血浆N末端脑钠肽前体对高龄左室肥厚病人预后的预测价值

doi:10.3969/j.issn.1003-9198.2024.08.010

摘要/Abstract

摘要： 目的探讨N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)对高龄(≥80岁)左室肥厚(LVH)病人预后的预测价值。方法连续纳入在中国人民解放军总医院第二医学中心住院的309例高龄LVH病人,记录病人临床基线资料、生化指标和血浆NT-proBNP水平。对病人全因死亡和主要不良心血管事件(MACEs)进行随访。采用线性回归方法筛选与NT-proBNP相关的临床因素,采用Cox风险比例回归模型评估NT-proBNP水平与终点事件之间的关系,利用ROC曲线评估NT-proBNP对高龄LVH病人预后的预测价值。结果 309例高龄LVH病人的NT-proBNP中位水平为325(144,821)pg/mL。血浆NT-proBNP水平与年龄、心房颤动、起搏器植入、左室质量指数(LVMI)和使用β受体阻滞剂呈正相关,与估算的肾小球滤过率(eGFR)、Hb、血浆白蛋白和LVEF呈负相关。中位随访6.7(3.1,9.1)年,239例(77.3%)死亡,117例(37.9%)发生MACEs。多因素Cox回归模型显示,与最低分位组相比,NT-proBNP最高分位组全因死亡(HR=3.029; 95%CI:1.918~4.728)和MACEs(HR=3.173; 95%CI:1.612~6.244)风险显著增加。ROC曲线分析显示,NT-proBNP预测高龄LVH病人全因死亡和MACEs的AUC分别为0.669和0.594(均P <0.01)。结论血浆NT-proBNP对高龄LVH病人全因死亡和MACEs具有较好的预测价值。

关键词: 左室肥厚, 老年人, N末端脑钠肽前体, 主要不良心血管事件, 全因死亡

Abstract: Objective To explore the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for the prognosis in the elderly patients aged≥80 years old with left ventricular hypertrophy(LVH). Methods A total of 309 elderly patients aged ≥80 years old with LVH admitted to the Second Medical Center of the General Hospital of the People’s Liberation Army were enrolled in the study. The clinical baseline data, biochemistry index and the plasma level of NT-proBNP were collected. All-cause death and major adverse cardiovascular events (MACEs) of the patients were followed up. Linear regression was used to screen the clinical factors related to NT-proBNP. Cox risk proportional regression model was used to evaluate the relationship between NT-proBNP level and endpoint events. Receiver operating characteristic (ROC) curve wad used to evaluate the predictive value of NT-proBNP for the prognosis in the elderly patients with LVH. Results The median NT-proBNP level of 309 patients was 325 (144,821) pg/mL. The plasma level of NT-proBNP was positively correlated with aging, atrial fibrillation, pacemaker implantation, left ventricular mass index (LVMI) and the use of β-blockers, while negatively correlated with estimated glomerular filtration rate (eGFR), hemoglobin, plasma albumin and left ventricular ejection fraction(LVEF). A median follow-up of 6.7 (3.1,9.1) years showed 239(77.3%) cases of death and 117(37.9%) cases of MACEs. The multivariate Cox regression model showed that the highest percentile group of NT-proBNP had a significantly increased risk of all-cause death (HR= 3.029; 95% CI: 1.918-4.728) and MACEs (HR =3.173; 95% CI: 1.612-6.244) compared to the lowest percentile group. ROC curve analysis showed that the AUC of NT-proBNP in predicting all-cause death and MACEs was 0.669 and 0.594 respectively(P<0.01). Conclusions Plasma NT-proBNP has independent predictive value for all-cause death and MACEs in the elderly patients aged≥80 years old with LVH.

Key words: left ventricular hypertrophy, aged, N-terminal pro-brain natriuretic peptide, major adverse cardiovascular events, all-cause death

中图分类号:

R541

李慧颖, 蔡力力, 朱启伟. 血浆N末端脑钠肽前体对高龄左室肥厚病人预后的预测价值[J]. 实用老年医学, 2024, 38(8): 797-801.

LI Huiying, CAI Lili, ZHU Qiwei. Predictive value of plasma N-terminal pro-brain natriuretic peptide for prognosis in patients aged ≥80 years old with left ventricular hypertrophy[J]. Practical Geriatrics, 2024, 38(8): 797-801.

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