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目的评价扩张型心肌病合并慢性重度心力衰竭(心衰)血B型脑钠肽(B-type natriuretic peptide,BNP)浓度正常的临床意义。方法选取92例扩张型心肌病合并慢性重度心衰(心功能III～IV级)患者,血BNP浓度正常的24例为研究组,血BNP浓度升高的68例为对照组。对比两组患者的左室舒张末期内径(LVEDd)、左室射血分数(LVEF)及死亡率。结果研究组LVEDd值明显高于对照组,LVEF值明显低于对照组,两组比较差异均有统计学意义(均P<0.05)。研究组随访(17.36±10.38)个月,死亡率为54.2%;对照组随访(30.55±16.63)个月,死亡率为13.2%。两组死亡率比较差异有统计学意义(P<0.05)。Logistic多因素回归分析:血BNP降低为预测心源性死亡的独立预测因素,回归系数3.622,OR值42.466,95%可信区间5.115～355.796(P<0.05)。结论扩张型心肌病合并重度心衰血BNP浓度正常预示BNP分泌机制耗竭及心脏功能进一步恶化。
Objective To evaluate the clinical significance of normal B - type natriuretic peptide (BNP) in patients with dilated cardiomyopathy complicated with chronic heart failure (CHF). Methods Totally 92 patients with dilated cardiomyopathy and chronic severe heart failure (cardiac function III-IV) were enrolled in this study. Twenty-four patients with normal serum BNP concentration were selected as the study group. 68 patients with elevated BNP concentration were selected as the control group. Left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF) and mortality were compared between the two groups. Results The LVEDd value of the study group was significantly higher than that of the control group, and the LVEF value was significantly lower than that of the control group. There was significant difference between the two groups (all P <0.05). The follow-up of the study group was (17.36 ± 10.38) months, the mortality rate was 54.2%. The control group was followed up for 30.55 ± 16.63 months, the mortality rate was 13.2%. There was significant difference between the two groups in mortality (P <0.05). Logistic multivariate regression analysis: The decrease of blood BNP was an independent predictor of cardiac death. The regression coefficient was 3.622, OR was 42.466, and the 95% confidence interval was 5.115 ~ 355.796 (P <0.05). Conclusion The normal BNP concentration in patients with dilated cardiomyopathy complicated with severe heart failure indicates the depletion of BNP secretion and further deterioration of cardiac function.