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目的通过对充血性心力衰竭(CHF,心衰)患者的随访研究,探寻影响心衰预后的因素,并对N末端B型钠尿肽原(NTproBNP)对CHF患者预后及危险分层价值进行评价。方法对我院明确诊断为CHF的97例住院患者,测定入院时血清NTproBNP、心肌肌钙蛋白T(cTnT)、心肌肌钙蛋白I(cTnI)、肌酸激酶MB型同工酶(CKMB)以及纽约心脏病协会心功能分级(NYHA分级)和左室射血分数(LVEF)等指标。随访观察患者心脏事件的再发生。结果97例心衰患者,中位随访423d(43～505d),发生心脏事件23例(23.7%)。发生终点事件组与未发生终点事件组相比,患者的年龄(83比73,P=0.000)、NYHA分级(3比2,P=0.002)、NTproBNP(973pg/ml比212.35pg/ml,P=0.002)、cTnT(0比0,P=0.011)以及cTnI(0.04比0.02,P=0.038)中位数水平均明显偏高。Cox比例风险模型分析显示,在包括了年龄、NYHA分级、LVEF、LogNTproBNP、cTnT、cTnI及CKMB等指标后,只有年龄和NTproBNP是独立的心脏事件再发生的预后因素,OR分别为1.17和(95%CI:1.09～1.24,P<0.001)和3.17(95%CI:1.76～5.69,P<0.001)。以NTproBNP中位数水平302.1pg/ml对心衰患者进行危险分层,NTproBNP>302.1pg/ml的心衰患者,其心衰后心脏事件再发生的风险是NTproBNP≤302.1pg/ml患者的4.63倍(95%CI:1.80～9.46,P=0.0008)。年龄>74岁的心衰患者,其心脏事件再发生的风险是年龄≤74岁的心衰患者的5.40倍(95%CI:2.16～11.52,P=0.0002)。其他NYHA分级、LVEF、cTnT、cTnI及CKMB等指标对心衰后心脏事件再发生均没有预后价值。结论NTproBNP可以用于对心衰患者进行心衰后心脏事件再发生的预后分析及危险分层评估。
Objective To investigate the prognostic factors of heart failure by follow-up study of patients with congestive heart failure (CHF) and to evaluate the prognosis and risk stratification of CHF patients with NTproBNP . Methods A total of 97 hospitalized patients diagnosed as CHF in our hospital were enrolled. Serum levels of NTproBNP, cTnT, cTnI, CKMB, New York Heart Association cardiac function classification (NYHA classification) and left ventricular ejection fraction (LVEF) and other indicators. Follow-up observation of patients with cardiac events recurrence. Results 97 patients with heart failure, the median follow-up 423d (43 ~ 505d), 23 cases of cardiac events (23.7%). Patient’s age (83 vs 73, P = 0.000), NYHA classification (3 vs 2, P = 0.002), NTproBNP (973 pg / ml vs. 212.35 pg / ml, P = 0.002), cTnT (0 vs 0, P = 0.011), and cTnI (0.04 vs 0.02, P = 0.038) were significantly higher. Cox proportional hazards model analysis showed that only age and NTproBNP were independent predictors of recurrence of cardiac events after inclusion of age, NYHA class, LVEF, LogNTproBNP, cTnT, cTnI, and CKMB, with ORs of 1.17 and 95 % CI: 1.09-1.24, P <0.001) and 3.17 (95% CI: 1.76-5.69, P <0.001). Risk stratification of heart failure patients with a median NTproBNP level of 302.1 pg / ml showed a risk of reoccurrence of cardiac events after heart failure for CHF patients with an NTproBNP> 302.1 pg / ml was 4.63 for NTproBNP ≤ 302.1 pg / ml Fold (95% CI: 1.80 ~ 9.46, P = 0.0008). Risk of reoccurrence of a cardiac event is associated with a 5.40-fold (95% CI: 2.16 to 11.52; P = .0002) risk of heart failure in patients ≤ 74 years of age with heart failure at> 74 years of age. Other NYHA classification, LVEF, cTnT, cTnI and CKMB and other indicators of cardiac events after heart failure recurrence no prognostic value. Conclusion NTproBNP can be used to predict the prognosis and risk stratification of cardiac events after heart failure in patients with heart failure.