摘要
目的评价入院时血浆N末端B型利钠肽原（NT-proBNP）在预测失代偿的收缩功能不全性心衰患者住院病死率中的价值。方法连续检测366例急性失代偿的收缩功能不全性心衰患者入院时的血浆NT-proBNP浓度，依据出院时情况分为存活组和死亡组，比较两组间血浆NT-proBNP浓度的差异。通过ROC曲线下面积评价血浆NT-proBNP在判断住院死亡中的意义并找出其切点。比较血浆NT-proBNP浓度高于切点和低于切点者的住院病死率。并应用多元回归分析判断NT-proBNP是否为心衰患者住院死亡的独立预测因素。结果366例失代偿的收缩功能不全性心衰患者中有19例住院期间死亡，死亡组的血浆NT-proBNP浓度显著高于存活组[3970（3452，6934）pmoL／L比2340（1132，4002）pmol／L，P〈0．01]。血浆NT-proBNP判断住院死亡的ROC曲线下面积是0．762（95％CI：0．657-0．857，P〈0．01）。根据ROC曲线，通过切点定量对比发现NT-proBNP在3300-3700pmol／L时判断死亡的敏感性、特异性和准确性均维持在70％左右，阳性和阴性预测值分别恒定在10％和97％以上。当将血浆NT-proBNP判断住院死亡的切点值定为3500pmol／L时，大于或等于此值时预测死亡的敏感性、特异性和准确性分别为73．7％、66．9％和67．6％，阴性预测值高达98％。大于此值者住院病死率（10．9％）约是小于此值者（2．1％）的5倍（P〈0．01）。回归分析表明，血浆NT-proBNP、心率、房颤和NYHA心功能分级是心衰患者住院死亡的独立预测因素（P〈0．01或0．05），以NT-proBNP的作用最强。结论人院时血浆NT-proBNP是急性失代偿收缩性心衰患者住院死亡的最强的独立预测因素。
Objective To evaluate the value of NT-proBNP in predicting in-hospital mortality in patients with decompensated systolic heart failure. Methods Plasma NT-proBNP levels within 24 hours of admission were obtained in 366 patients with decompensated systolic heart failure. The levels were compared between dying patients in hospital and survival patients at discharge. ROC analyses were performed to evaluate if NT-proBNP was a predictor for in-hospital mortality and identify the optimal NT-proBNP cut-off point for predicting in-hospital mortality. A binary logistic regression analysis was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality. Results 19 cases of the 366 patients died in hospital. NT-proBNP levels of the dying cases were much higher than those of the survivals 3970 （3452, 6934） pmol/L vs 2340 （1132, 4002） pmol/L respectively, P 〈 0. 01 ）. ROC analysis of NT-proBNP to predict in-hospital mortality had an area under the curve （AUC） of 0. 762 （95% CI：O. 657-0. 857, P 〈0. 01 ）, the optimal NT-proBNP cut-off point for predicting in-hospital mortality was 3500 pmol/L with a sensitivity of 73.7%, a specificity of 66. 9%, an accuracy of 67.6% and a negative predictive value of 97.9%. Patients whose NT-proBNP levels were equal or more than 3500 pmoLZL had an in-hospital mortality of 10. 9%, compar with 2. 1% in those NT-proBNP levels less than 3500 pmoL/L （P 〈0. 01 ）. Binary logistic regression analysis demonstrated that NT-proBNP was an independent predictor for in-hospital mortality in patients with decompensated systolic heart failure （P 〈 0. 01 ）. Conclusion Admission plasma NT-proBNP level is an independent predictor for in-hospital mortality in patients with decompensated systolic heart failure. The ootimal NT-oroBNP cut-off point for oredicting in-hosoital mortality is 3500 pmoL/L.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第28期1955-1959,共5页
National Medical Journal of China
基金
北京市科委重大科技支撑项目（D0906004040291）
关键词
心力衰竭
充血性
利钠肽
脑
医院死亡率
Heart failure, congestive
Natriuretic peptide,brain
Hospital mortality
