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中国全科医学 ›› 2018, Vol. 21 ›› Issue (18): 2179-2184.DOI: 10.3969/j.issn.1007-9572.2018.00.165

所属专题： 心血管最新文章合辑； 脑健康最新研究合辑

• 专题研究 • 上一篇    下一篇

血浆脑钠肽联合氨基末端脑钠肽前体与常规心功能指标对心脏外科瓣膜置换术患者预后的预测价值研究

谭今1，于涛1，黄克力1*，刘科1，杨倩2   

  1. 1.610072四川省成都市，四川省人民医院心脏外科　2.310009浙江省杭州市，浙江大学医学院附属第二医院超声诊断科
    *通信作者：黄克力，主任医师；E-mail：18980051097@163.com
  • 出版日期:2018-06-20 发布日期:2018-06-20
  • 基金资助:
    浙江省教育厅科研计划项目（Y200803689）

Plasma BNP Combined with NT-proBNP versus Routine Cardiac Function Parameters for Predicting Postoperative Prognosis in Patients with Heart Valve Replacement Surgery：a Comparative Study　

  1. 1.Department of Cardiac Surgery，Sichuan Provincial People's Hospital，Chengdu 610072，China
    2.Department of Ultrasound Diagnosis，the Second Affiliated Hospital of Zhejiang University School of Medicine，Hangzhou 310009，China
    *Corresponding author：HUANG Ke-li，Chief physician；E-mail：18980051097@163.com
  • Published:2018-06-20 Online:2018-06-20

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摘要： 目的　评价血浆脑钠肽（BNP）、氨基末端脑钠肽前体（NT-proBNP）对心脏外科瓣膜置换术患者预后情况的预测能力及临床应用价值，并与常规心功能指标对心脏外科瓣膜置换术患者预后的预测价值进行比较。方法　选取2014年8月—2016年2月四川省人民医院心脏外科心瓣膜病患者138例为研究对象，均由风湿性心脏病引起。记录患者一般资料及检测指标；于患者出院1个月后开始随访，随访时间为18个月，根据随访结局分为预后良好组与预后不良组。结果　随访的138例患者中，删失14例，其余124例中预后良好73例（预后良好组），预后不良51例（预后不良组），患者不良预后发生率为41.1%（51/124）。多因素Cox回归分析显示左心室舒张末期内径（LVEDD）（RR=1.578，P=0.039）、血浆BNP（RR=1.935，P=0.013）和NT-proBNP（RR=2.346，P<0.001）是心脏外科瓣膜置换术患者不良预后的影响因素；LVEDD、血浆BNP和NT-proBNP预测心脏外科瓣膜置换术患者预后的ROC曲线下的面积分别为0.774、0.814、0.800，血浆BNP联合NT-proBNP预测心脏外科瓣膜置换术患者预后的ROC曲线下面积为0.856，特异度为78.9%，灵敏度为83.6%。结论　血浆BNP和NT-proBNP对心脏外科瓣膜置换术患者预后有较好的预测能力，有望作为临床评估患者术后预后风险的指标之一。

关键词: 心脏瓣膜假体植入, 利钠肽, 脑, 氨基末端脑钠肽前体, 预后

Abstract: Objective　To evaluate the clinical application value of plasma brain natriuretic peptide（BNP） combined with N-terminal prohormone of brain natriuretic peptide（NT-proBNP） based on comparing its value for predicting postoperative prognosis of patients with heart valve replacement surgery with that of routine cardiac function parameters.Methods　We enrolled 138 patients with rheumatic heart disease undergoing heart valve replacement surgery from Department of Cardiac Surgery，Sichuan Provincial People's Hospital from August 2014 to February 2016 and collected their baseline characteristics，measurement levels of plasma BNP，NT-proBNP and routine cardiac function parameters at 1 week after surgery.They were divided into good prognosis group and poor prognosis group based on the conditions during a 18 month-follow-up initiated at 1 month after discharge.Results　Except 14 were lost to follow-up，the other 124 completing the follow-up were included in the final analysis.73 of them were found with good prognosis（good prognosis group），and other 51 with poor prognosis（poor prognosis group），the rate of poor prognosis was 41.1%（51/124）.Multivariate Cox regression analysis showed that left ventricular end diastolic diameter（LVEDD）（RR=1.578，P=0.039），plasma BNP（RR=1.935，P=0.013） and NT-proBNP（RR=2.346，P<0.001） were the associated factors of poor prognosis after heart valve replacement surgery.For predicting the patient prognosis，the AUC of LVEDD，plasma BNP，and NT-proBNP were 0.774，0.814，and 0.800，respectively，and the AUC of plasma BNP combined with NT-proBNP was 0.856，with a corresponding specificity of 78.9%，and a sensitivity of 83.6%.Conclusion　As its predictive accuracy for the prognosis of patients undergoing cardiac valve replacement surgery，plasma BNP combined with NT-proBNP is expected to be used as one of the clinical parameters for postoperative prognosis prediction of such patients.

 

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