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《脑钠肽与终末期心力衰竭预后关系的临床研究aammt.tmmu.edu.cn5099脑钠肽与严重慢性心力衰竭预后关系的临床研究1.doc》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、脑钠肽与严重慢性心力衰竭预后关系的临床研究郭宗强1孙同文2摘要:目的评价脑钠肽(BNP)与严重慢性心力衰竭(心衰)预后的关系。方法测量80例纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级的严重慢性心衰患者入院时的血BNP水平,随访12±2月,根据随访结果分为死亡组和存活组。结果死亡组血BNP水平明显低于存活组(501±72ng/L比877±89ng/L,P<0.01);调整年龄、性别、心衰病程、左室射血分数、血肌酐水平和药物治疗(包括β受体阻滞剂、血管紧张素转换酶抑制剂、地高辛、利尿剂和静脉应用血管活性药物)的影响,logi
2、stic回归结果显示入院时低BNP水平(<520ng/L)是严重慢性心衰患者心源性死亡的独立预测因子(OR=1.56,95%可信区间1.04~2.32,P<0.01).结论严重慢性心衰患者心脏利钠肽不能提供有效的代偿,低BNP水平可能是严重慢性心衰预后不良的标志。关键词:脑钠肽,心力衰竭,预后PrognosticvalueofbrainnatriureticpeptideinpatientswithadvancedchronicheartfailureGuozongqiang1,Suntongwen21.Out-Patie
3、ntDepartmentofAirDefenseForcesCommandAcademy,Zhengzhou450052,HenanProv,China2.DepartmentofEmergency,TheFirstAffiliatedHospital,ZhengzhouUniversity,Zhengzhou450052,HenanProv,ChinaAbstractObjectiveToinvestigatetheprognosticvalueoflowBNPlevelinadvancedchronicheartfai
4、lure(CHF)patients.Methods80advancedCHFpatientswithNewYorkHeartAssociation(NYHA)functionalclassⅢandⅣwereenrolledinthisstudy.TheirbloodBNPlevelweremeasuredbyBiositeTriageBNPtestonadmissionandtheywere1.郭宗强防空兵指挥学院门诊部郑州市建设东路24号邮编4500522.孙同文郑州大学第一附属医院急诊科邮编4500526followe
5、d-upfor12±2monthafterhospitaldischarge.ResultsCardiovascularmortalityduringfollow-upwas25%.BNPlevelswerelowerinpatientswhodied(501±72vs.877±89ng/L,P<0.01).Afteradjustedforage,sex,durationofHF,leftventricularejectionfraction,serumcreatininelevelanddrugtherapy(inclu
6、dingβ-blocker,angiotensin-convertingenzymeinhibitor,digoxin,diureticsandintravenousvasoactivemedications),logisticstepwiseregressionanalysisshowedthatlowerBNPlevel(<520ng/L)onadmissionwasanindependentpredictorofcardiovascularmortalityinadvancedCHFpatients(OR=1.56,
7、95%confidenceinterval1.04~2.32,P<0.01).ConclusionsCardiacnatriureticpeptidesystemcannolongercontributeadequatelytoneurohormonalcompensationandthatparadoxicallylowBNPlevelisanadverseprognosticmarkerinadvancedCHF.Keywords:brainnatriureticpeptide;Heartfailure;Prognos
8、is慢性心力衰竭(心衰)发生发展的病理生理机制是神经内分泌的过度激活如交感神经系统、肾素-血管紧张素-醛固酮系统和内皮素系统,利钠系统的激活是一种良性代偿[1-3]。因此,心衰时血脑钠肽(brainnatriureticpeptide,BNP)水平升高对机体是有益的。重组人类脑钠肽(nesiritide