血浆NT-proBNP和总胆固醇浓度联合预测心脏瓣膜病病人恶性心律失常的价值  

Value of plasma NT-proBNP and total cholesterol levels of patients with heart valve disease predicting malignant arrhythmia

作　　者：李春芝[1] 赵鑫[2] 郭士强 

机构地区：[1]河北省人民医院感染性疾病科,石家庄050051 [2]河北省人民医院超声科,石家庄050051 [3]河北省邯郸市第七医院内科,河北邯郸056005

出　　处：《首都医科大学学报》2017年第1期108-112,共5页Journal of Capital Medical University

摘　　要：目的探讨血浆N端脑利钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)和总胆固醇(total cholesterol,TC)浓度联合预测心脏瓣膜病病人恶性心律失常(malignant arrhythmia,MA)的价值。方法以心脏瓣膜病病人168例作为研究组,另选取30例同期健康查体者作为对照组。采用酶联免疫吸附法(enzyme-linked immunosorbent,ELISA)检测对照组和研究组术前(T_0)、术后1 d(T_1)、3 d(T_2)、1周(T_3)和1个月(T_4)的血浆NT-proBNP和TC浓度。统计研究组随访2年期间MA的发生情况,并根据其MA发生情况分为MA组(n=18)和非MA组(n=150)2个亚组,比较2组围术期的血浆NT-proBNP和TC浓度并采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析心脏瓣膜病病人血浆NT-proBNP和TC浓度预测其MA的价值。结果与对照组比较,研究组围术期的血浆NT-proBNP和TC浓度均升高;与T_0比较,研究组T_1、T_3和T_4的血浆NT-proBNP和TC浓度均降低(P<0.05)。研究组MA发生率为10.71%(18/168),且MA组围术期的血浆T-proBNP和TC水平均高于非MA组(P<0.05)。ROC分析结果显示,以728.28 pg/m L和4.15 mmol/L为血浆NT-proBNP和TC浓度临界值时AUC=0.884(95%CI:0.791~0.936),ROC上MA病人17例,灵敏度为94.44%,曲线下非MA病人148例,特异度为98.67%,准确性、阳性预测值和阴性预测值分别为98.21%、89.47%和99.33%,心脏瓣膜病病人血浆NT-proBNP和TC浓度联合预测其MA的价值良好。结论心脏瓣膜病病人血浆NT-proBNP和TC浓度均较高且两者联合预测其MA的价值良好,这可能与NT-proBNP与病人心功能损伤相关和TC调节心脏电解质平衡作用相关,因此心脏瓣膜病病人血浆NT-proBNP和TC浓度可能用于其MA的预测从而为其预后改善提供依据。Objective To investigate the value of plasma N-terminal brain natriuretic peptide precursor （NT-proBNP） and total cholesterol （TC） levels of patients with heart valve disease predicting malignant arrhythmia（MA）. Methods Totally 168 patients with heart valve disease were selected to constitute a research group, and other 30 healthy persons who had physical examination in the same period were selected to constitute a control group. Enzyme-linked immunosorbent （ELISA） was applied in detection of plasma NT-proBNP and TC levels of the control group and the research group preoperative （T0）, postoperative 1d （T1）, 3d （T2）, 1 week （T3）, and 1 month （T4）. The research group was followed up for two years and the occurrence of MA was statistically analyzed. The research groups were divided into MA group （n=18） and non-MA group（n=150） two subgroups according to the occurrence of MA. perioperative plasma NT-proBNP and TC levels of MA group and non-MA group were compared and receiver operating characteristic curve （ROC） was applied in analysis of value of plasma NT-proBNP and TC levels of patients with heart valve disease predicting the MA. Results Compared with control group, perioperative plasma NT-proBNP and TC levels of the research group were increased; compared with T0, T1, T3 and T4 plasma NT-proBNP and TC levels of the research group were lower （P〈0.05）. MA incidence of the research group was 10.71% （18/168）, and perioperative plasma NT-proBNP and TC levels of MA group were higher than that of non-MA group （P〈0.05）. ROC curve analysis results showed that when the cutoff valued of plasma NT-proBNP and TC level were 728.28 pg/mL and 4.15 mmol/L, the AUC=0.884（95%CI：0.791-0.936）, there was 17 patients with MA on the curve, thus the sensitivity was 94.44%, and there was 148 cases of patients without MA under the curve, thus the specificity was 98.67%, and the accuracy, positive predictive value and negative predictive value were 98.21%, 89.47% and 99.33%

关 键 词：血浆N端脑利钠肽前体 胆固醇 预测 心脏瓣膜病 恶性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]