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題 名 | N-terminal Pro-brain Natriuretic Peptide as a Prognostic Predictor in Critical Care Patients with Acute Cardiogenic Pulmonary Edema=NT-proBNP為重症加護病人急性心因性肺水腫之預後預測因子 |
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作 者 | 莊俊斌; 駱惠銘; 吳章瑜; 鍾鈺壎; 何豐名; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 23:1 2007.03[民96.03] |
頁 次 | 頁20-28 |
分類號 | 415.46 |
關鍵詞 | 急性肺水腫; 急性心衰竭; 預後預測; NT-proBNP; Pro-brain natriuretic peptid; Acute pulmonary edema; Acute heart failure; Prognoses; |
語 文 | 英文(English) |
中文摘要 | 背景 本研究之目的在評估加護病房急性心因性肺水腫病人住院後24小時內血清NT-proBNP濃度對病人預後之預測。方法 五十位住入本院內科加護病房急性心因性肺水腫病人進入本研究,初分為兩組。其中24人為心舒功能不良組(左心室射出率大於50%),26人為心縮功能不良組(左心室射出率小於50%)。血清及心臟超音波檢查於住院24小時內完成收集,後於實驗室內分析血清NT-proBNP濃度。持續追蹤病人住院及出院後死亡或不良事件(再次急性心衰竭住院)之情形。結果 血清NT-proBNP濃度在心舒功能不良組與心縮功能不良組分別為6055.7±5039.5pg/mL及20343.8±11968.4pg/mL(p<0.001)。本實臉發現血清NT-proBNP濃度較高(NT-proBNP≥9215pg/mL)之病人有較低之身體質量指數(Body Mass Index)、貧血及腎功能不全情形。持續追蹤病人預後發現血清NT-proBNP濃度較高者有較高之不良事件(危險率4.967,P=0.011)及總死因死亡率(危險率58.95,P=0.004)。血清NT-proBNP濃度為不良事件及死亡率之唯一有義意獨立預測因子。使用昇壓素轉化酶抑制劑或昇壓素Ⅱ受器阻斷劑、乙型阻斷劑可預測較小之總死因死亡危險率(0.030及0.064,P=0.002及0.046)。結論 住院24小時內血清NT-proBNP濃度可做為評估加護病房急性心因性肺水腫病人預後之工具,較高血清NT-proBNP濃度為日後不良事件及死亡率之獨立預測因子,使用昇壓素轉化酶抑制劑或昇壓素Ⅱ受器阻斷劑、乙型阻斷劑身體可減少病人之死亡率。 |
英文摘要 | Background: This study evaluated plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) as a potential prognostic predictor in critical care patients with acute cardiogenic pulmonary edema within 24 hours after admission. Methods: Fifty patients with acute cardiogenic pulmonary edema admitted to our intensive care unit (ICU) were enrolled. They were divided into two groups: a nonsystolic heart failure (NS-CHF) group with preserved left ventricular ejection fraction (LVEF≥50%, n = 24) and a systolic heart failure (S-CHF) group with reduced LVEF (< 50%, n = 26). Plasma NT-proBNP levels and LVEF by bedside echocardiography were measured within 24 hours of admission. Combined adverse cardiac events (death or heart failure) and all-cause mortality were monitored. Results: The levels of plasma NT-proBNP in NS-CHF and S-CHF groups were 6055.7 ± 5039.5 pg/mL and 20343.8 ± 11968.4 pg/mL, respectively (p<0.001). Patients with lower body mass index (BMI), anemia, and impaired renal function were more frequently found in the high plasma NT-proBNP group (NT-proBNP levels ≥9215 pg/mL). During the follow-up period, the group of patients with higher plasma NT-proBNP levels (≥ 9215 pg/mL) had more adverse cardiac events (hazard ratio 4.967, p = 0.011) and a higher mortality rate (hazard ratio 58.94, p = 0.004). The plasma NT-proBNP level was the only significant independent predictor of combined adverse cardiac events and all-cause mortality. The use of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker (ACEI/ARB) and beta-blocker was also associated with a lower hazard ratio of all-cause mortality (0.030 and 0.064 respectively, p=0.002 and 0.046). Conclusions: In critical care patients with acute cardiogenic pulmonary edema, plasma NT-proBNP level within 24 hours after admission is an independent predictor of combined adverse cardiac events and all-cause mortality. The use of ACEI/ARB and beta-blocker also predicts a lower rate of all-cause mortality in these patients. |
本系統中英文摘要資訊取自各篇刊載內容。