血清FT_(3)、cTnⅠ、BNP对老年急性心力衰竭患者危险分层和预后预测的应用价值比较  

Comparison of the value of serum FT_(3), cTnⅠ and BNP in risk stratification and prognosis prediction to elderly patients with acute heart failure

作　　者：刘誉 王素丹 罗苑苑[3] 吴思慧[3] LIU Yu;WANG Sudan;LUO Yuanyuan;WU Sihui(The First Clinical Medical College,Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou510410,China;Department of Oncology,Shaoyang Hosiptal of Traditional Chinese Medicine,Hunan Province,Shaoyang422001,China;Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Province,Guangzhou510410,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510410 [2]湖南省邵阳市中医医院肿瘤科,湖南邵阳422001 [3]广州中医药大学第一附属医院重症医学科,广东广州510410

出　　处：《中国医药导报》2021年第26期54-59,共6页China Medical Herald

基　　金：广东省医学科学技术研究基金项目(A2019505)。

摘　　要：目的比较血清游离三碘甲状腺原氨酸(FT_(3))、心肌肌钙蛋白Ⅰ(cTnⅠ)、脑钠肽(BNP)水平对老年急性心力衰竭(AHF)患者危险分层和预后预测的应用价值。方法回顾性纳入2018年10月至2020年3月广州中医药大学第一附属医院232例65岁及以上老年AHF患者,记录患者临床资料并随访90 d,根据严重程度判定标准分为危重组(92例)和非危重组(140例),比较危重组和非危重组一般资料,采用多因素logistic回归分析评估AHF患者危重的影响因素,并绘制受试者操作特征曲线分析相关指标对AHF患者危重预测效能。根据90 d内生存情况,将患者分成死亡组(34例)和非死亡组(198例)。比较死亡组和非死亡组一般资料,运用Cox回归分析相关指标对AHF患者全因死亡的影响。结果危重组FT_(3)水平、左室射血分数(LVEF)低于非危重组,肌酐、BNP、cTnⅠ水平高于非危重组,差异有统计学意义(P <0.05);两组纽约心脏病协会(NYHA)心功能分级比较,差异有统计学意义(P <0.05)。多因素logistic回归分析显示,在校正年龄、性别、体重指数(BMI)后,FT_(3)、LVEF、肌酐是老年AHF危重的影响因素(P <0.01)。FT_(3)预测危重组曲线下面积(AUC)为0.719,95%CI:0.653~0.786,灵敏度为83%,特异度为57%;cTnⅠ预测危重组AUC为0.601,95%CI:0.526~0.675,灵敏度为72%,特异度为48%;BNP预测危重组AUC为0.623,95%CI:0.552~0.695,灵敏度为69%,特异度为56%。死亡组FT_(3)水平低于非死亡组,cTnⅠ高于非死亡组(P <0.05)。多因素Cox回归分析显示,在校正了年龄、性别、BMI、肌酐、NYHA心功能分级后,FT_(3)和cTNⅠ是老年AHF患者90 d全因死亡的影响因素(P <0.01)。结论在预测病情和预后方面,FT_(3)、cTnⅠ、BNP各有利弊,在合并肾功能不全的老年AHF患者中FT_(3)是一个更好的选择。Objective To compare the application value of serum free triiodothyronine(FT_(3)),cardiac troponin I(cTnI)and brain natriuretic peptide(BNP)in risk stratification and prognosis prediction of elderly patients with acute heart failure(AHF).Methods A retrospective study of 232 patients aged 65 and over with AHF in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2018 to March 2020 was performed.Clinical data of the patients were recorded and followed up for 90 days.According to the severity criteria,the patients were divided into critical group(92 cases)and non-critical group(140 cases).The general data of the critical group and the non-critical group were compared.Multivariate logistic regression analysis was used to evaluate the influencing factors of the critical severity of AHF patients,and receiver-operating characteristic curve was drawn to analyze the predictive effectiveness of relevant indicators for the critical severity of AHF patients.According to the survival within 90 days,patients were divided into death group(34 cases)and non-death group(198 cases).Compared with the general data of the death group and the non-death group,Cox regression was used to analyze the influence of related indicators on the all-cause death of AHF patients.Results The levels of FT_(3) and left ventricular ejection fraction(LVEF)in the critical group were lower than those in the non-critical group.The levels of creatinine,BNP,and cTnI in the critical group were higher than those in the non-critical group,the differences were statistically significant(P<0.05).The comparison of New York Heart Association(NYHA)cardiac function grading between the two groups showed statistical significance(P<0.05).Multivariate logistic regression analysis showed that FT_(3),LVEF and creatinine were the influencing factors for the severity of elderly AHF after adjusting for age,sex and body mass index(BMI)(P<0.01).The area under the curve(AUC)predicted by FT_(3) of critical group was 0.719,95%CI:0.653-0.786,sensi

关 键 词：急性心力衰竭 危险分层 预后 低T_(3)综合征 游离三碘甲状腺原氨酸 

分 类 号：R541[医药卫生—心血管疾病]