氨基末端脑钠肽水平与老年血液透析合并心力衰竭死亡的相关性

孙波; 田红霞; 李晟; 王月娥; 荆忱; 王军

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武警医学 ›› 2016, Vol. 27 ›› Issue (11) : 1113-1116.

论著

氨基末端脑钠肽水平与老年血液透析合并心力衰竭死亡的相关性

孙波¹,田红霞¹,李晟¹,王月娥¹,荆忱¹,王军²

作者信息 +

Relevance of NT-proBNP level to elderly hemodialysis patients with congestive heart failure

SUN Bo¹,TIAN Hongxia¹,LI Sheng¹,WANG Yuee¹,JING Chen¹,and WANG Jun²

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摘要

目的研究氨基末端脑钠肽(N terminal-pro brain nalriuretic peptide,NT-proBNP)水平与老年维持性血液透析并充血性心力衰竭死亡的相关性。方法选择维持性血液透析并充血性心力衰竭入院患者52例,因心力衰竭死亡22例为死亡组,心力衰竭缓解30例为非死亡组,比较住院前、住院期间死亡组和非死亡组NT-proBNP水平,采用二分类Logistic回归分析影响死亡的相关因素,偏相关分析影响死亡组NT-proBNP水平的相关因素,受试者工作特征(ROC)曲线评价NT-proBNP水平对死亡的预测效能。结果死亡组入院时NT-proBNP中位数为31 000 ng／L,与非死亡组入院时NT-proBNP中位数28 500 ng／L比较无统计学意义;死亡组住院期间NT-proBNP中位数为9200 ng／L,明显高于非死亡组NT-proBNP中位数4700 ng／L,差异有统计学意义(P＜0.01);二分类Logistic回归分析提示住院期间NT-proBNP水平为影响死亡的唯一相关因素(P＜0.01);左室EF值、透析间期体质量增加值、左室扩大为影响死亡组住院期间NT-proBNP水平相关因素(P＜0.01)。死亡组住院期间NT-proBNP的AUC值为0.962,差异有统计学意义(P＜0.05);NT-proBNP＞7650 ng／L作为界值(Cut off值)的敏感度为82.4%,特异度为84%;非死亡组住院期间NT-proBNP的AUC值为0.038,差异无统计学意义。结论老年维持性血液透析并充血性心力衰竭住院期间高水平NT-proBNP与死亡具有相关性,可作为预测死亡的指标。

Abstract

Objective To investigate the predictive value of the NT-proBNP level for elderly patients of maintenance hemodialysis and congestive heart failure. Methods 52 cases of maintenance hemodialysis combined with congestive heart failure were selected, 22 cases of congestive heart failure were selected as death group, and another 30 patients with congestive heart failure remission as non-death group. The NT-proBNP level before and during hospitalization was compared between the death group and non-death group. Binary logistic regression methods were used to analyze the correlation factors that affected death, especially the related factors that influenced NT-proBNP of death group. The diagnostic performance of NT-proBNP of patients was evaluated using the receiver-operating characteristic (ROC) curve to determine the prediction efficiency. Results The median value of NT-proBNP in death group before hospitalization was 31000ng/L, compared with 28 500 ng/L in non-death group. The difference was of no statistical significance(P>0.05). The median value of NT-proBNP in death group was 9200 ng/L before admission, significantly higher than 4700ng/L in non-death group. The difference was statistically significant (P<0.01). The left ventricular EF value , mass increase during dialysis and left ventricular enlargement were the main factors that influenced the NT-proBNP level of death group during hospitalization. The NT-proBNP AUC value of death group during hospitalization was 0.962, which was statistically significant(P＜0.05). The sensitivity was 82.4% and the specificity was 84% when NT-proBNP>7650 ng/L served as the boundary value (cutoff value). NT-proBNP AUC value was 0.038 in non-death group during hospitalization, which was of no statistical significance. Conclusions The NT-proBNP level of elderly patients with maintenance hemodialysis combined with congestive heart failure can be used as a prediction index of death during hospitalization.

导出引用

孙波,田红霞,李晟,王月娥,荆忱,王军. 氨基末端脑钠肽水平与老年血液透析合并心力衰竭死亡的相关性[J]. 武警医学. 2016, 27(11): 1113-1116

SUN Bo,TIAN Hongxia,LI Sheng,WANG Yuee,JING Chen,and WANG Jun. Relevance of NT-proBNP level to elderly hemodialysis patients with congestive heart failure[J]. Medical Journal of the Chinese People Armed Police Forces. 2016, 27(11): 1113-1116

中图分类号： R692.5

参考文献

[1] 赵玉清,袁桂莉,张进顺,等. 和肽素联合N末端B型利钠肽原评估慢性心力衰竭患者预后的价值[J].中国循环杂志,2014,29(4): 275-278.
[2] Stienen S, Salah K, Moons A H, et al.Rationale and design of PRIMA II: a multicenter, randomized clinical trial to study the impact of in-hospital guidance for acute decompensated heart failure treatment by a predefined NT-PRoBNP target on the reduction of readmIssion and Mortality rAtes [J]. Am Heart J, 2014, 168(1): 30-36.
[3] Sargento L, Longo S, Lousada N, et al.Serial measurements of the Nt-ProBNP during the dry state in patients with systolic heart failure are predictors of the long-term prognosis [J]. Biomarkers, 2014, 19(4): 302-313.
[4] 孙波,刘玉华,李晟,等.氨基末端脑钠肽对老年血液透析合并充血性心力衰竭的心功能诊断分级的判断价值[J]. 武警医学,2014, 25(6): 566-569.
[5] 王新房.超声心动图学[M].3版.北京:人民卫生出版社,1999:311.
[6] Sudoh T, Kangawa K, Minamino N, et al. A new natriuretic peptide in porcine brain[J]. Nature, 1988, 332 ( 159 ): 78-81.
[7] Anwaruddin S, Lloyd-Jones D M, Baggish A, et al. Renal function, congestive heart failure, and aminoterminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department ( PRIDE ) Study[J]. J Am Coll Cardiol, 2006, 47(1): 91-97.
[8] Seino Y, Ogawa A, Yamashita T, et al. Application of NT-proBNP and BNP measurements in cardiac care:a more discerning marker for the detection and evaluation of heart failure[J]. Eur J Heart Fail, 2004, 6( 3): 295-300.
[9] Sivalingam M, Suresh M, Farrington K. Comparison of Btype natriuretic peptide and NT-proBNP as predictors of survival in patients on highflux hemodialysis and hemodiafiltration[J]. Hemodial Int, 2011, 15(3): 359-365.
[10] Codognotto M, Piccoli A, Zaninotto M, et al. Effect of a dialysis session on the prognostic values of NT-proBNP, troponins, endothelial damage and inflammation biomarkers[J]. J Nephrol, 2010, 23(4): 465-471.
[11] Paniagua R, Ventura M D, Avila-Díaz M, et al. NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients[J]. Nephrol Dial Transplant, 2010, 25(2): 551-557.
[12] 杨跃进,赵雪燕.NT-proBNP在心血管疾病诊断中的应用进展[J].中华检验医学杂志,2012,35(10):865-869.
[13] Booth J, Pinney J, Davenport A. Nterminal proBNP-marker of cardiac dysfunction,fluid overload, or malnutrition in hemodialysis patients?[J]. Clin J Am Soc Nephrol,2010,5(6):1036-1040.
[14] Michtalik H J,Yeh H C,Campbell C Y,et al.Acute changes in N-terminal pro-B-type natriuretic peptide during hospitalization and risk of readmission and mortality in patients with heart failure[J]. Am J Cardiol, 2011, 107(8): 1191- 1195.
[15] Goonewardena S N, Gemignani A, Ronan A, et al. Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure[J]. JACC Cardiovasc Imaging, 2008, 1(5): 595-601.
[16] McKie P M,Cataliotti A,Sangaralingham S J,et al.Predictive utility of atrial, Nterminal pro-atrial, and Nterminal pro-Btype natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study[J]. Mayo Clin Proc, 2011,86(12):1154-1160.