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目的:探讨重症心衰患者血浆N端脑钠肽前体(NT-proBNP)与心功能的关系,评价其对死亡的预测价值。方法:入选31例ICU重症心力衰竭患者,测定血浆NT-proBNP水平,同时行心脏彩超及无创血流动力学检查测定心室射血分数(EF)、心脏指数(CI)、左心做功指数(LCWI)、加速指数(ACI)等心功能指标,并将其与NT-proBNP水平行相关性分析。根据28d预后将入选患者分为存活组和死亡组,比较两组患者的一般情况、NT-proBNP水平、急性生理和慢性健康状况(APACHEⅡ)评分等指标的差异,其后以Logistic回归分析确定其中影响28d预后的独立危险因素,并以ROC曲线评价NT-proBNP水平对重症心衰患者预后的预测作用。结果:CI、LCWI、ACI、EF正常患者组的NT-proBNP水平均低于异常患者组。死亡组血浆NT-proBNP明显高于存活组[(7056.1±1354.8)ng/L比(2516.8±450.9)ng/L,P<0.05],Logistic回归分析显示NT-proBNP水平、APACHEⅡ评分、并发严重感染为重症心衰患者28d死亡的独立危险因素。28d死亡的ROC曲线分析示NT-proBNP水平曲线下面积为0.759(95%CI0.584～0.935,P<0.05)。结论:重症心衰患者的血浆NT-proBNP水平与传统心功能指标相关,并对预后判断有重要参考价值。
Objective: To investigate the relationship between plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac function in patients with severe heart failure and to evaluate its predictive value for mortality. Methods: Thirty-one patients with severe ICU were enrolled in this study. Plasma NT-proBNP levels were measured. Cardiac echocardiography and noninvasive hemodynamic tests were performed to determine the ventricular ejection fraction (EF), cardiac index (CI), left ventricular function index ), Acceleration index (ACI) and other cardiac function indicators, and its correlation with NT-proBNP level. According to the 28d prognosis, the patients were divided into survival group and death group. The general conditions, NT-proBNP level, acute physiology and chronic health status (APACHEⅡ) score were compared between the two groups. Logistic regression analysis was used to determine The prognostic factors of 28d were independent risk factors, and the predictive value of NT-proBNP level in patients with severe heart failure was evaluated by ROC curve. Results: The levels of NT-proBNP in CI, LCWI, ACI and EF normal patients were lower than those in abnormal patients. The level of NT-proBNP in the death group was significantly higher than that in the survival group [(7056.1 ± 1354.8) ng / L vs 2516.8 ± 450.9 ng / L, P <0.05]. Logistic regression analysis showed NT-proBNP level, APACHEⅡscore and severe infection It was an independent risk factor for 28 d death in patients with severe heart failure. The ROC curve analysis of 28-day mortality showed that the area under the NT-proBNP level curve was 0.759 (95% CI 0.584-0.935, P <0.05). Conclusion: The plasma NT-proBNP level in patients with severe heart failure is related to the traditional cardiac function indexes and has an important reference value for the prognosis.