【摘要】 目的探讨心力衰竭患者B型钠尿肽(B-type natriuretic peptide,BNP)分层与纽约心功能分级(NYHA分级)的对应关系,评价BNP预测终点心脏事件的价值。方法前瞻性选择252例心力衰竭患者,入院24h内完成BNP水平、NYHA分级等指标测评,采用简单对应分析NYHA分级与BNP分层的关系。随访终点心脏事件(包括住院期间死亡、出院后心力衰竭恶化再住院、心肌梗死、心绞痛、心律失常和心源性死亡)2年,采用Cox比例风险回归探讨影响预后的独立因素,Life Table法、Kaplan-Meier法生存分析。结果①对应分析显示,心功能Ⅰ级偏重于BNP1(<200ng/L),Ⅲ级偏重于BNP4(601～800ng/L),Ⅳ级偏重于BNP5(801～1000ng/L)和BNP6(>1000ng/L),BNP2(201～400ng/L)和BNP3(401～600ng/L)没有显示与某一NYHA分级有明显的对应性;②BNP(r=0.276,HR=1.318,95%CI=1.171～1.854,P=0.000)、NYHA分级、射血分数(EF)、房颤房扑等4个因素入选以终点心脏事件为应变量的Cox比例风险模型;③BNP1组、BNP2组、BNP3组、BNP4组、BNP5组和BNP6组2年累计发生心脏事件分别是7例(29%)、18例(46%)、33例(63%)、35例(75%)、32例(87%)和30例(88%),BNP1组与BNP2组未获得心脏事件发生的中位时间,BNP3组、BNP4组、BNP5组和BNP6组中位时间(95%CI)分别是549(339.577～758.423)d、469(313.668～624.332)d、365(126.266～603.734)d和379(50.775～507.225)d,χ2=43.681,P=0.000。结论心力衰竭患者血浆BNP水平对心力衰竭严重程度判断和预后预测有重要参考价值。更多还原

【Abstract】 Objective To explore the corresponding relationship between B-type natriuretic peptide(BNP) and New York heart function(NYHA) classification,and evaluate the value of BNP in predicting the final heart events.Methods 252 patients with heart failure were prospectively involved.The evaluation of BNP and NYHA classification were finished in 24 h after admission to hospital.The relationship between the BNP and NYHA classification was analyzed using simple correspondence analysis and stratification.The final heart events(including death in hospital,readmission because of worsening heart failure,myocardial infarction,angina,arrhythmia and cardiac death) were followed up for 2 years.Cox proportional risk regression was used to study the independent factors of the prognosis risk.Life Table method,Kaplan-Meier method were used for survival analysis.Results ①Cardiac function in level Ⅰ lay stress on BNP1(<200 ng/L),level Ⅲ lay stress on BNP4(601～800 ng/L),level Ⅳ lay stress on BNP5(801～1 000 ng/L) and BNP6(>1 000 ng/L),BNP2(201～400 ng/L) and BNP3(401～600 ng/L) did not show obvious correspondence with any NYHA classification.②The BNP(r=0.276,HR=1.318,95% CI=1.171～1.854,P=0.000),NYHA classification,ejection fraction(EF) and atrial fibrillation and atrial flutter were included in Cox proportional risk model which regarded the final heart events as the dependent variables.③The accumulative occurrence of heart events in 2 years of BNP1 group,BNP2 group,BNP3 group,BNP4 group,BNP5 group and BNP6 group were 7 cases(29%),18 cases(46%),33 cases(63%),35 cases(75%),32 cases(87%) and 30 cases(88%) respectively.BNP1 group and BNP2 group didn’t obtain the median time of heart events.The median time(95%CI) of heart events in BNP3 group,BNP4 group,BNP5 group and BNP6 was respectively 549(339.577～758.423) d,469(313.668～624.332) d,365(126.266～603.734) d and 379(50.775～507.225) d(χ2=43.681,P=0.000).Conclusion Plasma BNP level in patients with heart failure has important reference value in the judgment of heart failure severity and the prognosis of heart failure.更多还原