NT-proBNP水平检测指导强化药物治疗对慢性心力衰竭预后的影响
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摘要
目的分析血清N末端B型利钠肽原(N-Terminal Pro-B-Type Natriuretic Peptide,NT-proBNP)水平预测慢性心力衰竭(CHF)患者预后的效能,并分析利用血清NT-proBNP水平作为指导强化药物治疗CHF的效果。方法首先,选取2015年3月—2016年1月期间,上海市嘉定区安亭医院收治的CHF患者100例作为研究对象,随访1年,根据患者随访期间转归情况,将患者分为良好转归组(GO组)和不良转归组(BO组),收集患者一般资料、临床资料等,应用logistic回归分析影响CHF患者预后的危险因素。绘制不同转归的受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC)及危险因素判断转归的最优阈值。随后,选取2017年1月—2017年8月期间,上海市嘉定区安亭医院收治的CHF患者100例作为研究对象,对比利用左室射血分数(LVEF)指导强化药物治疗和利用NT-proBNP判断转归的最优阈值指导强化药物治疗对于CHF患者的转归影响。结果随访1年期间,共有13例患者死亡,死亡率为13. 00%,44例患者再入院,再入院率为44. 00%。统计结果显示,BO组患者年龄、心率、NT-proBNP高于GO组,收缩压、BMI、LVEF低于GO组,差异具有统计学意义(P <0. 05)。非条件Logistic回归分析结果显示NT-proBNP、LVEF是发生再入院或死亡的独立危险因素(P <0. 05)。绘制ROC曲线,计算AUC,结果显示,CHF患者血清NT-proBNP水平预测转归的AUC为0. 937 (95%CI:0. 895～0. 980,P=0. 000)大于PVEF的AUC:0. 656(95%CI:0. 550～0. 762,P=0. 007)。血清NT-proBNP=930. 42ng/L是判断转归的最优阈值。以NT-proBNPP=930. 42ng/L作为指导强化药物治疗的患者,其再入院率和死亡率均低于以LVEF作为指导的患者,差异具有统计学意义(P <0. 05)。结论 CHF患者血清NT-proBNP水平和LVEF指标是发生再入院或死亡的独立危险因素,以血清NT-proBNP最优阈值(930. 42ng/L)作为指导强化药物治疗可减少再入院率和死亡率。
Objective To analyze the prognostic efficacy of serum N-Terminal Pro-B-Type Natriuretic Peptide( NT-proBNP) in patients with chronic heart failure,and to analyze the use of serum NT-proBNP level as a guide to intensive drug therapy on the chronic heart failure. Methods First,100 patients with chronic heart failure admitted to our hospital from March 2015 to January 2016 were enrolled in the study. All patients were followed up for 1 year. According to the outcome of the patients during the follow-up period,the patients were divided into good outcome groups( GO group) and bad outcome group( BO group),general data and clinical data were collected,and logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients with chronic heart failure. The receiver operating characteristic curve( ROC curve) of different outcomes was plotted,and the area under the curve( AUC) and the optimal threshold for determining the outcome of the risk factors were calculated. Subsequently,from January 2017 to August 2017,100 patients with chronic heart failure admitted to our hospital were selected as subjects. The left ventricular ejection fraction( LVEF) and the NT-proBNP were used to guide the intensive drug therapy. The outcome of intensive drug therapy in patients with chronic heart failure was compared between the two groups. Results During the 1-year follow-up period,a total of 13 patients died,with a mortality rate of 13. 00%. 44 patients were admitted to the hospital and the readmission rate was 44. 00%. The statistical results showed that the age,heart rate,and NT-proBNP were higher in the BO group than in the GO group,and the systolic blood pressure,BMI,and LVEF were lower than those in the GO group( P < 0. 05). Unconditional logistic regression analysis showed that NT-proBNP and LVEF were independent risk factors for re-admission or death( P < 0. 05). The ROC curve was drawn and the AUC was calculated.The results showed that the AUC of the predicted NT-proBNP level in CHF patients was 0. 937( 95% CI: 0. 895 ～0. 980,P = 0. 000),which was greater than the AUC of PVEF: 0. 656( 95% CI: 0. 550 ～ 0. 762,P = 0. 007). Serum NT-proBNP = 930. 42 ng/L was the optimal threshold for judging outcome. Patients with NT-proBNPP = 930. 42 ng/L as the intensive drug therapy guiding had lower readmission rate and mortality than those with LVEF as the guiding,and the difference was statistically significant( P < 0. 05). Conclusion Serum NT-proBNP levels and LVEF in CHF patients were independent risk factors for readmission or death. Intensive drug therapy guided by serum NT-proBNP optimal threshold( 930. 42 ng/L) can reduce readmission rate and mortality.
Objective To analyze the prognostic efficacy of serum N-Terminal Pro-B-Type Natriuretic Peptide( NT-proBNP) in patients with chronic heart failure,and to analyze the use of serum NT-proBNP level as a guide to intensive drug therapy on the chronic heart failure. Methods First,100 patients with chronic heart failure admitted to our hospital from March 2015 to January 2016 were enrolled in the study. All patients were followed up for 1 year. According to the outcome of the patients during the follow-up period,the patients were divided into good outcome groups( GO group) and bad outcome group( BO group),general data and clinical data were collected,and logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients with chronic heart failure. The receiver operating characteristic curve( ROC curve) of different outcomes was plotted,and the area under the curve( AUC) and the optimal threshold for determining the outcome of the risk factors were calculated. Subsequently,from January 2017 to August 2017,100 patients with chronic heart failure admitted to our hospital were selected as subjects. The left ventricular ejection fraction( LVEF) and the NT-proBNP were used to guide the intensive drug therapy. The outcome of intensive drug therapy in patients with chronic heart failure was compared between the two groups. Results During the 1-year follow-up period,a total of 13 patients died,with a mortality rate of 13. 00%. 44 patients were admitted to the hospital and the readmission rate was 44. 00%. The statistical results showed that the age,heart rate,and NT-proBNP were higher in the BO group than in the GO group,and the systolic blood pressure,BMI,and LVEF were lower than those in the GO group( P < 0. 05). Unconditional logistic regression analysis showed that NT-proBNP and LVEF were independent risk factors for re-admission or death( P < 0. 05). The ROC curve was drawn and the AUC was calculated.The results showed that the AUC of the predicted NT-proBNP level in CHF patients was 0. 937( 95% CI: 0. 895 ～0. 980,P = 0. 000),which was greater than the AUC of PVEF: 0. 656( 95% CI: 0. 550 ～ 0. 762,P = 0. 007). Serum NT-proBNP = 930. 42 ng/L was the optimal threshold for judging outcome. Patients with NT-proBNPP = 930. 42 ng/L as the intensive drug therapy guiding had lower readmission rate and mortality than those with LVEF as the guiding,and the difference was statistically significant( P < 0. 05). Conclusion Serum NT-proBNP levels and LVEF in CHF patients were independent risk factors for readmission or death. Intensive drug therapy guided by serum NT-proBNP optimal threshold( 930. 42 ng/L) can reduce readmission rate and mortality.
引文
[1]董洪玲,王中鲁,张亮,等.慢性心力衰竭的治疗进展[J].中国循证心血管医学杂志,2017,9(2):246-248.
[2]黎励文,李明敏.慢性心力衰竭的治疗进展[J].中华老年心脑血管病杂志,2016,18(7):673-675.
[3]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.
[4]Ponikowski P,Voors A A,Anker S D,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].European journal of heart failure,2016,18(8):891-975.
[5]Pandey A,Parashar A,Kumbhani D J,et al.Exercise training in patients with heart failure and preserved ejection fraction:meta-analysis of randomized control trials[J].Circulation:Heart Failure,2015,8(1):33-40.
[6]陈雷,张旗.倍他乐克对慢性心衰临床症状及LVEDD、LVEF水平的影响观察[J].中国现代药物应用,2016,10(15):122-123.
[7]曲争艳,率中泰,张利敏,等.新当归补血颗粒对冠心病心衰患者LVEF及CysC的影响[J].世界中西医结合杂志,2016,11(9):1265-1267.
[8]王洁妤,华琦.左心室射血分数保留的心力衰竭研究进展[J].中华老年心脑血管病杂志,2016,31(7):766-769.
[9]刘利群,耿煜,段卉娣.NT pro BNP与心力衰竭相关性研究[J].中西医结合心脑血管病杂志,2016,14(7):751-753.
[10]丛辉,吴珊,储海丹,等.BNP、NT-proBNP在心力衰竭患者中的应用价值再评估[J].国际检验医学杂志,2016,37(7):954-956.
[11]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[12]Abebe T B,Gebreyohannes E A,Tefera Y G,et al.Patients with HFpEF and HFr EF have different clinical characteristics but similar prognosis:a retrospective cohort study[J].BMC cardiovascular disorders,2016,16(1):232-237.
[13]邱伯雍,王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志,2017,31(6):23-29.
[14]刘育,于胜波,赵庆彦,等.慢性心力衰竭患者心率的特点及其预后价值的性别差异[J].中华心律失常学杂志,2017,21(2):266-269.
[15]林茂海,黄开建,林守学.NT-proBNP水平与心功能分级及LVEF值的相关性[J].心血管康复医学杂志,2015,(2015年06):617-620.
[16]王璐,李晓晓,高枫,等.N-末端脑钠肽前体在心力衰竭患者心功能分级中的应用[J].检验医学与临床,2015,12(15):2151-2152.
[17]赵玉红,秦桂华,吴敬伟,等.血浆NT-pro BNP检测指导老年慢性心力衰竭患者治疗的研究[J].心血管康复医学杂志,2012,21(6):623-626.
[18]林琳,李俊,龚青,等.BNP与老年心力衰竭患者LVEF、心功能分级及预后相关性研究[J].中国循证心血管医学杂志,2014,(4):464-466.
[2]黎励文,李明敏.慢性心力衰竭的治疗进展[J].中华老年心脑血管病杂志,2016,18(7):673-675.
[3]张骞,刘小慧,董建增.慢性心力衰竭药物治疗进展[J].中国实用内科杂志,2016,36(4):272-276.
[4]Ponikowski P,Voors A A,Anker S D,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].European journal of heart failure,2016,18(8):891-975.
[5]Pandey A,Parashar A,Kumbhani D J,et al.Exercise training in patients with heart failure and preserved ejection fraction:meta-analysis of randomized control trials[J].Circulation:Heart Failure,2015,8(1):33-40.
[6]陈雷,张旗.倍他乐克对慢性心衰临床症状及LVEDD、LVEF水平的影响观察[J].中国现代药物应用,2016,10(15):122-123.
[7]曲争艳,率中泰,张利敏,等.新当归补血颗粒对冠心病心衰患者LVEF及CysC的影响[J].世界中西医结合杂志,2016,11(9):1265-1267.
[8]王洁妤,华琦.左心室射血分数保留的心力衰竭研究进展[J].中华老年心脑血管病杂志,2016,31(7):766-769.
[9]刘利群,耿煜,段卉娣.NT pro BNP与心力衰竭相关性研究[J].中西医结合心脑血管病杂志,2016,14(7):751-753.
[10]丛辉,吴珊,储海丹,等.BNP、NT-proBNP在心力衰竭患者中的应用价值再评估[J].国际检验医学杂志,2016,37(7):954-956.
[11]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[12]Abebe T B,Gebreyohannes E A,Tefera Y G,et al.Patients with HFpEF and HFr EF have different clinical characteristics but similar prognosis:a retrospective cohort study[J].BMC cardiovascular disorders,2016,16(1):232-237.
[13]邱伯雍,王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志,2017,31(6):23-29.
[14]刘育,于胜波,赵庆彦,等.慢性心力衰竭患者心率的特点及其预后价值的性别差异[J].中华心律失常学杂志,2017,21(2):266-269.
[15]林茂海,黄开建,林守学.NT-proBNP水平与心功能分级及LVEF值的相关性[J].心血管康复医学杂志,2015,(2015年06):617-620.
[16]王璐,李晓晓,高枫,等.N-末端脑钠肽前体在心力衰竭患者心功能分级中的应用[J].检验医学与临床,2015,12(15):2151-2152.
[17]赵玉红,秦桂华,吴敬伟,等.血浆NT-pro BNP检测指导老年慢性心力衰竭患者治疗的研究[J].心血管康复医学杂志,2012,21(6):623-626.
[18]林琳,李俊,龚青,等.BNP与老年心力衰竭患者LVEF、心功能分级及预后相关性研究[J].中国循证心血管医学杂志,2014,(4):464-466.