N-端心房利钠肽与N-端脑利钠肽对预测左室收缩功能障碍的价值

Predictive value of N-terminal atrial natriuretic peptide and N-terminal brain natriuretic peptide for left ventricular systolic dysfunction

摘要:

目的比较N-端心房利钠肽(心钠素NT-proANP)和N-端脑钠肽(NT-proBNP)对左室收缩功能障碍(LVSD)预测效率,依据二者特性确定适用范围并界定最佳下限(cut-off)值。方法入选心血管病患者380例(病例组),依据左室射血分数(LVEF)将患者划分为LVSD组(LVEF≤40%,n=90)及非LVSD组(LVEF>40%,n=290)。另选136名健康体检者作为对照组。超声心动图测定LVEF;ELISA法测定血浆NT-proANP和NT-proB-NP浓度。描记NT-proANP和NT-proBNP预测左室收缩功能障碍受试者工作特征(ROC)曲线。依据年龄(以65岁为分界)、性别及原发心血管疾病种类划分亚组,分别描记各组患者NT-proANP和NT-proBNP预测左室收缩功能障碍ROC曲线;确定最佳cut-off值。结果病例组血浆NT-proANP和NT-proBNP浓度均显著高于对照组log(NT-proANP):(3.30±0.41)vs(2.98±0.16),P<0.01;log(NT-proBNP):(2.71±0.30)vs(2.49±0.13),P<0.01。NT-proANP和NT-proBNP对不同程度LVSD(LVEF≤40%或LVEF≤30%)患者诊断ROC曲线下面积(AUC)均大于0.73(P<0.01);对LVEF≤40%的患者,NT-proANPAUC大于NT-proBNP(0.820vs0.738);对LVEF≤30%的患者,NT-proANPAUC明显小于NT-proBNP(0.853vs0.877)。根据各亚组ROC曲线确定cut-off值,NT-proANP为1676.92pmol/L时对各组LVSD预测敏感度88.9%～100%;特异度14.0%～58.7%;阳性预测值9.04%～30.04%;阴性预测值96.96%～98.77%。NT-proBNP为417.37pmol/L时,敏感度77.8%～94.4%;特异度10.0%～55.8%;阳性预测值7.07%～48.88%;阴性预测值94.46%～98.87%。结论 NT-proBNP与NT-proANP均能够反映心力衰竭高危人群心脏功能状态,可作为LVSD的诊断指标,对于LVEF≤40%的预测,NT-proANP效果优于NT-proBNP,有助于早期发现LVSD患者。?更多

Abstract:

Objective To compare the performance of N-terminal proatrial natriuretic peptide (NT-proANP) and N-terminal probrain natriuretic peptide (NT-proBNP) in identifying left ventricular systolic dysfunction (LVSD) in patients at high risk for heart failure,and to determine their optimal ranges and cut-off values.Methods A total of 380 patients with cardiovascular disease were enrolled (case group).Based on left ventricular ejection fraction (LVEF),they were divided into LVSD group (LVEF≤40%,n=90) and non-LVSD group (LVEF>40%,n=290).Another 136 healthy people were taken as controls.LVEF was measured by echocardiography.Plasma concentrations of NT-proANP and NT-proBNP were measured by ELISA.Patients were further grouped according to LVEF,age,gender and primary cardiovascular diseases.The ability of NT-proANP and NT-proBNP to predict LVSD was examined from the area under the receiver operating characteristic (ROC) curve.And the cut-off values were determined.Results The plasma concentrations of NT-proANP and NT-proBNP were much higher in case group than in healthy controls log(NT-proANP): (3.30±0.41) vs (2.98±0.16),P<0.01;log(NT-proBNP): (2.71±0.30) vs (2.49±0.13),P<0.01.In case group,the area under ROC curve (AUC) for NT-proANP and NT-proBNP was at least 0.73(P<0.01).The AUC was larger for NT-proANP than NT-proBNP in patients with LVEF ≤ 40% (0.820 vs 0.738),and was smaller for NT-proANP than NT-proBNP in patients with LVEF ≤ 30% (0.853 vs 0.877).Using a cut-off value of 1676.92pmol/L,NT-proANP had a sensitivity of 88.9%-100.0%,specificity of 14.0%-58.7%,positive predictive value (PPV) of 9.04%-30.04%,and negative predictive value(NPV) of 96.96%-98.77%.Using a cut-off value of 417.37pmol/L,NT-proBNP had the sensitivity of 77.8%-94.4%,specificity of 10.0%-55.8%,PPV of 7.07%-48.88%,and NPV of 94.46%-98.87%.Conclusions Both NT-proANP and NT-proBNP have good performance in reflecting heart function of patients at high risk for heart failure,and both can be used to diagnose LVSD.For patients with LVEF≤40%,NT-proANP seems to have a better predictive value than NT-proBNP.