N末端B型钠尿肽原和大内皮素-1对严重心力衰竭患者的预后作用及其与心血管病关系的研究

来源 :中华检验医学杂志 | 被引量 : 0次 | 上传用户:cox_7261
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的探讨两检测指标血浆 N 末端 B 型钠尿肽原(NT-proBNP)和大内皮素-1(bigET-1)之间,两指标与心力衰竭(心衰)伴心房颤动(Af)、心衰伴肺动脉高压(PAH)等心血管病的关系,以及两指标对严重心衰患者半年期预后的预测价值。方法阜外医院严重心衰患者132人,测定他们入院时的血浆 LgNT-proBNP 和 big ET-1浓度(酶联免疫法)以及纽约心脏病协会心功能分级(NYHA分级)、左室射血分数(LVEF)等指标。随访观察患者出院后半年内心血管事件的再发生。结果严重心衰患者132人(NYHAⅢ-Ⅳ级,年龄24~80岁,男83人,女49人,LVEF 13%~66%),其血浆 LgNT-proBNP 与 big ET-1呈正相关(r=0.414,P=0.000)。有、无 Af 的两组间 big ET-1水平比较差异有统计学意义(P=0.022);有、无 PAH 的两组间 LgNT-proBNP 和 big ET-1浓度差异均有统计学意义(P=0.019,P=0.000)。以 big ET-1诊断严重心衰患者伴 PAH 的 ROC 曲线下面积为0.74(95%CI:0.65~0.83,P=0.000),以4.09 fmol/ml 为 big ET-1诊断心衰伴 PAH 的 cutoff 值时,灵敏度为71.4%,特异度67.8%。经过6个月的随访,132例严重心衰患者中,有20例发生心源性死亡(15.2%),有25例因心脏原因再住院(18.9%)。Cox 比例风险模型分析显示,包括了年龄、性别、NYHA 分级、LVEF、LgNT-proBNP、big ET-1等指标后,只有 NT-proBNP 是独立的心脏事件再发生的预后因素,RR 为5.30(95%CI:2.07~13.55,P=0.001)。Logistic 回归显示也只有 NT-proBNP 是独立的心源性死亡发生的危险因素,OR 为13.67(95%CI:2.59~72.25,P=0.002)。big ET-1、LVEF、NYHA分级等指标对严重心衰患者心血管事件再发生没有预后价值。结论 NT-proBNP 与 big ET-1间可能存在相互作用;严重心衰伴 Af 的患者可能有内皮细胞损伤和功能异常;big ET-1可辅助诊断严重心衰患者伴发 PAH;NT-proBNP 可用于严重心衰患者半年期预后的评估,而 big ET-1没有此预测价值。 Objective To investigate the correlation between plasma NT-proBNP and bigET-1 and between two indexes of heart failure (CHF) and atrial fibrillation (AF) And pulmonary hypertension (PAH) and other cardiovascular diseases, as well as two indicators of prognosis in patients with severe heart failure prognostic value. Methods 132 patients with severe heart failure in Fuwai Hospital were enrolled in this study. Plasma concentrations of LgNT-proBNP and big ET-1 (enzyme-linked immunosorbent assay) and NYHA classification (NYHA classification), left ventricular ejection fraction (LVEF) and other indicators. Follow-up observation of patients with cardiovascular events within six months after discharge recurrence. Results There were 132 patients with severe heart failure (NYHAⅢ-Ⅳ grade, aged from 24 to 80 years, 83 men and 49 women, LVEF 13% to 66%). The plasma LgNT-proBNP was positively correlated with big ET- 0.414, P = 0.000). There were significant differences in the levels of big ET-1 between the two groups with and without Af (P = 0.022). There was a significant difference in the concentrations of LgNT-proBNP and big ET-1 between the two groups = 0.019, P = 0.000). The area under the ROC curve of patients with severe heart failure diagnosed with big ET-1 was 0.74 (95% CI: 0.65-0.83, P = 0.000). The cutoff of PAH with big ET-1 at 4.09 fmol / ml Value, the sensitivity was 71.4%, the specificity of 67.8%. After 6 months of follow-up, of 132 patients with severe heart failure, 20 developed cardiogenic death (15.2%) and 25 received cardioversion (18.9%). Cox proportional hazards model analysis showed that only NT-proBNP was an independent predictor of reoccurrence of cardiac events, including age, gender, NYHA class, LVEF, LgNT-proBNP and big ET-1. RR was 5.30 % CI: 2.07 ~ 13.55, P = 0.001). Logistic regression also showed that only NT-proBNP was a risk factor for independent cardiac death with an OR of 13.67 (95% CI: 2.59 to 72.25, P = 0.002). Big ET-1, LVEF, NYHA classification and other indicators of cardiovascular events in patients with severe heart failure recurrence no prognostic value. Conclusions There may be interaction between NT-proBNP and big ET-1; patients with severe heart failure and Af may have endothelial cell injury and dysfunction; big ET-1 may help diagnose patients with severe heart failure accompanied by PAH; NT-proBNP is available The prognosis of patients with severe heart failure in the assessment of half a year, while the big ET-1 does not have this predictive value.
其他文献
初步计算昆明地区孕妇夫妇及新生儿葡萄糖 - 6 -磷酸脱氢酶基因六种基因突变类型 (G1376T ,G1388A ,A95G ,C10 2 4T ,C5 92T及G392T突变 )的频率 .应用突变特异性扩增系统 (A
目的 通过检测系统性红斑狼疮 (SLE)患者血清白细胞介素 4(IL 4)、γ 干扰素(IFN γ)的水平 ,探讨T淋巴细胞亚群与SLE发病的关系。方法 采用酶联免疫吸附法测定SLE患者和
目的研究骨性反牙合的矫治方法与效果.方法对9例骨性反牙合儿童,采用上颌前方牵引装置进行矫治,力量300~500 g侧,方向向下向前与牙合平面呈20°角.结果 9例患儿均取得满意外形
甲醛甲酚是口腔科常用根管消毒剂,有较好的消毒防腐作用,作者接诊1例因使用甲醛甲酚消毒根管而引起广泛血管神经性水肿的过敏反应病例,报告如下:患者,女,20岁,因|6深龋,穿髓,
目的检测孕妇血浆胎儿 DNA 的父源性东南亚缺失型α地中海贫血1(SEAα地贫1)基因突变,进行无创伤性产前基因诊断。方法应用荧光聚合酶链反应(PCR)和基因扫描方法分析10例孕妇
目的 研究LrrG蛋白不同片段的免疫原性及保护功能,为B族链球菌(GBS)蛋白疫苗及组分疫苗的研究奠定基础.方法 采用生物信息学的方法预测LrrG蛋白的抗原表位,结合该蛋白的一级
目的探讨高脂血症性重症急性胰腺炎(HL-SAP)综合治疗的原则与措施。方法回顾性分析1996年1月至2000年12月和2001年1月至2006年8月两阶段收治的54例 HL-SAP 患者的临床资料。
目的:探讨连续性肾脏替代治疗(CRRT)置换液或透析液糖浓度对患者血糖的影响.方法:在23例急性肾功能衰竭(ARF)的患者中,分别采用高糖和低糖置换液或透析液行CRRT,高糖组8例使
目的 分析类鼻疽影像表现,以提高对其认识,减少误诊.方法 选择经血液、脓液及痰液培养证实的类鼻疽患者12例,均做了X线摄影,9例做了CT、2例做了超声检查.结果 12例中有10例出
目的 探讨骨化三醇加碘油对MHCC97肝癌细胞增殖能力的影响及其对肝细胞生长因子(HGF)及受体c-met表达的调控作用.方法 分别用10-6~10-9mol/L的骨化三醇、0.5%的碘油+10-6 mol/