目的：分析缺血性心力衰竭（心衰）患者的血浆N端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平，及其与患者新发心房颤动（房颤）间的关系。方法：本研究纳入120例射血分数降低（<40%）的窦性心律的缺血性心衰患者，分别在基线0 d、6个月和12个月测定其血浆NT-proBNP水平，并在入组时行超声心动图检查，于入组后1、3、6、12个月时进行24 h动态心电图检查，根据随访12个月中是否发生房颤，将患者分为房颤组（n=44）和无房颤组（n=76）。分析2组患者的临床资料和心动超声图资料，应用受试者操作特征（receiver operating characteristic, ROC）曲线，分析NT-proBNP检测对新发房颤的预测作用及其最佳临界值。采用多因素logistic回归分析NT-proBNP与缺血性心衰患者新发房颤间的关系。结果：在12个月的随访期间，缺血性心衰患者中新发房颤率为36.7%。与无房颤组相比，房颤组的纽约心功能分级、NT-proBNP水平（入组当天、6个月和12个月）、心动超声检查中二尖瓣口舒张早期/舒张晚期峰值速度比值（E/A）、二尖瓣口/二尖瓣环速度比值（E/E’）、肺动脉收缩压（pulmonary artery systolic pressure, PASP）、肺毛细血管楔嵌压(pulmonary capillary wedge pressure, PCWP）、左心房容量（left atrial volume, LAV）和左心房容量指数（left atrial volume index，LAVI）更高（P<0.05）。NT-proBNP与E/A、E/E’、PASP、PCWP、LAV和LAVI呈显著正相关（P<0.05)。ROC曲线显示，基线0 d的NT-proBNP水平对新发房颤的预测能力最强，临界值取NT-proBNP≥2 357.5 pg/mL时，其预测新发房颤的灵敏度为69%，特异度为83%，ROC曲线下面积为0.825（95%CI为0.722~0.924，P<0.001）。回归分析发现，仅NT-proBNP是缺血性心衰患者新发房颤的独立预测因子（OR=1.24，95%CI为1.08~1.43）(P=0.001）。结论：血浆NT-proBNP水平检测在预测缺血性心衰患者新发房颤中有一定的临床价值。

Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P<0.05). NT-proBNP levels demonstrated positive correlations with these echocardiographic parameters (P<0.05). ROC curve analysis identified a baseline NT-proBNP cutoff value of 2357 pg/mL as the most predictive of new-onset AF, with 69% sensitivity and 83% specificity (AUC = 0.825, 95% CI: 0.722-0.924, P<0.001). Logistic regression analysis further established NT-proBNP as the only independent predictive predictor of new-onset AF (OR = 1.24, 95% CI: 1.08-1.43, P=0.001). Conclusions Serum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.