关键词: 心脏瓣膜假体植入, 利钠肽, 脑, 氨基末端脑钠肽前体, 预后

Abstract: Objective　To evaluate the clinical application value of plasma brain natriuretic peptide（BNP） combined with N-terminal prohormone of brain natriuretic peptide（NT-proBNP） based on comparing its value for predicting postoperative prognosis of patients with heart valve replacement surgery with that of routine cardiac function parameters.Methods　We enrolled 138 patients with rheumatic heart disease undergoing heart valve replacement surgery from Department of Cardiac Surgery，Sichuan Provincial People's Hospital from August 2014 to February 2016 and collected their baseline characteristics，measurement levels of plasma BNP，NT-proBNP and routine cardiac function parameters at 1 week after surgery.They were divided into good prognosis group and poor prognosis group based on the conditions during a 18 month-follow-up initiated at 1 month after discharge.Results　Except 14 were lost to follow-up，the other 124 completing the follow-up were included in the final analysis.73 of them were found with good prognosis（good prognosis group），and other 51 with poor prognosis（poor prognosis group），the rate of poor prognosis was 41.1%（51/124）.Multivariate Cox regression analysis showed that left ventricular end diastolic diameter（LVEDD）（RR=1.578，P=0.039），plasma BNP（RR=1.935，P=0.013） and NT-proBNP（RR=2.346，P<0.001） were the associated factors of poor prognosis after heart valve replacement surgery.For predicting the patient prognosis，the AUC of LVEDD，plasma BNP，and NT-proBNP were 0.774，0.814，and 0.800，respectively，and the AUC of plasma BNP combined with NT-proBNP was 0.856，with a corresponding specificity of 78.9%，and a sensitivity of 83.6%.Conclusion　As its predictive accuracy for the prognosis of patients undergoing cardiac valve replacement surgery，plasma BNP combined with NT-proBNP is expected to be used as one of the clinical parameters for postoperative prognosis prediction of such patients.

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