心脏手术前氨基末端前B型利钠肽的影响因素及其对预后的评估作用  

Influence Factors and Prognosis Prediction Function of Preoperative N-terminal Pro-B-type Natriuretic Peptide in Patients Undergoing Cardiac Surgery

作　　者：刘华[1] 王春生[1] 刘岚[1] 庄亚敏[1] 杨晓梅[1] 张颖[1] 

机构地区：[1]上海市心血管病研究所复旦大学附属中山医院心外科,上海200032

出　　处：《中国胸心血管外科临床杂志》2011年第1期40-44,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的了解心脏手术前患者氨基末端前B型利钠肽（N-terminal pro-B-type natriuretic peptide,NT-proBNP）水平的影响因素,研究术前NT-proBNP对预后的评估作用,为其在心脏外科围术期的广泛应用奠定基础。方法将2008年10月至2009年5月在复旦大学附属中山医院接受心脏手术患者120例纳入研究,其中男83例,女37例;年龄25-84岁,平均年龄62.13岁。病理诊断：心脏瓣膜病35例、冠心病74例、先天性心脏病3例和胸主动脉瘤8例。患者于术前和术后24 h抽血检查NT-proBNP、肌酐、心肌肌钙蛋白T（cTnT）和肌酸激酶同工酶（CK-MB）,并随访患者机械辅助通气时间、ICU停留时间、住院天数和病死率。有以下情况之一者作为终点事件：（1）ICU停留时间〉4 d;（2）呼吸机辅助时间〉48 h;（3）30 d内死亡。采用受试者工作特征（ROC）曲线分析术前NT-proBNP对终点事件的预测作用,并以截断值为界分为NT-proBNP升高组和非升高组,对影响术前NT-proBNP的水平进行单因素和logistic多因素分析。结果术前NT-proBNP为37.5-30867.0 pg/ml（1 929.12±3 749.44 pg/ml）,术后24h NT-proBNP为177.7-35000.0 pg/ml（2950.32±4 006.14 pg/ml）,较术前明显增高（t=-2.599,P=0.012）。ROC曲线分析认为术前NT-proBNP〉867 pg/ml对终点事件有预测作用,灵敏度和特异度分别为77.8%和62.7%。术前NT-proBNP升高组患者气管内插管时间、住院时间明显高于NT-proBNP非升高组（26.44±32.75 h vs.14.49±9.23 h,t=2.507,P=0.015;23.70±24.02 d vs.16.21±8.11 d,t=2.117,P=0.039）。影响术前NT-proBNP水平的因素包括术前心房颤动、心功能分级、左心室舒张期末内径、射血分数（EF）、肺动脉压力、术前肌酐、cTnT和病理诊断;独立因素为EF（P=0.007）和心房颤动（P=0.018）。术前NT-proBNP与气管内插管时间（P=0.015）、住院时间（P=0.039）有关。结论术前NT-proBNP水平有明显的个体差异性,与NT-proBNP增高有关的独立因素Objective To find out the factors which influence plasma N-terminal pro-B-type natriuretic peptide（NT-proBNP） levels and assess whether preoperative plasma NT-proBNP levels can predict postoperative outcomes of cardiac surgery. Methods A total of 120 patients including 83 males and 37 females undergoing various cardiac procedures between December 2008 and May 2009 were included in the study.Their age ranged from 25 to 84 years with an average age of 62.13 years.Through pathological diagnosis,35 patients had heart valve diseases,74 had coronary artery diseases,3 had congenital heart diseases and 8 had aortic aneurysm.NT-proBNP,creatinine,cardiac troponin T（cTnT） and creatine kinase-MB（CK-MB） levels were measured preoperatively and 24 hours after operation.Ventilation time,length of stay in ICU or in hospital,and mortality were closely monitored after operation.The following events were regarded as endpoints：（1） ICU stay time〉4 d;（2） Ventilation time〉48 h;（3） Death occurred during the first 30 days after operation.Receiver operating characteristic（ROC） curve was used to analyze the prediction function of NT-proBNP on endpoint events.Based on the cut-off value,the patients were divided into the NT-proBNP increasing group and non-increasing group.Univariate and logistic multi-factor analysis were adopted to analyze factors which had an influence on preoperative NT-proBNP level. Results NT-proBNP concentration increased significantly from 37.5-30 867.0 pg/ml（1 929.12±3 749.44 pg/ml） preoperatively to 177.7-35 000.0 pg/ml（2 950.32±4 006.14 pg/ml） 24 hours after operation（t=-2.599,P=0.012）.ROC curve demonstrated that a cut-off value above 867 pg/ml preoperatively could predict endpoint events with a sensitivity of 77.8% and a specificity of 62.7%.Ventilation time and length of stay in hospital for the patients in the NT-proBNP increasing group were significantly longer than those of patients in the non-increasing group（26.44±32.75 h vs.14.49±9.23 h,t=2.507,P=0.015;23.7

关 键 词：氨基末端前B型利钠肽 心脏手术 预后 

分 类 号：R654.2[医药卫生—外科学]