与急性心力衰竭改善相关的连续测量：对反复定量检测血浆 BNP 水平的分析。
Serial measurements associated with an amelioration of acute heart failure: an analysis of repeated quantification of plasma BNP levels.
机构信息
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
出版信息
Eur Heart J Acute Cardiovasc Care. 2012 Sep;1(3):240-7. doi: 10.1177/2048872612458580.
BACKGROUND
The magnitude of improvement of acute heart failure achieved during treatment varies greatly among patients. We examined changes in the plasma B-type natriuretic peptide (BNP) levels of patients with acute heart failure and attempted to elucidate the clinical factors associated with amelioration of acute heart failure.
METHODS AND RESULTS
The study population consisted of 208 consecutive patients admitted to our institution with acute heart failure. We measured plasma BNP levels before and after treatment of acute heart failure and evaluated these levels based on median age, body mass index (BMI), creatinine (Cr) level, and left ventricular ejection fraction (EF). Plasma BNP levels before treatment were equivalent between the younger and older age groups; however, plasma BNP levels after treatment were higher in the older age group (p<0.01). Plasma BNP levels before treatment were significantly high in the lower BMI group (p<0.05) and the higher Cr group (p<0.01). Similarly, plasma BNP levels after treatment were high in both the lower BMI and higher Cr groups (p<0.01 for both). In the low EF group, plasma BNP levels before treatment were significantly high (p<0.01), while plasma BNP levels after treatment were equivalent to those in the high EF group. A multiple linear regression analysis revealed that Cr was positively correlated and BMI and EF were negatively correlated with plasma BNP levels before treatment; however, the contributions of age, BMI, and Cr in reducing plasma BNP levels were more significant after treatment.
CONCLUSIONS
The contributions of clinical factors working against amelioration of heart failure vary before and after treatment. Regarding plasma BNP levels, older age, very low BMI, and the presence of renal dysfunction eventually act to prevent amelioration of acute heart failure. Systolic dysfunction does not act against amelioration of acute heart failure.
背景
急性心力衰竭治疗期间的改善程度在患者之间差异很大。我们检查了急性心力衰竭患者的血浆 B 型利钠肽（BNP）水平的变化，并试图阐明与急性心力衰竭改善相关的临床因素。
方法和结果
该研究人群包括 208 例连续因急性心力衰竭入院的患者。我们测量了急性心力衰竭治疗前后的血浆 BNP 水平，并根据中位年龄、体重指数（BMI）、肌酐（Cr）水平和左心室射血分数（EF）对这些水平进行了评估。治疗前，年轻组和老年组的血浆 BNP 水平相当；然而，老年组治疗后的血浆 BNP 水平更高（p<0.01）。治疗前，BMI 较低组（p<0.05）和 Cr 较高组（p<0.01）的血浆 BNP 水平显著升高。同样，治疗后 BMI 较低和 Cr 较高组的血浆 BNP 水平均升高（p<0.01 均）。在 EF 较低组，治疗前的血浆 BNP 水平显著升高（p<0.01），而治疗后的血浆 BNP 水平与 EF 较高组相当。多元线性回归分析显示，Cr 与血浆 BNP 水平呈正相关，BMI 和 EF 与血浆 BNP 水平呈负相关；然而，治疗后年龄、BMI 和 Cr 在降低血浆 BNP 水平方面的贡献更为显著。
结论
治疗前后对抗心力衰竭改善的临床因素的贡献不同。就血浆 BNP 水平而言，年龄较大、非常低的 BMI 和肾功能障碍最终会阻碍急性心力衰竭的改善。收缩功能障碍不会对抗急性心力衰竭的改善。
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