血浆TMAO联合NT-proBNP对于缺血性心力衰竭患者预后及住院时长的预测价值  

Predictive value of plasma TMAO combined with NT-proBNP on the prognosis and length of hospitalization of patients with ischemic heart failure

作　　者：丘伟达 肖小菊 夏爽 高志平 黎励文 Qiu Weida;Xiao Xiaoju;Xia Shuang;Gao Zhiping;Li Liwen(Department of Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Second School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China;Concord Medical Center,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省医学科学院广东省人民医院广东省心血管病研究所心血管内科,广州510080 [2]南方医科大学第二临床医学院临床医学系,广州510515 [3]广东省医学科学院广东省人民医院协和医疗中心,广州510080

出　　处：《中华心血管病杂志》2022年第7期684-689,共6页Chinese Journal of Cardiology

基　　金：广东省冠心病防治重点实验室项目(Y0120220151)。

摘　　要：目的:评估血浆氧化三甲胺(TMAO)联合N末端B型利钠肽原(NT-proBNP)对缺血性心力衰竭(IHF)患者预后的预测价值,及其与患者住院时长和费用的相关性。方法:该研究为诊断性试验。连续入选2016年3月至2020年12月在广东省人民医院心内科住院的IHF患者,根据TMAO及NT-proBNP水平将患者分为3组,即低TMAO+低NT-proBNP组、高TMAO或高NT-proBNP组和高TMAO+高NT-proBNP组。通过电子病历系统收集患者的基线临床资料。通过电话进行随访,随访时间=死亡日期(或最后一次随访日期)-出院日期,以全因死亡作为观察终点。采用Kaplan-Meier生存分析分析各组患者的全因死亡率,多因素Cox回归模型计算各组患者的死亡风险比(HR),受试者工作特征(ROC)曲线评估TMAO联合NT-proBNP对IHF患者全因死亡的预测价值,Spearman相关分析评估TMAO及NT-proBNP水平与住院时长、住院费用的相关性。结果:研究最终入选患者189例,男性157例(83.1%),年龄(64.0±10.5)岁,其中低TMAO+低NT-proBNP组50例、高TMAO或高NT-proBNP组89例、高TMAO+高NT-proBNP组50例。随访中位时间3.0年,共70例(37.0%)患者死亡,其中高TMAO+高NT-proBNP组27例(54.0%)、高TMAO或高NT-proBNP组有29例(32.6%)、低TMAO+低NT-proBNP组有14例(28.0%)。Kaplan-Meier生存分析结果显示,三组间全因死亡率差异有统计学意义(log-rank P<0.001)。多因素Cox回归分析结果显示,校正了患者的一般情况、既往史、入院病因、实验室及彩色超声心动图检查结果、住院治疗情况后,高TMAO+高NT-proBNP组患者的全因死亡风险仍为最高(HR=3.11,95%CI 1.53~6.31,P<0.001)。ROC曲线分析结果显示TMAO联合NT-proBNP对于IHF患者全因死亡有良好的预测价值(AUC=0.727,95%CI 0.640~0.813,敏感度为55.0%,特异度为83.1%)。Spearman相关分析结果显示,血浆TMAO联合NT-proBNP水平与IHF患者住院时长呈正相关(r=0.191,P=0.009),与住院费用未见相关性(r=0.030,P=0.686)。结论:TMAO联合NT-proBNObjective To explore the value of the assessment of plasma trimethylamine N-oxide(TMAO)combined with N-terminal pro-B-type natriuretic peptide(NT-proBNP)on predicting the all-cause mortality,length of hospitalization,and hospital cost in ischemic heart failure(IHF)patients.Methods This prospective cohort study included 189 patients(157 males,mean age(64.0±10.5)years)with a left ventricular ejection fraction<45%caused by coronary artery disease,who hospitalized in our department from March 2016 to December 2020.Baseline data,including demographics,comorbid conditions and laboratory examination,were analyzed.The cumulative rate of all-cause mortality was evaluated using the Kaplan-Meier method and compared between the groups according to the log-rank test.Relative risks were reported as hazard ratios(HR)and 95%confidence interval(95%CI)calculated using the Cox proportional-hazards analysis,with stepwise adjustment for covariables.Spearman correlation analysis was then performed to determine the relationship between TMAO combined with NT-proBNP and length of hospitalization and hospital cost.Results There were 50 patients in the low TMAO+low NT-proBNP group,89 patients in high TMAO or high NT-proBNP group,50 patients in high TMAO+high NT-proBNP group.The mean follow-up period was 3.0 years.Death occurred in 70 patients(37.0%),27 patients(54.0%)in high TMAO+high NT-proBNP group,29 patients(32.6%)in high TMAO or high NT-proBNP group and 14 patients(28.0%)in low TMAO+low NT-proBNP group.TMAO,in combination with NT-proBNP,improved all-cause mortality prediction in IHF patients when stratified as none,one or both biomarker(s)elevation,with the highest risk of all-cause mortality in high TMAO+high NT-proBNP group(HR=3.62,95%CI 1.89-6.96,P<0.001).ROC curve analysis further confirmed that TMAO combined with NT-proBNP strengthened the prediction performance on the risk of all-cause death(AUC=0.727(95%CI 0.640-0.813),sensitivity 55.0%,characteristic 83.1%).Spearman correlation analysis showed that IHF patients with high TMAO

关 键 词：心力衰竭 利钠肽 脑 预后 氧化三甲胺 

分 类 号：R541.6[医药卫生—心血管疾病]