缺血性心力衰竭患者N端脑钠肽前体与新发房颤的相关性研究

doi:10.16150/j.1671-2870.2024.03.009

摘要/Abstract

摘要：

目的：分析缺血性心力衰竭（心衰）患者的血浆N端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平，及其与患者新发心房颤动（房颤）间的关系。方法：本研究纳入120例射血分数降低（<40%）的窦性心律的缺血性心衰患者，分别在基线0 d、6个月和12个月测定其血浆NT-proBNP水平，并在入组时行超声心动图检查，于入组后1、3、6、12个月时进行24 h动态心电图检查，根据随访12个月中是否发生房颤，将患者分为房颤组（n=44）和无房颤组（n=76）。分析2组患者的临床资料和心动超声图资料，应用受试者操作特征（receiver operating characteristic, ROC）曲线，分析NT-proBNP检测对新发房颤的预测作用及其最佳临界值。采用多因素logistic回归分析NT-proBNP与缺血性心衰患者新发房颤间的关系。结果：在12个月的随访期间，缺血性心衰患者中新发房颤率为36.7%。与无房颤组相比，房颤组的纽约心功能分级、NT-proBNP水平（入组当天、6个月和12个月）、心动超声检查中二尖瓣口舒张早期/舒张晚期峰值速度比值（E/A）、二尖瓣口/二尖瓣环速度比值（E/E’）、肺动脉收缩压（pulmonary artery systolic pressure, PASP）、肺毛细血管楔嵌压(pulmonary capillary wedge pressure, PCWP）、左心房容量（left atrial volume, LAV）和左心房容量指数（left atrial volume index，LAVI）更高（P<0.05）。NT-proBNP与E/A、E/E’、PASP、PCWP、LAV和LAVI呈显著正相关（P<0.05)。ROC曲线显示，基线0 d的NT-proBNP水平对新发房颤的预测能力最强，临界值取NT-proBNP≥2 357.5 pg/mL时，其预测新发房颤的灵敏度为69%，特异度为83%，ROC曲线下面积为0.825（95%CI为0.722~0.924，P<0.001）。回归分析发现，仅NT-proBNP是缺血性心衰患者新发房颤的独立预测因子（OR=1.24，95%CI为1.08~1.43）(P=0.001）。结论：血浆NT-proBNP水平检测在预测缺血性心衰患者新发房颤中有一定的临床价值。

关键词: N端脑钠肽前体, 射血分数降低的心衰, 缺血性心肌病, 新发心房颤动

Abstract:

Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P<0.05). NT-proBNP levels demonstrated positive correlations with these echocardiographic parameters (P<0.05). ROC curve analysis identified a baseline NT-proBNP cutoff value of 2357 pg/mL as the most predictive of new-onset AF, with 69% sensitivity and 83% specificity (AUC = 0.825, 95% CI: 0.722-0.924, P<0.001). Logistic regression analysis further established NT-proBNP as the only independent predictive predictor of new-onset AF (OR = 1.24, 95% CI: 1.08-1.43, P=0.001). Conclusions Serum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.

Key words: N-terminal pro-brain natriuretic peptide, Heart failure with low ejection fraction, Ischemic cardiomyopathy, New-onset atrial fibrillation

中图分类号:

罗晓颖, 章安迪, 许燕, 吴立群, 戚文航. 缺血性心力衰竭患者N端脑钠肽前体与新发房颤的相关性研究[J]. 诊断学理论与实践, 2024, 23(03): 313-317.

LUO Xiaoying, ZHANG Andi, XU Yan, WU Liqun, QI Wenhang. Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(03): 313-317.

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参考文献 16

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Item	AF（+）（n=44）	AF（-）（n=76）	P value
Age（years）	62.3±10.8	56.1±12.4	0.698
Male（%）	33.3	32.9	0.611
BMI（kg/m²）	29.1±5.2	30.9±5.1	0.205
CHA₂DS₂-VAS_C score	3	2	0.634
DM（%）	42.1	45.7	0.470
HT（%）	50.8	48.3	0.391
NYHA class（%）
Ⅱ	43.2	65.8	0.005
Ⅲ	50.0	30.3	0.021
Ⅳ	6.8	3.9	0.051
Drugs（%）
Beta Blocker	75.4	73.1	0.755
ACEI or ARB	81.1	83.5	0.346
MRA	46.3	52.4	1.001
Ivabradin	13.2	14.7	0.528
Dogoxin	11.7	9.5	0.563
Diuretic	33.8	35.2	0.877
SBP（mmHg）	117.5±20.8	122.4±25.1	0.340
DBP（mmHg）	67.3±12.9	72.2±14.8	0.109
Heart rate（beats/min）	72	69	0.993
Hemoglobin（g/L）	9.2	10.3	0.765
Creatinin（μmol/L）	118	107	0.437
eGFR[mL/(min·1.73 m²)]	55	62	0.494
ALT（U/L）	52	50	0.910
AST（U/L）	49	51	0.935

Item	AF(+)（n=44）	AF(-)（n=76）	P value
LVEDV(mm)	69.3±4.6	68.2±4.9	0.841
LVESV(mm)	59.8±3.8	58.9±5.1	0.918
Interventricular septal thickness（mm）	8	9	0.507
LVEF(%)	35.5±3.0	38.1±1.9	0.319
E/A	2.4±1.0	1.3±0.7	0.006
E/E’	20.3±12.0	8.7±4.1	0.001
PASP（mmHg）	54.4±9.2	33.0±4.5	<0.001
PCWP(mmHg)	20.1±4.4	12.0±4.7	<0.001
LAV(mL)	80.8±27.6	63.1±15.8	0.005
LAVI(ml/m²)	41.5±13.2	30.5±7.0	0.002

Time	NT-proBNP (pg/mL）		P value
Time	AF（+）（n=44）	AF(-)(n=76)	P value
0 mon	2571.3±403.6	1881.6±362.6	<0.001
6 mon	2612.9±577.0	2079.2±395.6	0.005
12 mon	2733.5±499.7	2201.4±411.3	0.007