200 Original Article Korean Circulation J 2006;36:200-207 ISSN 1738-5520 ⓒ 2006, The Korean Society of Circulation ORIGINAL ARTICLE 급성 심부전 환자에서 조기 추적 BNP 수치와 울혈 정도 및 예후와의 관계 연세대학교 원주의과대학 순환기내과학교실, 1 응급의학과학교실 2 정일형 1 ·유병수 1 ·유호열 1 ·왕희성 1 ·최현민 1 김장영 1 ·이승환 1 ·황성오 2 ·윤정한 1 ·최경훈 1 The Relationship between the Early Follow-Up BNP Level and Congestive Status or Prognosis in Acute Heart Failure Il-Hyung Chung, MD 1 , Byung-Su Yoo, MD 1 , Ho Yoel Ryu, MD 1 , Hee-Sung Wang, MD 1 , Hyun-Min Choi 1 , Jang-Young Kim, MD 1 , Seung-Hwan Lee, MD 1 , Sung-Oh Hwang, MD 2 , Junghan Yoon, MD 1 and Kyung-Hoon Choe, MD 1 1 Department of Cardiology and 2 Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea ABSTRACT Background and Objectives：A correlation between the BNP reduction ratio and prognosis could be expected to be found by evaluating the BNP reduction depending on the volume status during the early period. Subjects and Methods：Between October 2002 and June 2004, 120 patients with acute heart failure (AHF)(<1 month) were included. The patients were divided into three groups according to their volume status, as follows. Group I: patients with clinical & radiological wet status, Group II: clinical dry & radiological wet status and Group III: clinical & radiological dry status. The blood BNP (Triage ® ) level and clinical parameters were analyzed. The bad prognostic parameters were defined as readmission due to heart failure, a major adverse cardiac event or cardiovascular death. Results：The mean patient age was 68.0±12.7 years, and 50.0% of the subjects were male. The most frequent etiology of AHF was ischemic heart disease (35.8%). There were 61.7, 24.1 and 14.2% in Groups I, III and III, respectively. The baseline BNP level was higher in group I and II than in group III patients (I: 1540.4±1202.8, II: 1482.8±1281.6, III: 666.4±827.9 pg/mL, p=0.036) as was the early BNP reduction ratio (I: 69.8±27.1, II: 67.4±32.8, III: 1.3±144.9%, p=0.007). Sixteen (13.3%) patients had a poor prognosis. From a logistical analysis, the early BNP reduction ratio (p=0.004) and creatinine level (p=0.029) were significant predictors of the clinical outcomes. Conclusion：The early change in the BNP level varied depending on the degree of congestive status, and was also correlated with the level of clinical outcomes. Therefore, in our opinion, the early monitoring of the BNP level will provide significant clinical information in AHF patients. (Korean Circulation J 2006;36:200-207) KEY WORDS：B-type natriuretic peptide；Heart failure, congestive；Prognosis. 서 론 B-type natriuretic peptide(BNP)나 N-terminal pro-BNP (NT-pro-BNP)의 혈중 농도는 심실 용적 증가 및 심실 압력 과부하 등의 혈역학적인 자극에 반응하여 주로 심실에서 생 성 분비되어 심실 기능 이상을 잘 반영하는 것으로 알려져 있다, 1) 특히 급성 호흡곤란을 주소로 내원한 환자에 있어서 BNP 수치는 심부전의 진단에 유용하고 2-6) 예민도와 특이도 가 높은 것으로 알려져 있으며 7)8) 최근에는 BNP 수치를 치료 의 목표 혹은 추적 검사치로 이용하여 치료 반응 내지 약제 의 용량 결정에 중요한 생화학적 지표로 사용될 수 있을 지 에 대한 연구가 진행되고 있다. 9) 또한 BNP 수치의 변화는 논문접수일：2005년 8월 23일 수정논문접수일：2005년 12월 28일 심사완료일：2006년 1월 24일 교신저자：유병수, 220-956 강원도 원주시 일산동 162 연세대학교 원주의과대학 순환기내과학교실 전화：(033) 741-0917·전송：(033) 741-1219 E-mail：yubs@wonju.yonsei.ac.kr