NT-proMPT、CTnI、C-反应蛋白联合检测对急性心力衰竭患者预后评价价值研究  

The application value of combination detection of NT proBNP,CTnI,C reactive protein in prognostic evaluation of patients with acute heart failure

作　　者：冯星源 陈谦 关义健 FENG Xingyuan;CHEN Qian;GUAN Yijian(Department of Clinical Laboratory,TCM Hospital of Sanya City,Hainan,Sanya 572000,China)

机构地区：[1]海南省三亚市中医院检验科,572000 [2]海南省乐东县乐东人民医院检验科

出　　处：《河北医药》2019年第2期215-218,共4页Hebei Medical Journal

摘　　要：目的探讨N-末端前-B-型利钠肽(NT-proMPT)、心肌肌钙蛋白T(CTn I)、C-反应蛋白联合检测对急性心力衰竭患者预后评价价值。方法收治的399例急性心力衰竭患者,使用基于参考群体浓度的各种生物标志物和基于急性心力衰竭中的三分位数的截点来确定全因死亡的风险。生物标志物研究包括NT-proBNP,高敏C-反应蛋白(hs CRP),cTnT。估计死亡的相对风险并计算生存曲线。结果 399例不同年龄的患者在跟进期间共发生101例死亡。基于正常临界值,NT-proBNP浓度升高并不能预测死亡率。然而,NT-proBNP的等级分析显著预测死亡率,并且有一块ROC面积等于或优于曲线下的任何其他生物标志物。独立预测存活的生物标志物分别是hs-CRP、cTnT和cTnI。在hs-CRP、cTnI和cTnT浓度均正常的情况下,2年死亡率为6%(n=45);在hs-CRP、cTnI增加和cTnT浓度正常的情况下,死亡率为19%(n=173);在hs-CRP、cTnT增加而cTnT浓度正常的情况下,2年死亡率为44%(n=160);在不管hs-CRP或cTnT浓度,cTnI(Dade)增加时,死亡率为61%(n=21)或cTnI(Beckman)增加时,死亡率为47%(n=74)。由正常临界值定义,提出增加生物标志物的浓度,对急性心力衰竭的患者进行各种比例化验:NT-proBNP,99%; hs-CRP,46%(Roche和Dade化验都有); cTnT,85%; cTnI,19%(Beckman化验)和5%(Dade化验)。结论血浆hs-CRP、cTnT和cTnI高于在我们的参考(正常)人群中的临界值,都是对急性心力衰竭患者随后死亡的独立预测。对NT-proBNP的等级分析也显示出预后价值。Objective To investigate the application value of combination detection of NT-proBNP,CTnI,C reactive protein(CRP)in prognostic evaluation of patients with acute heart failure.Methods A total of 399 patients with acute heart failure who were admitted and treated in our hospital from January 2013 to December 2017 were enrolled in the study,and the risk of all cause death was determined by various biomarkers which based on the concentration of reference group and the section of three quantile in acute heart failure.The biomarkers included N terminal B type natriuretic peptide(NT-proBNP),high sensitive C reactive protein(hs-CRP),and cardiac troponin T(cTnT).The relative risk of death was estimated and the survival curve was calculated.Results Among 399 patients with different ages,there were 101 cases of death during follow up.According to normal critical value,the increase of NT-proBNP concentration did not predict the mortality.However,the grade analysis of NT-proBNP could significantly predict mortality,moreover there was a piece of ROC area which was equal to or better than any other biomarkers under the curve.The biomarkers which could independently predict survival rate were hs-CRP,cTnT and cTnI respectively.Under the circumstance that the concentration of hs CRP,cTnI and cTnT was normal,the mortality rate of two years was 6%(n=45),however under the circumstance that the concentration of hs CRP and cTnI was increased and cTnT concentration was normal,the mortality rate of two years was 19%(n=173).In addition under the circumstance that the concentration of hs CRP and cTnT was increased and cTnI concentration was normal,the mortality rate of two years was 44%(n=160).Only when the cTnI concentration(Dade)was increased,regardless of the concentration of hs CRP and cTnT,the mortality rate of two years was 61%(n=21),and when cTnI(Beckman)was increased,the mortality rate was 47%(n=74).According to normal threshold value,it was proposed to increase the concentration of biomarkers,and carry out all kinds of tests for p

关 键 词：N-末端前-B-型利钠肽 高敏C-反应蛋白 心肌肌钙蛋白T 心力衰竭 

分 类 号：R541.61[医药卫生—心血管疾病]