NT—proBNP检测对老年慢性病患者5年内死亡风险评估的价值

The significance of serum NT-proBNP determination for the death risk evaluation in elderly patients with chronic disease in five years

目的探讨氨基末端B型钠尿肽原（NT—proBNP）对老年慢性病患者5年内死亡风险评估的价值。方法将765例老年慢性病患者[（冠心病（136例）、高血压病（76例）、慢性阻塞性肺疾病（86例）、2型糖尿病（75例）、脑梗死（76例）、冠心病合并高血压病（73例）、冠心病合并慢性阻塞性肺疾病（71例）、冠心病合并糖尿病（61例）、冠心病合并脑梗死（51例）、三种疾病并存者（60例）]按随访期内病情转归情况分为生存组（312例）和死亡组（453例）。采用双向侧流免疫法检测所有入选患者和88例健康对照者血清NT—proBNP水平。所有患者随访5年，观察随访期间发生的死亡事件。对资料进行统计分析。结果各慢性疾病死亡组NT—proBNP水平均明显高于其生存组（P〈0．01），死亡患者与生存患者年龄、男性比例差异无统计学意义（P〉0．05）；各慢性疾病死亡组血清NT—proBNP水平、患者年龄和男性比例差异均无统计学意义（P〉0．05）。各不同生存时间死亡组患者之间血清NT-proBNP水平比较差异有统计学意义（P〈0．01），且明显高于生存组和对照组（P〈0．01）；随患者生存时间减少，血清NT—proBNP水平逐步升高，NT—proBNP水平与随访期内患者生存时间呈负相关（r=-0．369，P=0．00）。根据ROC曲线选取NT-proBNP为1499．50ng／L作为预测老年慢性病患者5年内死亡的临界值，可获最佳诊断价值。Kaplan-Meier曲线分析表明，不同NT-proBNP水平组患者5年内生存率差异有统计学意义（P〈0．01），随NT-proBNP水平升高，患者生存率逐步降低。结论血清NT-proBNP水平对不同老年慢性病患者死亡风险均有预测价值，是老年慢性病患者死亡发生的独立危险因素；且血清NT—proBNP水平与老年慢性病患者5年内生存率及生存时间密切相关，可作为老年慢性病患者危险分层的监测指标。

Objective To explore the significance of serum N- terminal pro-B-type natriuretie peptide （NT-proBNP） for the death risk evaluation in elderly patients with chronic disease in five years. Methods A total of 765 elderly patients with chronic disease [ 136 patients with coronary heart disease （CHD）, 76 patients with hypertension disease （HD）, 86 patients with chronic obstructive pulmonary disease （COPD）, 75 patients with Type 2 diabetic mellitus （T2DM）, 76 patients with cerebral infarction （CI） ,73 patients with coronary heart disease combined with hypertension, 71 patients with coronary heart disease combined with chronic obstructive pulmonary disease, 61 patients with coronary heart disease combined with diabetic, 51 patients with coronary heart disease combined with cerebral infarction, and 60 patients with three comorbidityl were classified into the survival group （312 cases） and the death group （453 cases） according to disease prognosis. The serum NT-proBNP levels of 88 healthy controls and 765 elderly patients with chronic disease were determined by bi-directional lateral flow immunoassay. The death events were followed up and observed for an average of 5 years. The results were analyzed statistically. Results The serum NT-proBNP levels in the death group with various diseases were significantly higher than the survival group （P 〈 0. 01 ）, the patients age and the proportion of male in the death group and the survival group had no significant difference （P 〉 0. 05）. The serum NT-proBNP levels, the patiet＇s age and the Proportion of male in the death group with various elderly chronic diseases had no statistical significance （ P 〉 0.05 ）. The serum NT-proBNP levels in the death group with various elderly chronic diseases had no statistical sig-nificance （P 〉0. 05） ,and were significantly higher than the survival group （P 〈0. 01 ）. The patient＇s age and the proportion of male in the death group and the survival group had no significant difference （ P 〉 0. 05）. The serum NT-proBNP levels in the death group in the different periods had statistical significance （P 〈 0. 01 ）, and were significantly higher than the survival group and healthy control group （P 〈 0. 01 ）. The more shorter of the survival time was, the higher the serum NT- proBNP leve was. The serum NT-proB- NP levels were negatively correlated with the survival time of the patients （ r = -0. 378 ,P = 0. 000）. The receiver operator characteristic （ROC） curve indicated that the optimal cut-off values of serum NT-proBNP levels for the death risk evaluation in eider patients with chronic disease were 1 499.50 ng/L. Kaplan-Meier survival curve showed that the survival rates of serum NT-proBNP levels had significant difference （P 〈 0. 01 ）. The higher the serum NT-proBNP level was,the more shorter of the Survival rates were. Conclusions The levels of serum NT-proBNP have an important prognostic value in the death risk evaluation in elderly patients with various chronic disease. It is an independent risk factor for the death occurred in elderly patients with chronic disease. The levels of serum NT-proBNP are closely correlated with the survival rates and survival time of elderly patients, It can be used as a monitoring indicator of the elderly patients with chronic disease in risk stratification.