李竹

【摘要】 目的：探討N末端B型利钠肽原（NT-proBNP）水平对射血分数保留或降低的急性失代偿性心力衰竭（ADHF）患者预后的预测价值。方法：选择本院2019年1-12月收治的ADHF患者150例，记录其基本资料、用药、实验室检查、合并症、超声心动图等情况，以射血分数（EF）40%为分界值，将患者分为EF降低组（EF<40%，n=84）及EF保留组（EF≥40%，n=66）;以上述每组患者NT-proBNP中位数为界值分为高NT-proBNP（NT-proBNP≥中位数）及低NT-proBNP（NT-proBNP<中位数）两个亚组，随访1年，应用COX回归模型分析NT-proBNP对EF保留或降低的ADHF患者不良事件及全因死亡的预测价值。结果：EF降低组NT-proBNP中位数为3 788 ng/L，EF保留组NT-proBNP中位数为2 850 ng/L，共有64例（42.67%）患者发生不良事件，其中全因死亡22例（14.67%）。EF降低组与EF保留组中，高NT-proBNP患者在年龄、合并心房颤动、使用利尿剂、Hb及肌酐清除率方面与低NT-proBNP患者比较，差异均有统计学意义（P<0.05）。单因素COX回归分析显示，NT-proBNP为EF保留或降低的ADHF患者不良事件发生及全因死亡的预测因素（P<0.001），校正混杂因素年龄、合并心房颤动、使用利尿剂、Hb及肌酐清除率后，多因素COX回归分析显示，高NT-proBNP为EF保留或降低的ADHF患者不良事件发生及全因死亡的独立危险因素（P<0.001），对EF保留患者的预测价值高于EF降低患者。结论：NT-proBNP为EF保留或降低的ADHF患者不良事件发生及全因死亡的独立预测因素，对EF保留患者的预测价值高于EF降低患者。

【关键词】 N末端B型利钠肽原 射血分数 急性失代偿性心力衰竭

Effect of N-terminal Pro-B-type Natriuretic Peptide Level on Prognosis of Patients with Acute Decompensated Heart Failure with Preserved or Decreased Ejection Fraction/LI Zhu. //Medical Innovation of China， 2021， 18（23）： 0-056

[Abstract] Objective： To investigate the predictive value of N-terminal pro-B-type natriuretic peptide （NT-proBNP） level in the prognosis of patients with acute decompensated heart failure （ADHF） with the retention or decrease of ejection fraction. Method： A total of 150 patients in our hospital with ADHF from January 2019 to December 2019 were selected. The basic information， medication， laboratory examination， complications and echocardiography were recorded. The patients were divided into EF reduction group （EF<40%） and EF retention group （EF≥40%）; patients in the two groups were divided into two subgroups according to the median NT-proBNP of each group： high NT-proBNP group （NT-proBNP≥middle value） and low NT-proBNP group （NT-proBNP<middle value）. After one year follow-up， COX regression model was used to analyze the predictive value of NT-proBNP for adverse events and all-cause death in ADHF patients with preserved or reduced EF. Result： The median of

NT-proBNP in EF reduction group was 3 788 ng/L， and that of the EF retention group was 2 850 ng/L， and 64 patients （42.67%） had adverse events， of which 22 patients （14.67%） died. In the EF reduction group and EF retention group， there were significant differences in age， atrial fibrillation， diuretic use， Hb and creatinine clearance rate between high NT-proBNP patients and low NT-proBNP group （P<0.05）. Single factor COX regression analysis showed that NT-proBNP was the predictor of adverse events and all-cause death in patients with EF retention or reduction （P<0.001）. After correcting the confounding factors of age combined with atrial fibrillation， diuretics， Hb and creatinine clearance rate， multivariate COX regression analysis found that high NT-proBNP was an independent risk factor for adverse events and all-cause death in patients with EF retention or reduction （P<0.001）， the predictive value in EF retention patients was higher than that in patients with EF reduction. Conclusion： NT-proBNP is an independent predictor of adverse events and all-cause death in patients with EF retention or reduction， the predictive value of NT-proBNP in EF retention patients is higher than that in patients with EF reduction.

[Key words] NT-proBNP Ejection fraction Acute decompensated heart failure

First-author’s address： Zhuanghe Central Hospital， Zhuanghe 116400， China

doi：10.3969/j.issn.1674-4985.2021.23.013

急性失代偿性心力衰竭（ADHF）是新发或再发的心衰症状或体征逐渐加重或急速恶化，占心力衰竭（HF）住院患者的75%，患者入院和出院的预后分析很差，高达50%的患者在6个月内再次入院或死亡[1-2]。……