韓婷婷 王虹 吳美美 楊利嬌 李舒承

摘要：目的? 探討N-proBNP對(duì)慢性心力衰竭患者合并肺動(dòng)脈高壓的預(yù)測(cè)價(jià)值。方法? 選取我院心臟科住院的140例心力衰竭患者，根據(jù)是否發(fā)生肺動(dòng)脈高壓，分為心衰合并肺動(dòng)脈高壓組110例及心衰未合并肺動(dòng)脈高壓組30例，收集臨床資料及實(shí)驗(yàn)室指標(biāo)，分析N-ProBNP水平對(duì)心衰發(fā)生肺動(dòng)脈高壓預(yù)測(cè)價(jià)值。結(jié)果? 與未發(fā)生肺動(dòng)脈高壓相比，合并肺動(dòng)脈高壓組中N-proBNP、尿酸、總膽紅素、心率、心功能分級(jí)差異有統(tǒng)計(jì)學(xué)有意義（P<0.05）。相關(guān)性分析顯示，尿酸、總膽紅素、心率、紅細(xì)胞分布寬度、N-proBNP與肺動(dòng)脈高壓之間存在正相關(guān)（r=0.237、0.355、0.225、0.259、0.357，P<0.05），將其進(jìn)行多元線性回歸分析發(fā)現(xiàn)，總膽紅素及N-proBNP與肺動(dòng)脈高壓獨(dú)立相關(guān)。ROC曲線顯示，N-proBNP對(duì)心衰合并肺動(dòng)脈高壓有很好的預(yù)測(cè)價(jià)值，曲線下面積為0.678。結(jié)論? N-ProBNP對(duì)心衰肺動(dòng)發(fā)生脈高壓有很好的預(yù)測(cè)價(jià)值。

關(guān)鍵詞：慢性心力衰竭;肺動(dòng)脈高壓;N末端腦鈉肽前體

中圖分類號(hào)：R541.6? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻(xiàn)標(biāo)識(shí)碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2019.05.035

文章編號(hào)：1006-1959（2019）05-0114-03

Abstract：Objective? To investigate the predictive value of N-proBNP in patients with chronic heart failure complicated with pulmonary hypertension. Methods? A total of 140 patients with heart failure admitted to our department of cardiology were enrolled. According to whether pulmonary hypertension occurred， 110 patients with heart failure and pulmonary hypertension group and 30 patients with heart failure without pulmonary hypertension were collected. Clinical data and laboratory indicators were collected and analyzed. The predictive value of N-ProBNP levels for pulmonary hypertension in patients with heart failure. Results? Compared with no pulmonary hypertension， the difference of N-proBNP， uric acid， total bilirubin， heart rate and cardiac function between the patients with pulmonary hypertension was statistically significant （P<0.05）. Correlation analysis showed that there was a positive correlation between uric acid， total bilirubin， heart rate， red blood cell distribution width， N-proBNP and pulmonary hypertension （r=0.237， 0.355， 0.225， 0.259， 0.357， P<0.05）. Multiple linear regression analysis found that total bilirubin and N-proBNP were independently associated with pulmonary hypertension. The ROC curve showed that N-proBNP has a good predictive value for heart failure combined with pulmonary hypertension， and the area under the curve is 0.678. Conclusion? N-ProBNP has a good predictive value for pulmonary hypertension in patients with heart failure.

Key words：Chronic heart failure;Pulmonary hypertension;N-terminal pro-brain natriuretic peptide

慢性心力衰竭（chronic heart failure）是各種心臟疾病的終末階段，隨著疾病進(jìn)展會(huì)出現(xiàn)不同程度的肺動(dòng)脈高壓。研究表明，慢性心力衰竭繼發(fā)肺動(dòng)脈高壓患者短期及長(zhǎng)期的不良風(fēng)險(xiǎn)可能達(dá)到40.3%，并且約2/3的心力衰竭患者可能繼發(fā)肺動(dòng)脈高壓，這往往提示預(yù)后不良[1，2]。N-末端腦鈉肽前體（N-proBNP）目前是心力衰竭病情評(píng)估、嚴(yán)重程度的敏感指標(biāo)之一。研究表明，N-proBNP可作為肺動(dòng)脈高壓病情預(yù)測(cè)指標(biāo)，將有望成為肺動(dòng)脈高壓嚴(yán)重的預(yù)測(cè)因子[3]，但目前N-proBNP對(duì)心衰是否發(fā)生肺動(dòng)脈高壓的預(yù)測(cè)價(jià)值尚未報(bào)道。本研究旨在分析N-proBNP水平對(duì)慢性心力衰竭發(fā)生肺動(dòng)脈高壓的預(yù)測(cè)價(jià)值，現(xiàn)報(bào)道如下。