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目的脑钠肽(BNP)是在心脏受到神经递质刺激、心肌张力改变等情况下释放,也是心脏对血流动力学改变的反应。N端B型钠尿肽(NT-pro BNP)是BNP的前体。本研究旨在研究NT-pro BNP与中国肥厚型心肌病患者生存率等预后指标之间的关系。方法本研究纳入了393例1999年-2010年住院治疗的肥厚型心肌病患者,采集了包括NT-pro BNP在内的一系列生化指标以及心电图、心脏超声检测结果。对所有患者进行了跟踪随访至2014年。结果根据NT-pro BNP水平三分位将患者分为三组。平均5.27±2.55年随访结果显示,总死亡率随着NT-proB NP水平升高而升高,低、中、高三组患者死亡率分别是4.6%、6.9%、17.6%(P=0.001)。生存分析显示,随着NT-pro BNP水平升高,组间全因死亡(P=0.004)以及新进展为慢性心功能不全(P=0.036)存在显著差异。根据单因素COX分析,与NTpro BNP低水平组相比较,高水平组死亡风险升高2.409倍(P=0.008,相对危险度95%区间为1.381-8.417)。经过多因素校正后,NT-pro BNP水平仍然与全因死亡显著相关(P<0.001)。结论在此较大样本量中国肥厚型心肌病患者的长期随访结果显示,NT-pro BNP的升高与患者的死亡、心衰等不良预后均相关,是患者全因死亡的独立危险因素。
Objective BNP is released by the neurotransmitter in the heart and changes in cardiac tension, which is also the response of the heart to hemodynamic changes. N-terminal B-type natriuretic peptide (NT-pro BNP) is a precursor of BNP. The aim of this study was to investigate the relationship between NT-pro BNP and prognosis in patients with hypertrophic cardiomyopathy in China. Methods A total of 393 hypertrophic cardiomyopathy patients admitted to hospital from 1999 to 2010 were enrolled. A series of biochemical parameters including NT-pro BNP, as well as ECG and echocardiography were collected. All patients were followed up until 2014. Results Patients were divided into three groups based on the tertile of NT-pro BNP levels. The average follow-up of 55.27 years showed that the overall mortality rate increased with the increase of NT-proB NP level. The mortality rates in the low, middle and high groups were 4.6%, 6.9% and 17.6%, respectively (P = 0.001). Survival analysis showed significant differences in all-cause mortality (P = 0.004) and new progression to chronic cardiac insufficiency (P = 0.036) as NT-pro BNP levels increased. According to univariate COX analysis, the risk of death was 2.409 times higher in the high-grade group (P = 0.008, 95% relative risk range, 1.381-8.417) compared with the NTpro BNP low-grade group. After multivariate adjustment, NT-pro BNP levels remained significantly associated with all-cause mortality (P <0.001). Conclusions Long-term follow-up of patients with hypertrophic cardiomyopathy in this large sample size in China showed that the elevated NT-pro BNP was associated with poor prognosis such as death and heart failure and was an independent risk factor for all-cause mortality in patients.