NT-proBNP联合肾小球滤过率对慢性心功能不全患者心衰程度的预测价值  

The predictive value of NT-proBNP combined with glomerular filtration rate on the degree of heart failure in patients with chronic heart failure

作　　者：汪芸玏 王如兴 WANG Yun-le;WANG Ru-xing(Department of Cardiology, the Affiliated Wuxi People′s Hospital of Nanjing Medical University, Wuxi Jiangsu 214027, China)

机构地区：[1]南京医科大学附属无锡人民医院心血管内科,江苏无锡214027

出　　处：《江苏大学学报（医学版）》2020年第2期173-176,共4页Journal of Jiangsu University：Medicine Edition

基　　金：南京医科大学科技发展基金资助项目(NMUB2018360)。

摘　　要：目的:研究N末端B型利钠肽原(NT-proBNP)联合估算肾小球滤过率(eGFR)对慢性心衰患者心衰程度的预测价值。方法:收募有慢性心衰病史、入院完善NT-proBNP和eGFR的临床心功能下降患者124例,并按照心功能等级及eGFR进行分组,分析肾功能正常及减低患者间血浆NT-proBNP水平差异,Pearson相关分析NT-proBNP与eGFR的相关性,二元Logistic回归分析纳入心衰程度的危险因素并构建预测模型,受试者工作特征(ROC)曲线评估NT-proBNP与预测模型对慢性心衰程度的预测效能。结果:肾功能减低组血浆NT-proBNP水平较肾功能正常组明显增高(P<0.01)。对心功能Ⅲ级和Ⅳ级分别进行亚组分析,结果显示肾功能正常组与肾功能减低组患者NT-proBNP亦有统计学差异(P均<0.01)。Pearson相关性分析显示,慢性心衰患者的血浆NT-proBNP水平与eGFR呈负相关(r=-0.499,P<0.01)。Logistic回归分析后纳入NT-proBNP、肾功能分期以及两变量乘积建立模型,ROC曲线分析提示预测模型比单用NT-proBNP对慢性心衰患者心功能恶化程度预测性更好(曲线下面积分别为0.808和0.751)。结论:慢性心衰患者血浆NT-proBNP水平与eGFR呈负性关联,且NT-proBNP联合eGFR对慢性心功能不全患者心衰程度具有较高的预测能力。Objective:To assess the predictive value of the combination of NT-proBNP and eGFR on the degree of heart failure in patients with chronic heart failure.Methods:A total of 124 patients with history of chronic heart failure who were admitted to hospital and with results of NT-proBNP and eGFR were divided into two groups according to cardiac function grade and eGFR.The difference of plasma NT-proBNP level between patients with normal renal function and decreased renal function was analyzed.Pearson correlation analysis was used to detect the correlation of NT-proBNP and eGFR.Binary Logistic regression analysis included the risk factors of the degree of heart failure and a prediction model was developed.The area under ROC curve was calculated to assess the prediction effect of NT-proBNP and prediction model on the degree of chronic heart failure.Results:There was a significant difference in the level of NT-proBNP between the normal renal function group and the decreased renal function group(P<0.01).It is the same in subgroup analysis of cardiac function(gradeⅢ:P<0.01;gradeⅣ:P<0.01).Pearson correlation analysis showed that the plasma NT-proBNP level was negatively correlated with eGFR in patients with chronic heart failure(r=-0.499,P<0.01).After Logistic regression analysis,NT-proBNP,renal function stage and product of two variables were included to establish the model.ROC curve analysis showed that the prediction model was better than NT-proBNP alone in predicting the degree of deterioration of heart function in patients with chronic heart failure(AUC:0.808 vs.0.751).Conclusion:There was a negative correlation between NT-proBNP and eGFR in patients with chronic heart failure,and NT-proBNP combined with eGFR could be used to predict the degree of heart failure in patients with chronic heart failure.

关 键 词：慢性心力衰竭 N末端B型利钠肽原 肾功能减低 估算肾小球滤过率 

分 类 号：R541.6[医药卫生—心血管疾病]