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目的对脑钠肽(BNP)、甲状腺激素水平在老年心力衰竭(心衰)患者病情及预后判断中的价值进行探讨。方法 92例老年心衰患者,心功能分级:Ⅰ级24例,Ⅱ级20例,Ⅲ级22例,Ⅳ级26例,对各级患者血清中游离三碘甲腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)及BNP水平进行测定。并对患者进行为期1年的随访,以心源性死亡为临床终点,根据随访结果分为死亡组与存活组,观察两组BNP、FT_3水平。对心衰程度及预后与各检测指标的关系进行评价。结果随心衰的加重,患者BNP水平逐渐升高、FT_3水平逐渐降低,比较差异有统计学意义(P<0.05);不同心功能分级间FT_4、TSH水平比较差异无统计学意义(P>0.05)。存活组BNP、FT_3(911.44±464.14)pg/ml、(3.88±1.28)pmol/L优于死亡组(23308.96±1002.77)pg/ml、(2.66±0.96)pmol/L(P<0.05);Logistic回归分析显示BNP的增高与FT_3的降低会影响患者死亡。结论在老年心衰患者病情及预后判断中,BNP、甲状腺激素水平中的FT_3具有重要临床指标价值,值得临床推广应用。
Objective To investigate the value of brain natriuretic peptide (BNP) and thyroid hormone in the diagnosis and prognosis of elderly patients with heart failure (heart failure). Methods Totally 92 elderly patients with heart failure were divided into two groups: grade Ⅰ (24 cases), grade Ⅱ (20 cases), grade Ⅲ (22 cases) and grade Ⅳ (26 cases). The levels of free triiodothyronine (FT_3) Free thyroxine (FT_4), thyroid stimulating hormone (TSH) and BNP levels were measured. The patients were followed up for one year. Cardiac death was the clinical endpoint. According to the follow-up results, the patients were divided into death group and survival group. The levels of BNP and FT_3 in both groups were observed. The relationship between the degree of heart failure and prognosis and each test index was evaluated. Results With the aggravation of heart failure, BNP level gradually increased and FT_3 level decreased gradually (P <0.05). There was no significant difference in FT_4 and TSH levels between different cardiac function grades (P> 0.05 ). Survival group BNP, FT_3 (911.44 ± 464.14) pg / ml, (3.88 ± 1.28) pmol / L was better than death group (23308.96 ± 1002.77) pg / ml and (2.66 ± 0.96) pmol / Regression analysis showed that the increase of BNP and the decrease of FT_3 will affect the death of patients. Conclusion BNP and FT_3 in the level of thyroid hormone have important clinical value in the diagnosis and prognosis of elderly patients with heart failure, which is worthy of clinical application.