BNP) and follow-up study in CHF patients. Methods CHF patients (n=184, male 109, female 75, aged from 25 to 92 and average age=67±12) were chosen from Jan. 2009 to Dec. 2012, and then divided, according to whether or not having major adverse cardiovascular events (MACE), into non-MACE group (n=141) and MACE group (n=43). The levels of H-FABP and BNP were detected at admission time, and incidence of MACE was followed up after discharge for 6 m. The cut-off values of H-FABP and BNP were determined by using receiver operating characteristic curve (ROC), and then according to these cut-off values, the patients were given risk stratification and divided into normal group (n=67), low-risk group 1 (n=30), low-risk group 2 (n=33) and high-risk group (n=54). Results Age increased, percentage of cases of NYHA grade IV increased and levels of BNP and H-FABP were higher in MACE group compared with non-MACE group (all P<0.05). When the cut-off value of H-FABP was 4.3 ng/mL, the specificity was 62.1%and sensitivity was 84.0%. When the cut-off value of BNP was 200 pg/mL, the specificity was 61.9%and sensitivity was 70.2%. H-FABP>4.3 ng/mL (RR=5.415, 95%CI:2.201~13.324) and BNP>200 pg/mL (RR=2.412, 95%CI:1.016~5.731) were risk factors of MACE. There were 4 cases (6.0%) with MACE in normal group, 3 (10.0%) in low-risk group 1, 8 (24.2%) in low-risk group 2 and 28 (51.9%) in high-risk group. The incidence of MACE increased in high-risk group compared with normal group (P<0.01). Conclusion The joint detection of H-FABP and BNP is a reliable index for determining prognosis and risk stratification in CHF patients.