急性心力衰竭入院时收缩压水平与心功能及预后关系

摘要

Objective: To study relationship among cardiac function, prognosis and different level of systolic blood pressure (SBP) at admission in patients with acute heart failure (AHF). Methods: A total of 229 AHF inpatients were enrolled and their cardiac function was assessed by NYHA classification. According to SBP level at admission, 229 patients were divided into group A (SBP<100mmHg, n= 22), group B (100mmHg140mmHg, n = 84). Levels of N terminal pro brain natriuretic peptide (NT-proBNP), creatinine, cardiothoracic ratio (C/T), left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were measured after admission. According to cardiogenic death or not after six-month follow-up, patients were divided into event group (n = 65) and no event group (n = 164). Results: There were significant difference in 1gNT-proBNP, LVEF and LVEDV among three groups (P<0. 01 all); Pearson correlation analysis indicated that SBP level was negatively correlated with lgNT-proBNP, C/T and LVEDV (r = - 0. 382, - 0. 546, -0.401 respectively, P<0. 01 all), and positively correlated with LVEF (r = 0. 678, P<0.01). Compared with no event group, there were significant increase in percentage of patients with NYHA cardiac function class Ⅳ (42. 1% vs. 70. 8%), C/T [ (0.55 ±0.07) vs. (0. 60 ± 0. 07)], LVEDV [ (87. 85 ± 36. 93) ml vs. (119. 74 ± 70. 38) ml], lgNT-proBNP [ (3. 58 ± 0. 37) pg/ml vs. (4. 05 ± 0. 32) pg/ml], P<0. 05 all; and significant decrease in creatinine clearance rate [ (57. 81 ± 24. 98) ml/min vs. (49. 40 ± 28. 32) ml/min], levels of LVEF [ (51. 51 ± 8. 95)% vs. (42.45±8.41)%] and SBP [ (141.19±27.80) mm Hg vs. (120.30±21.03) mmHg] in event group, P<0. 05 all. Incidence rate of cardiogenic death in group A was significantly higher than those of group B and C (54. 5% vs. 34.1% vs. 13. 1%, P<0. 01). Conclusion; Level of systolic blood pressure at admission is an important index reflecting cardiac function in patients with acute heart failure.%目的:探讨急性心力衰竭患者入院时收缩压(SBP)水平与心功能及预后的关系.方法:研究对象为急性心力衰竭住院的患者229例,按入院时SBP水平分为:A组(SBP≤100mmHg,22例),B组(100mmHg＜SBP≤140mmHg,123例),C组(SBP＞ 140mmHg,84例),测定入院后N末端B型利钠肽前体(NT-proBNP)、肌酐等水平,并测量心胸比例、左室舒张末容积(LVEDV)、左室射血分数(LVEF)等.半年后根据有无心源性死亡分为事件组(65例)和非事件组(164例).结果:不同血压组间lgNT-proBNP、LVEF、LVEDV均有显著性差异(P均＜0.01)；Pearson相关分析显示,SBP水平与lgNT-proBNP、心胸比、LVEDV呈负相关(r分别为-0.382,-0.546,-0.401,P均＜0.01),与LVEF呈正相关(r=0.678,P＜0.01).与非事件组比较,事件组的心功能NYHAⅣ级比例(42.1％比70.8％)、心胸比[(0.55±0.07)比(0.60±0.07)]、LVEDV[(87.85±36.93) ml比(119.74±70.38) ml]明显增加,lgNT-proBNP[(3.58±0.37) pg/ml比(4.05±0.32) pg/ml]水平明显升高(P均＜0.05)；而其肌酐清除率[(57.81±24.98) ml/min比(49.40±28.32) ml/min],LVEF[(51.51±8.95)％比(42.45±8.41)％],SBP[(141.19±27.80) mmHg比(120.30±21.03) mmHg]水平则显著降低(P均＜0.05).A组患者心源性死亡事件发生率明显高于B、C组患者(54.6％比34.2％比13.1％,P＜0.01).结论:入院收缩压水平是反映急性心力衰竭患者心功能的一项重要指标.收缩压水平越低,预后越差.