摘要
目的 分析联合氨基末端脑钠肽前体(NT-proBNP)水平与QRS波群时限对慢性心力衰竭致心源性猝死的预测价值。方法 回顾性分析2015年1月至2016年12月首都医科大学附属北京友谊医院收治的106例慢性心力衰竭患者的临床资料,检测患者血浆NT-proBNP和QRS波群时限。比较不同心功能分级(NYHA分级)的患者血浆NT-proBNP和QRS波群时限的差异;记录患者终点事件,并比较存活者、心源性猝死者及非心源性猝死者血浆NT-proBNP和QRS波群时限的差异;比较不同血浆NT-proBNP和QRS波群时限的患者心源性猝死的发生情况。结果 106例患者中,NYHA分级Ⅱ级者27例,Ⅲ级者49例,Ⅳ级者30例;NYHA分级Ⅱ、Ⅲ、Ⅳ级的患者NT-proBNP分别为(489.76±95.13)pg/ml、(1 712.75±119.85)pg/ml、(2 935.06±139.55)pg/ml,QRS波群时限分别为(101.95±20.85)ms、(109.98±24.76)ms、(126.98±25.96)ms。NYHA分级为Ⅳ级组血浆NT-proBNP的水平和QRS波群时限较Ⅱ、Ⅲ级者明显升高( P <0.05);NYHA分级为Ⅲ级血浆NT-proBNP的水平较Ⅱ级者明显升高( P <0.05)。106例患者中,存活79例,死亡27例(包括心源性猝死11例,非心源性猝死16例);存活、非心源性猝死、心源性猝死患者NT-proBNP分别为(384.87±79.98)pg/ml、(810.87±123.21)pg/ml、(2 432.09±236.87)pg/ml,QRS波群时限分别为(387.65±94.24)ms、(424.87±89.77)ms、(835.87±99.94)ms。心源性猝死者血浆NT-proBNP的水平和QRS波群时限较非心源性猝死者、存活者明显升高( P <0.05)。106例患者中,47例NT-proBNP<900 pg/ml,59例NT-proBNP≥900 pg/ml;血浆NT-proBNP≥900 pg/ml者死亡率(37.29%)和心源性猝死率(16.95%)较NT-proBNP<900 pg/ml者(10.64%、2.13%)明显升高( P <0.05)。106例患者中,66例QRS波群时限<120 ms,40例QRS波群时限≥120 ms;QRS波群时限≥120 ms者死亡率(40.00%)和心源性猝死率(22.50%)较QRS波群时限<120 ms者(16.67%、3.03%)明显升高( P <0.05)。结论 血浆NT-proBNP、QRS波群时限与慢性心力衰竭诱发心
Objective To analyze the predictive value of combined N terminal pro-brain natriuretic peptide( NT-proBNP) level and QRS wave duration in sudden cardiac death caused by chronic heart failure. Methods The clinical data of 106 patients with chronic heart failure in Beijing Friendship Hospital,Capital Medical University from January 2015 to December 2016 were retrospectively analyzed. The time limits of plasma NT-proBNP and QRS were measured. To compare the differences of plasma NT-proBNP and QRS wave duration in patients with different cardiac function classification( NYHA classification);the end-point events of patients was recorded,and the differences of plasma NT-proBNP and QRS wave duration among survivors,sudden cardiac death and non-sudden cardiac death were compared;and the occurrence of sudden cardiac death in patients with different plasma NT-proBNP and QRS wave duration were compared. Results Of the 106 cases,there were27 cases of NYHA class Ⅱ,49 cases of NYHA class Ⅲ,30 cases of NYHA class Ⅳ;the NT-proBNP in patients with NYHA class Ⅱ,Ⅲ,Ⅳwere respectively( 489. 76 ± 95. 13) pg/ml,( 1712. 75 ± 119. 85) pg/ml,( 2935. 06 ± 139. 55) pg/ml,the QRS wave duration were respectively( 101. 95 ± 20. 85) ms,( 109. 98 ± 24. 76) ms,( 126. 98 ± 25. 96) ms. The plasma NT-pro BNP level and QRS wave duration in NYHA grade Ⅳ group were significantly higher than those in grade Ⅱ and Ⅲ group( P < 0. 05),and the plasma NT-proBNP level in NYHA grade Ⅲ group was significantly higher than that in grade Ⅱ group( P < 0. 05). Among the 106 patients,79 survived and 27 died( including 11 cases of sudden cardiac death and 16 cases of non-cardiac death). The NT-proBNP in patients with survival,non-cardiac sudden death and cardiac sudden death were respectively( 384. 87 ± 79. 98) pg/ml,( 810. 87 ± 123. 21) pg/ml,( 2432. 09 ± 236. 87) pg/ml,and the QRS wave duration were( 387. 65 ± 94. 24) ms,( 424. 87 ± 89. 77) ms and( 835. 87 ± 99. 94) ms. The plasma NT-proBNP level and QRS wave duration in sudden card
作者
杨凤春
李丹
孙雪莲
车晶晶
YANG Feng-chun;LI Dan;SUN Xue-lian(Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)
出处
《临床和实验医学杂志》
2019年第14期1538-1541,共4页
Journal of Clinical and Experimental Medicine
基金
首都医科大学基础临床合作课题(编号:15JL24)
关键词
慢性心力衰竭
心源性猝死
氨基末端脑钠肽前体
QRS波群
Chronic heart failure
Sudden cardiac death
N terminal pro-brain natriuretic peptide
QRS wave group
