[因心力衰竭加重住院患者入院时及出院前N末端脑钠肽前体水平。与未来6至12个月死亡风险的关系]

[Admission and predischarge levels of NT pre brain natriuretic peptide in patients hospitalized because of worsening heart failure. relation to risk of death in the next 6-12 months].

作者信息

Mazovets O L, Trifonov I R, Katrukha A G, Gratsianskiĭ N A

出版信息

Kardiologiia. 2009;49(1):34-8.

PMID:19166399

Abstract

UNLABELLED

Inhospital treatment of patients with heart failure (HF) can cause changes of N-terminal pro-brain natriuretic peptide (NT proBNP) levels. It has not been established yet which NT proBNP value (before or at height of treatment activation) is closer related to prognosis of unfavorable outcome after discharge.

AIM

To compare relation to risk of post discharge unfavorable outcome of patients with HF of NT proBNP levels measured close to hospital admission and discharge.

MATERIAL AND METHODS

We studied 69 patients (64% men) aged 66.6 +/- 11.0 years with coronary heart disease or hypertension hospitalized because of worsening HF. Median left ventricular ejection fraction was 28%. NT-proBNP was measured during first 3 days of hospitalization (admission level) and in 2 weeks after first measurement (predischarge level). Duration of follow-up was 6-12 (mean 11.6 +/- 1.3) months.

RESULTS

Admission NT-proBNP level (median 13.23, interquartile range 5.95-25.89 ng/ml) exceeded upper limit of normal (ULN) in 67 patients (97.1%). Predischarge NT-proBNP became significantly lower (median 6.02 ng/ml, interquartile range 2.52-12.23 ng/ml; p=0.012), but remained above ULN in 62 patients (89.8%). During follow-up 27 patients (39.1%) died. Median NT-proBNP in the group of patients who later died compared with those who survived was insignificantly higher at admission (15.03 vs. 9.9 ng/ml, respectively, p=0.09) and significantly higher at predischarge (8.65 vs. 3.60 ng/ml, respectively, p=0.012). Analysis of receiver operating characteristic curves identified predischarge NT-proBNP level 3.5 ng/ml as cut - off value for increased risk of death. Multivariate regression analysis selected predischarge NT-proBNP more or equal 3.5 ng/ml as independent predictor of death during follow-up.

CONCLUSION

In this group of patients hospitalized because of worsening HF predischarge but not admission NT-proBNP level was independently related to risk of death during next 6-12 months.

摘要

未标注

心力衰竭（HF）患者的住院治疗可导致N末端脑钠肽前体（NT proBNP）水平发生变化。目前尚未确定哪个NT proBNP值（治疗启动前或治疗激活高峰时）与出院后不良结局的预后更相关。

目的

比较入院时和出院时测得的NT proBNP水平与HF患者出院后不良结局风险的关系。

材料与方法

我们研究了69例因HF恶化而住院的冠心病或高血压患者（64%为男性），年龄66.6±11.0岁。左心室射血分数中位数为28%。在住院的前3天（入院水平）和首次测量后的2周内（出院前水平）测量NT-proBNP。随访时间为6-12个月（平均11.6±1.3个月）。

结果

67例患者（97.1%）的入院NT-proBNP水平（中位数13.23，四分位间距5.95-25.89 ng/ml）超过正常上限（ULN）。出院前NT-proBNP显著降低（中位数6.02 ng/ml，四分位间距2.52-12.23 ng/ml；p=0.012），但62例患者（89.8%）仍高于ULN。随访期间，27例患者（39.1%）死亡。与存活患者相比，后来死亡的患者组入院时的NT-proBNP中位数略高（分别为15.03和9.9 ng/ml，p=0.09），出院前显著更高（分别为8.65和3.60 ng/ml，p=0.012）。受试者工作特征曲线分析确定出院前NT-proBNP水平3.5 ng/ml为死亡风险增加的临界值。多因素回归分析选择出院前NT-proBNP≥3.5 ng/ml作为随访期间死亡的独立预测因素。