邓潮超 朱鹏立 黄峰 肖华贞

【摘要】 目的：研究急性心力衰竭患者胃促生長素（Ghrelin）、氨基端B型利钠肽原前体（NT-proBNP）水平的预后预测价值。方法：选择241例急性心力衰竭患者，测定血浆Ghrelin和NT-proBNP水平，采用电话随访，记录死亡时间。采用Kaplan-Meier曲线做生存分析，采用Cox比例风险回归模型比较组间事件风险比（HR）。结果：所有患者，随访时间0～565 d，中位数时间为151 d。低Ghrelin组和高Ghrelin组年龄、舒张压、钠、肌酐、急性心肌梗死比较，差异均有统计学意义（P<0.05）。高Ghrelin组（Ghrelin>9.19 ng/mL）全因死亡率低于低Ghrelin组（Ghrelin≤9.19 ng/mL）（P<0.05）。高NT-proBNP组（NT-proBNP>3 801.0 pg/mL）和低NT-proBNP（NT-proBNP≤3 801.0 pg/mL）心率、血红蛋白、钠、肌酐、左心室舒张末期容积、左心室射血分数、冠心病、急性心肌梗死比较，差异均有统计学意义（P<0.05）。高NT-proBNP组全因死亡率高于低NT-proBNP组（P<0.01）。Kaplan-Meier曲线显示，高Ghrelin组的中位生存时间长于低Ghrelin组（P<0.01），低NT-proBNP组的中位生存时间长于高NT-proBNP组（P<0.05）。Cox比例风险模型分析显示，低Ghrelin高NT-proBNP组发生死亡事件风险为高Ghrelin低NT-proBNP组5.346倍[95%CI（1.461，19.561），P<0.01]。结论：低Ghrelin、高NT-proBNP水平的急性心力衰竭患者预后差。

【关键词】 急性心力衰竭 Ghrelin NT-proBNP 预后

Prognostic Value of Ghrelin and NT-proBNP in Patients with Acute Heart Failure/DENG Chaochao， ZHU Pengli， HUANG Feng， XIAO Huazhen. //Medical Innovation of China， 2021， 18（14）： 0-080

[Abstract] Objective： To study prognostic value of Ghrelin and NT-proBNP in patients with acute heart failure. Method： Clinical data of 241 patients with acute heart failure were collected， plasma Ghrelin and NT-proBNP levels were determined， telephone follow-up was performed， and time of death was recorded. Kaplan-Meier curve was used for survival analysis， and Cox proportional risk regression model was used to compare the inter-group event risk ratio （HR）. Result： All patients were followed up for 0-565 d， with a median of 151 d. There were statistically significant differences in age， diastolic blood pressure， sodium， creatinine and acute myocardial infarction between the low and high Ghrelin group （P<0.05）. All-cause mortality rate of high Ghrelin group （Ghrelin>9.19 ng/mL） was lower than that of low Ghrelin group （Ghrelin≤9.19 ng/mL） （P<0.05）. There were significant differences between the high NT-proBNP （NT-proBNP>3 801.0 pg/mL） group and the low NT-proBNP （NT-proBNP≤3 801.0 pg/mL）

in heart rate， hemoglobin， sodium， creatinine， left ventricular end-diastolic volume， left ventricular ejection fraction， coronary heart disease， and acute myocardial infarction （P<0.05）. All-cause mortality rate of high NT-proBNP group was higher than that of low NT-proBNP group （P<0.01）. Kaplan-Meier survival curve showed that the median survival time of high Ghrelin group was higher than that of low Ghrelin group （P<0.01）. The median survival time of low NT-proBNP group was higher than that of high NT-proBNP group （P<0.05）. Cox proportional hazards model analysis showed that， the death occurred HR of the low Ghrelin and high NT-proBNP group compared with the high Ghrelin and low NT-proBNP group was 5.346 [95%CI （1.461， 19.561）， P<0.01]. Conclusion： The low Ghrelin level and high NT-proBNP level have poor outcome in patients with acute heart failure.

[Key words] Acute heart failure Ghrelin NT-proBNP Prognosis

First-authors address： Fujian Provincial Hospital South Branch， Fuzhou 350000， China

doi：10.3969/j.issn.1674-4985.2021.14.019

心力衰竭是常见危重病，住院死亡率3%～13%，半年内再住院率达50%，5年死亡率高达60%，预后差[1-2]。氨基端B型利钠肽原前体（NT-proBNP）在心力衰竭的诊断、预后预测都有重要价值，但是仍有局限性，在肾功能不全、高龄的患者中局限性尤其大。因此，在心力衰竭患者的诊断、疗效判断及预后预测等方面，各国指南均推荐联合多种标志物检测。胃促生长素（Ghrelin）是一种活性多肽，由28个氨基酸构成[3]。研究表明，Ghrelin对心脏有多种益处，包括扩张血管、抑制交感神经活性、调节能量代谢、延缓心脏重构和正性肌力等[4-6]。动物实验表明，大鼠Ghrelin基因人为敲除后，心功能和生存率显著降低[7]，肌钙蛋白T部分基因敲除的心力衰竭大鼠中，生理盐水对照组死亡率高于Ghrelin治疗组[8]。国内一项随访研究显示，在慢性心力衰竭患者中心血管事件组Ghrelin水平与非事件组有差异[9]。……