Department of Cardiology, Heart Failure Unit, St. Vincent's University Hospital and University College Dublin, Elm Park, Dublin 4, Ireland.
Ir J Med Sci. 2011 Jun;180(2):355-62. doi: 10.1007/s11845-011-0689-1. Epub 2011 Mar 3.
To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF).
Five-hundred and fifty-nine patients attending a disease management programme were categorized into tertiles of BNP (group 1; ≤ 95 pg/ml, group 2; 96-249 pg/ml and group 3; ≥ 250 pg/ml). A change in BNP between two stable visits was recorded. Patients were followed up for 1 year for death and a composite morbidity measure of HF hospitalization, all-cause hospitalization, unscheduled visits for clinical deterioration(UC) of HF using survival analysis.
The risk of the combined morbidity outcome increased with increasing tertiles of BNP (Log rank = 17.8 (2), p < 0.001). Furthermore, a 50 and 25% increase in BNP predicted morbidity in stable HF patients with an initial BNP > 200 pg/ml (p = 0.02) and > 450 pg/ml (p = 0.03), respectively.
In a stable community HF population, an elevated BNP or an increase in BNP predicts an adverse prognosis thereby potentially identifying a population in need of closer clinical follow-up.
探讨稳定心力衰竭（HF）患者 BNP 绝对值和变化值的预后意义。
将 559 例参加疾病管理计划的患者按 BNP 三分位数分为三组（第 1 组：≤95pg/ml；第 2 组：96-249pg/ml；第 3 组：≥250pg/ml）。记录两次稳定就诊之间 BNP 的变化。使用生存分析对患者进行为期 1 年的随访，以死亡和 HF 住院、全因住院、因 HF 临床恶化（UC）而计划外就诊的复合发病率为终点。
随着 BNP 三分位数的增加，复合发病率的风险增加（对数秩检验=17.8（2），p<0.001）。此外，在初始 BNP>200pg/ml（p=0.02）和>450pg/ml（p=0.03）的稳定 HF 患者中，BNP 增加 50%和 25%分别预测发病率。
在稳定的社区 HF 人群中，BNP 升高或 BNP 增加预示着不良预后，从而可能确定需要更密切临床随访的人群。
