射血分数正常的老年男性患者营养不良参数与血清氨基末端B型利钠肽前体水平升高的关系

Relationship between serum elevation of N-terminal pro-brain natriuretic peptide and malnutrition in very old male patients with normal ejection fraction

目的 探讨射血分数正常的高龄老年男性患者营养不良参数与血清氨基末端B型利钠肽前体（NT-proBNP）水平的相关性. 方法 入选2005年1月至2010年12月在解放军总医院就医的老年男性住院患者197例,年龄80-95岁,平均（85.4±9.7）岁.超声心动图采用胸骨旁左心室长轴切面测量并计算左心室射血分数.采用电化学发光免疫法测定血清NT-pro-BNP水平. 结果 营养不良患者较营养正常患者血清NT-proBNP增加,（1375.2±1891.7）ng/L比（711.9±1063.3）ng/L（P=0.006）.Pearson相关性分析结果显示,血红蛋白、血清白蛋白、血清前白蛋白和体质指数与血清NT-proBNP水平呈负相关（均P＜0.05）.多变量Logistic回归分析结果显示,仅血清前白蛋白（P=0.028）和体质指数（P=0.006）与血清NT-proBNP水平升高相关.受试者工作特征（ROC）曲线分析结果显示,营养不良参数能够预测血清NT-proBNP水平升高,体质指数ROC曲线下面积0.7（P=0.002）,预测敏感性为75.5％、特异性为54.4％;血红蛋白曲线下面积0.7（P=0.004）,预测敏感性为51.0％、特异性为70.2％;白蛋白曲线下面积0.6（P=0.036）,预测敏感性为38.8％、特异性为84.2％;前白蛋白曲线下面积0.6（P=0.002）,预测敏感性为89.8％、特异性为31.6％. 结论 射血分数正常的老年男性营养不良参数体质指数、血红蛋白、白蛋白和前白蛋白能用干预测血清NT proBNP水平的升高;体质指数、前白蛋白是血清NT proBNP水平升高的独立影响因素.

Objective To investigate the association between malnutrition parameters and serum N-terminal pro-brain natriuretic peptide （NT-proBNP） level in male patients aged ≥ 80 years with normal ejection fraction.Methods A total of 197 elderly male patients aged 80 95 years （average 85.4±9.7） were enrolled.Each patient received echocardiograms following admission,and ejection fraction was calculated.Serum concentrations of NT-proBNP were measured by electrochemiluminescence immunoassay.Multiple Logistic regression analyses and receiver operating characteristic （ROC） curves were used to assess the association between malnutrition parameters and serum level of NT-proBNP.Results Serum NT-proBNP level was higher in patients with malnutrition than in the controls [（711.9±1063.3） ng/L vs.（1375.2±1891.7） ng/L,P=0.006].Pearson correlation analysis showed that the malnutrition parameters such as body mass index （BMI）,blood hemoglobin,albumin and pre-albumin were negatively correlated with serum NT proBNP level （all P〈0.05）.Logistic regression analysis showed that BMI and serum pre albumin level were independently associated with serum NT-proBNP level elevation （P=0.028 and 0.006,respectively）.ROC curve analysis showed that the malnutrition parameters could predict the serum NT-proBNP level elevation.The area under the ROC curves for BMI,levels of blood hemoglobin,albumin and prealbumin in predicting serum NT proBNP level elevation was 0.7 （P=0.002）,0.7 （P=0.004）,0.6 （P=0.036）,0.6 P=0.002）,the sensitivity was 75.5%,51.0%,38.8%,89.8%,and the specificity was 54.4%,70.2 %,84.2% and 31.6 %,respectively.Conclusions The malnutrition parameters including BMI,blood hemoglobin,albumin and pre-albumin can predict serum NT-proBNP level elevation.BMI and serum pre-albumin level are independently associated with serum NT-proBNP level elevation in male patients aged ≥ 80 years with normal ejection fraction.