CPR后患者血清NT-proBNP和ST2以及CysC动态变化及与预后的相关性

The correlation between the dynamic changes of serum NT-proBNP,ST2,CysC and the prognosis of patients after CPR

目的探讨心脏骤停实施心肺复苏(CPR)后恢复自主呼吸心跳患者血清可溶性ST2(sST2)、N末端-脑钠肽前体(NT-proBNP)、胱抑素C(Cys-C)的动态变化及与患者预后的相关性。方法对南京医科大学附属无锡人民医院2017年1月-2021年12月心脏骤停且实施CPR后恢复自主呼吸心跳患者167例进行临床分析,根据患者28 d内是否存活出院分为生存组69例,死亡组98例。动态比较两组患者CPR时、复苏后不同时间的血清NT-proBNP、ST2、CysC水平,以患者术后24 h时三项指标绘制受试者工作特征(ROC)曲线分析预测患者结局的价值。采用logistic模型分析三项指标变化值与心脏骤停患者CPR后预后结局的关系。结果生存组CPR时、CPR 24 h后、CPR 48 h后NT-proBNP、sST2水平均显著低于死亡组,差异均有统计学意义(P均<0.05)。生存组CPR 24、48 h后CysC水平均显著低于死亡组,差异均有统计学意义(P均<0.05)。NT-proBNP预测患者不良结局的灵敏度为79.85%、特异度为76.48%、AUC值为0.813;sST2水平预测患者不良结局的灵敏度为86.57%、特异度为71.64%、AUC值为0.856;CysC水平预测患者不良结局的灵敏度为70.82%、特异度为64.11%、AUC值为0.764。Logistic回归模型结果显示,患者年龄≥65岁、CPR持续时间≥15 min、CPR 24 h后NT-proBNP≥438.15 ng/mL、CPR 24 h后sST2≥184.63μg/L、CPR 24 h后CysC≥3.18 pg/mL是心脏骤停CPR后预后不良的独立危险因素(P<0.05),CPR前患者心律类型为心室颤动/无脉性室速有利于患者的预后(P<0.05)。结论心脏骤停CPR成功的患者复苏后血清NTproBNP、ST2、CysC水平与患者预后结局关系密切,并且对于预测患者预后结局具有一定的临床价值。

Objective To investigate the dynamic changes of serum soluble ST2(sST2),N-terminal-brain natriuretic peptide(NT-proBNP),and cystatin C(Cys-C)in patients who resume spontaneous breathing and heartbeat after cardiopulmonary resuscitation(CPR)after cardiac arrest.And also to probe the above-mentioned indexes’correlations with such patients’prognoses.Methods A clinical study was conducted on 167 patients with cardiac arrest in Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2017 to December 2021 who had resumed spontaneous breathing and heartbeat after performing CPR.According to whether the patients were alive and discharged within 28 days,they were divided into survival group 69 cases and death group 98 cases.The serum NT-proBNP,ST2,and CysC levels of the two groups of patients during CPR and at different times after resuscitation were dynamically compared,and the receiver operating curve(ROC)was drawn using the three indicators at 24 hours after the patient’s resuscitation to analyze the value of predicting the patient’s outcome;The relationship between the changes of the three indicators and the prognostic outcome of patients with cardiac arrest after CPR was analyzed.Results The NT-proBNP and sST2 levels,during CPR,24 h after CPR,and 48 h after CPR of the patients in the survival group were significantly lower than those in the death group(P<0.05).The CysC levels,24 h and 48 h after CPR of patients in the survival group were significantly lower than those in the death group(P<0.05).NT-proBNP has a sensitivity of 79.85%,a specificity of 76.48%,and an AUC value of 0.813 for predicting adverse patient outcomes;sST2 has a sensitivity of 86.57%and specificity for predicting patient adverse outcomes71.64%,and an AUC value of 0.856;CysC level predicts the patient’s adverse outcome with a sensitivity of 70.82%,specificity of 64.11%,and an AUC value of 0.764.Logistic regression model results show that the patient≥65 years old,CPR duration≥15 min,NT-proBNP≥438.13 ng/mL after CPR 24 h,sST2≥184.63μg/L after CPR 24 h,CysC≥3.18 pg/mL after CPR 24 h were independent risk factors for poor prognosis after CPR in cardiac arrest(P<0.05).The ventricular fibrillation/pulseless ventricular tachycardia heart rhythm was beneficial to the prognosis of patients(P<0.05).Conclusion The levels of serum NT-proBNP,ST2 and CysC in patients with successful CPR after cardiac arrest were closely related to the prognostic outcome of patients,and had certain clinical value for predicting the prognostic outcome of patients.