Oral Ivo, Mistrík Jergus, Náplava Robert
Internal Clinic, IPVZ, KNTB Zlin, Czech Republic.
Herz. 2007 Oct;32(7):583-8. doi: 10.1007/s00059-007-2903-5.
Levels of natriuretic peptides and their changes in the course of therapy may serve as a prognostic marker of long-term survival in patients with heart failure. The authors compared natriuretic peptide levels in patients with heart failure at admission and at hospital discharge and examined the relationship between their natriuretic peptide levels and clinical status at hospital discharge.
108 patients with acute heart failure underwent, at admission to hospital and discharge after clinical improvement, an examination consisting of a physical checkup, B-type natriuretic peptide (BNP) measurements, and echocardiography. In addition, each patient was asked to use a 1-100 graphic grading scale to indicate a level of satisfaction with his/her overall health status, as well as quality of breathing at admission and discharge.
All patients had elevated BNP levels at admission (1,066 +/- 887.8 pg/ml). In the course of treatment, all patients demonstrated a statistically significant downward trend in BNP levels (p < 0.002). However, BNP levels at discharge still remained in the pathologic range. Both at admission and discharge, patients with left ventricular systolic dysfunction had BNP values statistically significantly higher than those with diastolic dysfunction (1,880 +/- 1,160 vs. 454 +/- 323 pg/ml, and 993 +/- 828 vs. 338 +/- 226 pg/ml, respectively). Patients with repeated attacks of heart failure prior to admission had higher BNP levels compared to those with a first attack (p < 0.001). Both groups showed a statistically significant difference in subjective perception of difficulties which, both at admission and discharge, was reported by patients with a first decompensation attack as being more marked (p < 0.002 and p < 0.009, respectively).
The question arises, whether one's "objective" assessment of the final degree of compensation at discharge may or may not be premature, and whether a follow-up "prognostic" BNP determination should or should not be performed until the moment of a "subjective optimum" as reported by the patient.
利钠肽水平及其在治疗过程中的变化可作为心力衰竭患者长期生存的预后标志物。作者比较了心力衰竭患者入院时和出院时的利钠肽水平，并研究了他们的利钠肽水平与出院时临床状态之间的关系。
108例急性心力衰竭患者在入院时及临床症状改善出院时，接受了包括体格检查、B型利钠肽（BNP）测定和超声心动图检查在内的检查。此外，要求每位患者使用1-100的图形评分量表来表明其对总体健康状况以及入院和出院时呼吸质量的满意度。
所有患者入院时BNP水平均升高（1,066±887.8 pg/ml）。在治疗过程中，所有患者的BNP水平均呈现出具有统计学意义的下降趋势（p<0.002）。然而，出院时BNP水平仍处于病理范围内。入院和出院时，左心室收缩功能障碍患者的BNP值均显著高于舒张功能障碍患者（分别为1,880±1,160 vs. 454±323 pg/ml和993±828 vs. 338±226 pg/ml）。入院前有心力衰竭反复发作的患者相比首次发作的患者BNP水平更高（p<0.001）。两组在主观困难感受方面均存在统计学意义上的差异，首次失代偿发作的患者在入院和出院时均报告这种感受更为明显（分别为p<0.002和p<0.009）。
问题在于，对出院时最终代偿程度的“客观”评估是否可能为时过早，以及在患者报告达到“主观最佳状态”之前是否应该进行随访“预后”BNP测定。
