心力衰竭中的微神经ography和静脉阻塞体积描记法：与预后的相关性。 （注：“Microneurography”这里可能有误，推测可能是“Microneurograph”，可根据实际情况准确修正后理解。）
Microneurography and venous occlusion plethysmography in heart failure: correlation with prognosis.
作者信息
Munhoz Robinson Tadeu, Negrão Carlos Eduardo, Barretto Antonio Carlos Pereira, Ochiai Marcelo Eidi, Cardoso Juliano Novaes, Morgado Paulo Cesar, Del Carlo Carlos Henrique, Ramires José Antonio Franchini
机构信息
Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
出版信息
Arq Bras Cardiol. 2009 Jan;92(1):46-53. doi: 10.1590/s0066-782x2009000100008.
BACKGROUND
Microneurography and venous occlusion plethysmography can be considered methods of assessment of the sympathetic activity.
OBJECTIVE
To evaluate the intensity of the sympathetic activity through microneurography and venous occlusion plethysmography in patients with heart failure (HF) and correlate this intensity with prognosis.
METHODS
52 patients with HF (ejection fraction < 45% at the echocardiogram): 12 with FCII and 40 with FCIV. After compensation, the muscular sympathetic nervous activity (MSNA) in the peroneal nerve (microneurography) and the muscular blood flow (MBF) in the forearm were evaluated (venous occlusion plethysmography). After an 18-month follow-up, the patients were divided in 3 groups: 12 with FCII, 19 with FCIV that did not die and 21 with FCIV that died. The intensity of the sympathetic activity was compared in the three different groups.
RESULTS
Patients with FCII presented lower MSNA (p=0.026) and higher MBF (p=0.045) than the ones with FCIV that did not die. The patients with FCIV that died presented higher MSNA (p<0.001) and lower MBF (p=0.002) than the patients with FCIV that did not die. ROC curve: cutoff >53.5 impulses/min for MSNA (S=90.55. E=73.68%) and < 1.81 ml/min/100gr for MBF (S=90.4%. E=73.7%). Kaplan-Meier curve: higher survival with MSNA < 53.5 impulses/min (p<0.001), and/or MBF >1.81 ml/min/100gr (P<0.001). Logistic regression analysis: the higher the MSNA and the lower the MBF, the higher is the probability of death.
CONCLUSION
The intensity of the MSNA and the MBF can be considered prognostic markers in advanced HF.
背景
微神经ography和静脉阻塞体积描记法可被视为评估交感神经活动的方法。
目的
通过微神经ography和静脉阻塞体积描记法评估心力衰竭（HF）患者交感神经活动的强度，并将该强度与预后相关联。
方法
52例HF患者（超声心动图显示射血分数<45%）：12例为FCII级，40例为FCIV级。代偿后，评估腓总神经的肌肉交感神经活动（MSNA）（微神经ography）和前臂的肌肉血流量（MBF）（静脉阻塞体积描记法）。经过18个月的随访，患者被分为3组：12例FCII级，19例未死亡的FCIV级，21例死亡的FCIV级。比较三组中交感神经活动的强度。
结果
FCII级患者的MSNA低于未死亡的FCIV级患者（p = 0.026），MBF高于未死亡的FCIV级患者（p = 0.045）。死亡的FCIV级患者的MSNA高于未死亡的FCIV级患者（p < 0.001），MBF低于未死亡的FCIV级患者（p = 0.002）。ROC曲线：MSNA的截断值>53.5次/分钟（灵敏度=90.55，特异度=73.68%），MBF的截断值<1.81毫升/分钟/100克（灵敏度=90.4%，特异度=73.7%）。Kaplan-Meier曲线：MSNA<53.5次/分钟（p < 0.001）和/或MBF>1.81毫升/分钟/100克（P < 0.001）时生存率更高。逻辑回归分析：MSNA越高，MBF越低，死亡概率越高。
结论
MSNA和MBF的强度可被视为晚期HF的预后标志物。
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