N末端脑利钠肽前体和二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动速度比值预测心力衰竭患者预后价值  

NT-proBNP and E/e’ in Predicting the Prognosis of Patients with Heart Failure

作　　者：沈晓辉[1] 杨文娟[2] 程慧[1] 范卫泽[3] 耿静 臧会玲[1] SHEN Xiao-hui;YANG Wen-juan;CHENG Hui;FAN Wei-ze;GENG Jing;ZANG Hui-ling(Intensive Care Unit,the First Shijiazhuang Hospital,Shijiazhuang 050011,China;Hebei Blood Center,Shijiazhuang 050000,China;Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第一医院重症监护病房,石家庄050011 [2]河北省血液中心,石家庄050000 [3]河北医科大学第二医院心内科,石家庄050000

出　　处：《临床误诊误治》2020年第5期64-69,共6页Clinical Misdiagnosis & Mistherapy

基　　金：首都特色应用研究专项基金(Z181100001718026);石家庄市科技局课题(161460733)。

摘　　要：目的探讨心力衰竭患者出院时N末端脑利钠肽前体(NT-proBNP)和二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动速度比值(E/e’)的相关性,以及这2个指标预测此类患者预后的价值。方法选取经治疗好转出院时的成年急、慢性左心衰竭210例作为研究对象,收集其临床资料,出院时检测血NT-proBNP和超声E/e’,应用线性回归分析对出院时NT-proBNP与E/e’的相关性进行分析,应用受试者工作特征(ROC)曲线分析NT-proBNP与E/e’预测心力衰竭患者预后的价值。结果随访1年,成年急、慢性左心衰竭210例60 d再住院率为30.95%,1年病死率为20.48%。线性回归分析显示,心力衰竭患者出院时NT-proBNP与E/e’呈高度正相关(P<0.001,R^2=0.994)。NT-proBNP预测心力衰竭患者60 d再住院率的ROC曲线下面积是0.694,最佳截断值为339 ng/L,敏感度和特异度分别为81.54%和53.10%;E/e’预测心力衰竭患者60 d再住院率的ROC曲线下面积是0.702,最佳截断值为9.76,敏感度和特异度分别为83.08%和53.79%。NT-proBNP预测心力衰竭患者1年病死率的ROC曲线下面积是0.711,最佳截断值为374 ng/L,敏感度和特异度分别为74.42%和67.07%;E/e’预测心力衰竭患者1年病死率的ROC曲线下面积是0.727,最佳截断值为10.02,敏感度和特异度分别为86.05%和58.08%。E/e’较NT-proBNP预测心力衰竭患者60 d再住院率和1年病死率更有优势(P<0.05)。结论心力衰竭患者出院时NT-proBNP和E/e’呈正相关;出院时NT-proBNP和E/e’对心力衰竭患者60 d再住院率和1年病死率均具有预测价值,且E/e’较NT-proBNP预测价值略高。Objective To investigate the correlation of N-Terminal pro-brain natriuretic peptide(NT-proBNP) with the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus(E/e’) in patients with heart failure(HF) at discharge, and to evaluate the value of the two indicators in predicting the prognosis of those patients. Methods A total of 210 adult patients with acute or mild left HF who were treated and discharged from our hospital were enrolled in this study. The clinical data were collected, and blood NT-proBNP and E/e’ were detected at discharge. Linear regression analysis to analyze the correlation between NT-proBNP and E/e’ at discharge. Receiver operating characteristic curve(ROC) was used to analyze the value of NT-proBNP and E/e’ in predicting prognosis of HF patients. Results At 1-year follow-up, the 60-day rehospitalization rate of 210 adult patients with acute and mild HF was 30.95%, and the 1-year mortality was 20.48%. Linear regression analysis showed that NT-proBNP of HF patients was significantly and positively correlated with E/e’ at discharge(P<0.001, R^2=0.994). The area under the ROC curve(AUC) of NT-proBNP at discharge in predicting 60-day rehospitalization rate of HF patients was 0.694 for HF patients, the optimal cut-off value was 339 ng/L(sensitivity of 81.54%, specificity of 53.10%). In comparison, the AUC of E/e’ at discharge in predicting 60-day rehospitalization rate of HF patients was 0.702, and the optimal cutoff value was 9.76(sensitivity of 83.08%, specificity of 53.79%). In the meanwhile, the AUC of NT-proBNP at discharge in predicting 1-year mortality rate of HF patients was 0.711, and the optimal cutoff value was 374 ng/L(sensitivity of 74.42%, specificity of 67.07%). The AUC of E/e’ in predicting 1-year mortality rate was 0.727, and the optimal cutoff value was 10.02(sensitivity of 86.05%, specificity of 58.08%). E/e’ was superior to NT-proBNP in predicting the 60-day rehospitalization rate and 1-year mortality rate in HF patients(

关 键 词：心力衰竭 N末端脑利钠肽前体 二尖瓣舒张早期血流峰速度与二尖瓣环舒张早期运动速度比值 病死率 再住院率 

分 类 号：R541.6[医药卫生—心血管疾病]