血浆N末端B型利钠肽原对预测心力衰竭患者住院病死率的价值  

Predictive value of admission amino-terminal pro-B-type natriuretic peptide on in-hospital mortality in patients with decompensated heart failure

作　　者：韦丙奇[1] 杨跃进[1] 张健[1] 张春玲[2] 顾晴[3] 高鑫[3] 窦克非[1] 张宇辉[1] 黄晓红[1] 康连鸣[1] 杨艳敏[3] 戴研[3] 于丽天[3] 张慧敏[3] 吕蓉 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心力衰竭监护病房,100037 [2]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院临床检验中心,100037 [3]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院内科重症监护病房,100037

出　　处：《中华心血管病杂志》2009年第6期481-485,共5页Chinese Journal of Cardiology

基　　金：基金项目：北京市科委重大科技支撑项目（D0906004040291）

摘　　要：目的评价入院时血浆N末端B型利钠肽原（NT—proBNP）在预测失代偿心力衰竭（心衰）患者住院病死率中的价值。方法连续检测804例住院的失代偿心衰患者入院时的血浆NT—proBNP浓度。通过ROC曲线下面积评价血浆NT—proBNP浓度在判断心衰患者住院死亡中的价值并找出其切点。应用单因素和多元回归分析判断血浆NT—proBNP是否为心衰患者住院死亡的独立预测因素。结果804例心衰患者中有64例住院期间死亡，死亡组血浆NT—proBNP浓度显著高于存活组[中位数（第25百分位数，第75百分位数）分别为4321．1（3063．8，6606．5）pmol／L与1921．6（873．9，3739．2）pmol／L，P〈0．01]。血浆NT—proBNP判断住院死亡的ROC曲线下面积是0．772（95％CI：0．718～0．825，P〈0．01），根据ROC曲线，将NT—proBNP判断住院死亡的切点值定为3500pmol／L，大于或等于此值时预测死亡的敏感性、特异性和准确性分别是70．3％、72．0％和71．9％，阳性预测值和阴性预测值分别为17．8％和96．6％。大于此值者的住院病死率（17．8％）是小于此值者（3．4％）的5倍（P〈0．01）。回归分析表明，血浆NT—proBNP是失代偿心衰患者住院死亡的独立预测因素（P〈0．01）。结论入院时血浆NT—proBNP是急性失代偿心衰患者住院死亡的独立预测因素。以3500pmol／L为切点，预测住院死亡的敏感性、特异性和准确性均超过70％，阴性预测值高达96．6％。Objective To evaluate the predictive value of admission plasma amino-terminal pro-Btype natriurctic peptide （ NT-proBNP ） on in-hospital mortality in patients with decompensated heart failure. Methods Plasma NT-proBNP levels were measured in patients with decompensated heart failure within 24 hours after admission with ELISA method. The NT-proBNP levels were compared between survivals and dying patients in hospitaL. ROC analyses were performed to evaluate the predictive value of admission plasma NT-proBNP on in-hospital mortality and to identify the optimal NT-proBNP cut-point for predicting in- hospital mortality. A binary logistic regress analyses was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality. Results A total of 804 patients with decompensated heart failure were enrolled in his study （293 valvular heart diseases, 219 ischemic cardiomyopathy, 141 dilated cardiomyopathy, 14 hypertrophic cardiomyopathy, 21 restrictive cardiomyopathy, 39 hypertensive heart disease, 41 chronic pulmonary heart disease and 36 adult congenital heart disease） and 96 patients were in class Ⅱ, 450 in class Ⅲ and 258 in cases Ⅳ according to NYHA Classification. During hospitalization, 64 deaths were recorded and the on admission plasma NT-proBNP levels of patients died during hospitalization were significantly higher than those of survivals [ 4321.1 （3063.8, 6606. 5 ） pmoL/L vs. 1921.6 （873.9, 3739. 2） pmol/L,P 〈0. 01 3. Area under receiver operating characteristic curve （AUC） of NT-proBNP to predict in-hospital death was 0. 772 （ 95 % CI： 0. 718 - 0. 825, P 〈 0. 01 ） , the optimal plasma NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L, with a sensitivity of 70. 3%, a specificity of 72.0% , an accuracy of 71.9% , a positive predictive value of 17.8% and a negative predictive value of 96. 6%. Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had a much higher in- hospital mortality （17. 8% ） compared with those with

关 键 词：心力衰竭 充血性 医院病死率 N末端B型利钠肽原 

分 类 号：R686[医药卫生—骨科学]