血浆N端脑利钠肽水平对新疆维吾尔族慢性心衰患者预后的预测价值

目的 探寻血浆N端脑利钠肽（NT-ProBNP）对新疆维吾尔族慢性心力衰竭（CHF）患者预后的预测价值.方法 入选2011年1月至2012年1月在兵团农一师医院心脏中心住院维吾尔族CHF患者102例,男性71例,女性31例,年龄32～88（62.19±11.20）岁；NYHA Ⅰ级19例、Ⅱ级30例、Ⅲ级32例、Ⅳ级21例.所有入选患者于入院次日清晨抽血测定NT-proBNP、cTnT及CK-MB水平,并进行心脏彩色多普勒超声检测.结果 102例CHF患者,中位随访时间404（385～498）d,发生心血管事件41例（40.2％）.心血管事件组患者年龄、肌酐、NT-proBNP及NYHA分级和cTnT中位数水平显著高于非心血管事件组（P＜0.05）,CK-MB、LVEF、LVEDD、LVESD、FS及血红蛋白指标两组比较差异无统计学意义（P＞0.05）.死亡组年龄和NT-proBNP水平明显高于非死亡组,NYHA分级、cTnT、CK-MB、LVEF、LVEDD、LVESD、FS、肌酐及血红蛋白水平两组间差异无统计学意义（P＞0.05）.Cox回归模型分析显示,包括年龄、NYHA分级、cTnT、CK-MB、NT-proBNP、LVEF、LVEDD、LVESD、FS、糖尿病、肾功能不全、肌酐及血红蛋白等指标,只有NT-proBNP和年龄是心血管事件再发生的独立危险因素.年龄每增加1岁,心血管事件再发生的危险升高0.079倍OR=1.079,95％ CI for Exp（B）：1.027～ 1.134,P=0.002]；lgNT-proBNP每升高1个单位,风险就增加19.23倍OR=20.23,95％CI for Exp（B）：4.671～95.624,P=0.000].NYHA分级、cTnT、CK-MB、LVEF、LVEDD、LVESD、FS、糖尿病、肾功能不全、肌酐及血红蛋白等对心衰后心血管事件再发生均没有预测价值.结论 血浆NT-proBNP水平能较好地预测新疆维吾尔族CHF患者的长期预后.

Prognostic value of NT-proBNP level in Xinjiang Uigur patients with chronic heart failure

Objective This study was prospectively designed to investigate the prognostic value of chronic heart failure （CHF） patients with plasma N-termlnal brain natriuretic peptide precursor （NT-proBNP） in Xinjiang Uygur. Methods From January 2011 to January 2012,102 patients （aged from 32 to 88） with chronic heart fail- ure were enrolled. According to NYHA classification,102 hospitalized patients with chronic heart failure were divid- ed into four groups ,19,30,32 and 21 cases in grades I, II, ~I and IV, respectively. NT-proBNP, cTnT,CK-MB level and ultrasonic cardiogram was detected in all subjects. Results During a median follow-up period of 404 （385-498）days, the endpoint of recurrence for cardiac events was reached in 41（40.2%）. The age, creatinine, NT- proBNP, NYHA class and cTnT median levels in patients with cardiovascular events were significantly higher than that of non-cardiovascular event group （P〈0.05）, and the level of CK-MB, LVEF, LVEDD, LVESD, FS and hemoglobin index was no significant difference between the two groups （P〉0.05）. The baseline NT-proBNP levels and age were significantly higher in the death cases than in the non-death cases, while no significant differences concerning NYHA grading, cTnT, CK-MB, LVEF, LVEDD, LVESD, FS, creatinine and hemoglobin levels （P〉 0.05）. On a Cox proportional hazards analysis, including these biochemical markers, age,NYHA grading, cTnT, CK- MB, NT-proBNP, LVEF, LVEDD, LVESD, FS, diabetes, renal insufficiency, creatinine and hemoglobin , showed that age and NT-proBNP were the independent predictors of cardiac events OR were 1.079,95%CI for Exp（B）： 1.027-1.134,P=0.002 and 20.23, 95%C1 for Exp （B）：4.671-95.624,P=0.000]. NYHA classification, cTnT, CK-MB, LVEF, LVEDD, LVESD, FS, diabetes, renal insufficiency, creatinine and hemoglobin were not inde- pendently predictive of cardiac events. Conclusion Measurement of NT-proBNP can help to predict the long-term prognosis of patients with CHF in Xinjiang Uygnr .