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目的探讨两检测指标血浆 N 末端 B 型钠尿肽原(NT-proBNP)和大内皮素-1(bigET-1)之间,两指标与心力衰竭(心衰)伴心房颤动(Af)、心衰伴肺动脉高压(PAH)等心血管病的关系,以及两指标对严重心衰患者半年期预后的预测价值。方法阜外医院严重心衰患者132人,测定他们入院时的血浆 LgNT-proBNP 和 big ET-1浓度(酶联免疫法)以及纽约心脏病协会心功能分级(NYHA分级)、左室射血分数(LVEF)等指标。随访观察患者出院后半年内心血管事件的再发生。结果严重心衰患者132人(NYHAⅢ-Ⅳ级,年龄24～80岁,男83人,女49人,LVEF 13%～66%),其血浆 LgNT-proBNP 与 big ET-1呈正相关(r=0.414,P=0.000)。有、无 Af 的两组间 big ET-1水平比较差异有统计学意义(P=0.022);有、无 PAH 的两组间 LgNT-proBNP 和 big ET-1浓度差异均有统计学意义(P=0.019,P=0.000)。以 big ET-1诊断严重心衰患者伴 PAH 的 ROC 曲线下面积为0.74(95%CI:0.65～0.83,P=0.000),以4.09 fmol/ml 为 big ET-1诊断心衰伴 PAH 的 cutoff 值时,灵敏度为71.4%,特异度67.8%。经过6个月的随访,132例严重心衰患者中,有20例发生心源性死亡(15.2%),有25例因心脏原因再住院(18.9%)。Cox 比例风险模型分析显示,包括了年龄、性别、NYHA 分级、LVEF、LgNT-proBNP、big ET-1等指标后,只有 NT-proBNP 是独立的心脏事件再发生的预后因素,RR 为5.30(95%CI:2.07～13.55,P=0.001)。Logistic 回归显示也只有 NT-proBNP 是独立的心源性死亡发生的危险因素,OR 为13.67(95%CI:2.59～72.25,P=0.002)。big ET-1、LVEF、NYHA分级等指标对严重心衰患者心血管事件再发生没有预后价值。结论 NT-proBNP 与 big ET-1间可能存在相互作用;严重心衰伴 Af 的患者可能有内皮细胞损伤和功能异常;big ET-1可辅助诊断严重心衰患者伴发 PAH;NT-proBNP 可用于严重心衰患者半年期预后的评估,而 big ET-1没有此预测价值。
Objective To investigate the correlation between plasma NT-proBNP and bigET-1 and between two indexes of heart failure (CHF) and atrial fibrillation (AF) And pulmonary hypertension (PAH) and other cardiovascular diseases, as well as two indicators of prognosis in patients with severe heart failure prognostic value. Methods 132 patients with severe heart failure in Fuwai Hospital were enrolled in this study. Plasma concentrations of LgNT-proBNP and big ET-1 (enzyme-linked immunosorbent assay) and NYHA classification (NYHA classification), left ventricular ejection fraction (LVEF) and other indicators. Follow-up observation of patients with cardiovascular events within six months after discharge recurrence. Results There were 132 patients with severe heart failure (NYHAⅢ-Ⅳ grade, aged from 24 to 80 years, 83 men and 49 women, LVEF 13% to 66%). The plasma LgNT-proBNP was positively correlated with big ET- 0.414, P = 0.000). There were significant differences in the levels of big ET-1 between the two groups with and without Af (P = 0.022). There was a significant difference in the concentrations of LgNT-proBNP and big ET-1 between the two groups = 0.019, P = 0.000). The area under the ROC curve of patients with severe heart failure diagnosed with big ET-1 was 0.74 (95% CI: 0.65-0.83, P = 0.000). The cutoff of PAH with big ET-1 at 4.09 fmol / ml Value, the sensitivity was 71.4%, the specificity of 67.8%. After 6 months of follow-up, of 132 patients with severe heart failure, 20 developed cardiogenic death (15.2%) and 25 received cardioversion (18.9%). Cox proportional hazards model analysis showed that only NT-proBNP was an independent predictor of reoccurrence of cardiac events, including age, gender, NYHA class, LVEF, LgNT-proBNP and big ET-1. RR was 5.30 % CI: 2.07 ~ 13.55, P = 0.001). Logistic regression also showed that only NT-proBNP was a risk factor for independent cardiac death with an OR of 13.67 (95% CI: 2.59 to 72.25, P = 0.002). Big ET-1, LVEF, NYHA classification and other indicators of cardiovascular events in patients with severe heart failure recurrence no prognostic value. Conclusions There may be interaction between NT-proBNP and big ET-1; patients with severe heart failure and Af may have endothelial cell injury and dysfunction; big ET-1 may help diagnose patients with severe heart failure accompanied by PAH; NT-proBNP is available The prognosis of patients with severe heart failure in the assessment of half a year, while the big ET-1 does not have this predictive value.