摘要
目的探讨血N末端B型利钠肽原(NT-proBNP)水平对肥厚型心肌病(HCM)远期预后的预测价值。方法回顾性收集阜外医院2009年10月至2013年12月入院临床确诊为HCM的患者,且满足年龄≥16岁、NT-proBNP检查结果完整,研究最终纳入患者831例。根据NT-proBNP水平将入选者分为3组,即NT-proBNP〈860 pmol/L(n=276), 860 pmol/L≤NT-proBNP≤1 905 pmol/L(n=278),NT-proBNP〉1 905 pmol/L(n=277)。收集入选者相关基线资料、实验室检查结果和超声心动图检查结果。研究终点为全因死亡和心脏移植联合终点。随访截止时间为2016年12月。利用单因素和多因素Cox回归分析探索NT-proBNP对HCM患者远期预后的影响。生存分析采用Kaplan-Meier法和log-rank检验。结果本研究随访(53.3±15.4)个月,期间共37例患者死亡,2例患者进行了心脏移植术,总事件率为4.5%(37/831)。NT-proBNP〈860 pmol/L组中的事件率为1.4%(4/276),860 pmol/L≤NT-proBNP≤1 905 pmol/L组的事件率为4.0%(11/278),NT-proBNP〉1 905 pmol/L组的事件率为7.9%(22/277),三组间事件率差异有统计学意义(χ2=14.810,P〈0.01)。以全因死亡及心脏移植作为联合终点的单因素和多因素Cox回归分析结果显示,在校正了包括左心室射血分数、心房颤动病史、心脏结构改变情况等影响HCM预后的因素后,年龄(HR 1.066,95%CI 1.027~1.107)及NT-proBNP(HR 1.026,95%CI 1.010~1.042)均是HCM预后的独立危险因素。三组中,NT-proBNP〈860 pmol/L组的生存率最高,NT-proBNP〉1 905 pmol/L组生存率最低(χ2=14.169,P〈0.01)。结论NT-proBNP升高是HCM患者全因死亡和心脏移植联合终点事件的独立危险因素,NT-proBNP对HCM患者的远期预后具有良好的预测价值。
ObjectiveTo determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on predicting the long-term outcome of patients with hypertrophic cardiomyopathy (HCM) .MethodsNT-proBNP was measured in 831 consecutive patients with HCM at Fuwai Hospital from October 2009 to December 2013 and patients were followed up clinically for (53.3±15.4) months. Patients were divided into 3 groups according to NT-proBNP values: NT-proBNP〈860 pmol/L (n=276) , 860 pmol/L≤NT-proBNP≤1 905 pmol/L (n=278) , NT-proBNP〉1 905 pmol/L (n=277) . The related baseline data, laboratory examination and echocardiographic results were compared among groups. The primary endpoints of this study were all-cause mortality and cardiac transplantation. Cox proportional hazards model was used to estimate hazard ratio (HR) . Kaplan-Meier analysis was used to evaluate the survival status of patients among the 3 groups.ResultsDuring a median follow-up of (53.3±15.4) months, all-cause mortality or cardiac transplantation occurred in 37 patients (4.5%) , event rate was 1.4% (4/276) , 4.0% (11/278) and 7.9% (22/277) in patients with NT-proBNP〈860 pmol/L, 860 pmol/L≤NT-proBNP≤1 905 pmol/L and NT-proBNP〉1 905 pmol/L, respectively. Multivariable Cox regression analysis identified that age (HR 1.066, 95%CI 1.027-1.107) and NT-proBNP (HR 1.026, 95% CI 1.010-1.042) were independent predictors of all-cause mortality or cardiac transplantation. Among the 3 groups, the survival rate of the NT-proBNP〈860 pmol/L group was the highest,and that of the NT-proBNP〉1 905 pmol/L group was the lowest (P〈0.01) .ConclusionsThe level of NT-proBNP provides clinically relevant information for long-term adverse events risk stratification in patients with HCM.
作者
孟祥彬
王文尧
张阔
祁雨
安仕敏
王思远
郑济林
于钦军
唐兵
吴荣
王水云
高传玉
唐熠达
Meng Xiangbin;Wang Wenyao;Zhang Kuo;Qi Yu;An Shimin;Wang Siyuan;Zheng Jilin;Yu Qinjun;Tang Bing;Wu Rong;Wang Shuiyun;Gao Chuanyu;Tang Yida(Department of Cardiology,Coronary Heart Disease Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;不详)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2018年第3期192-197,共6页
Chinese Journal of Cardiology
基金
首都临床特色应用研究重点课题(Z151100004015175)
北京市自然科学基金(7152123)
关键词
心肌病
肥厚性
预后
死亡率
心脏移植
N末端B型利钠肽原
Cardiomyopathy, hypertrophic
Prognosis
Mortality
Heart transplantation
N-terminal pro-B-type natriuretic peptide
