NT-proBNP、血乳酸、肌钙蛋白Ⅰ及血浆胱抑素C等对体外循环心脏手术患者预后的影响

Effects of NT-pro BNP,blood lactate levels,troponin Ⅰ and plasma cystatin C on the prognosis of patients undergoing cardiopulmonary bypass

目的对比NT-proBNP、血乳酸水平、肌钙蛋白Ⅰ及血浆胱抑素C多个血清学指标对于体外循环心脏手术患者预后风险率的预测价值。方法选取2013年7月至2015年7月就诊于我科并后续行体外循环心脏手术患者127例为研究对象,记录其基线资料、?NT-proBNP、?血乳酸、?肌钙蛋白Ⅰ及?血浆胱抑素C水平、NYHA分级、LVEF及E/A。对所有患者进行为期2年的随访,在随访期间发生不良预后的患者定义为不良预后组,病情无恶化者定义为预后良好组,单因素分析显示影响体外循环心脏手术患者预后风险率的因素;Cox比例风险模型进一步评价存在统计学意义的所有因素对患者预后的影响程度;运用ROC曲线分析?NT-proBNP、?血浆胱抑素C水平及肌钙蛋白Ⅰ预测体外循环心脏手术患者预后风险的敏感性和特异性。结果单因素分析显示患者?NT-proBNP、?血浆胱抑素C水平、肌钙蛋白Ⅰ、NYHA分级以及LVEF能影响体外循环心脏手术患者预后风险率的大小,差异均具有统计学意义(P<0.05);多因素Cox比例风险模型结果显示患者?NT-proBNP(P=0.019)、?血浆胱抑素C(P=0.037)、肌钙蛋白Ⅰ水平(P=0.028)及LVEF(P=0.045)对患者预后有显著影响;四者相比,?NT-proBNP水平的影响程度最高(RR=1.598);而ROC曲线下?NT-proBNP水平的AUC为0.831,且其预测的敏感性和特异性分别为66.87%、72.44%,?NT-proBNP与LVEF联合诊断的ROC曲线下的AUC为0.842,其预测的敏感性和特异性分别为75.3%、76.2%。结论 NT-proBNP水平与LVEF联合诊断对体外循环心脏手术患者预后风险率的大小有较好的预测能力,有望作为体外循环心脏手术患者的常规评估指标广泛应用于临床。

Objective To explore the relationship between multiple serological indexes and cardiac prog- nosis risk of patients; To compare the four predictive value of prognosis of patients with cardiac surgery. Meth- ods A total of 127 patients treated by eardiopulmonary bypass surgery were enrolled from July 2013 to March 2015 in our department. Their baseline data were recorded. All patients were followed up for 2 years. Patients with adverse outcomes were defined as the unfavorableprognosis group during the follow-up period while the patients with nodisease progression were defined as the favorableprognosis group. Univariate analysis and Cox proportional risk model wereapplied to evaluate the effects of all factors on the patient＇ s prognosis. Meanwhile, the prediction ability of multiple serological indexes in predicting prognosis of patients with cardiac surgery was calculated by ROC curve analysis. Results Multivariate Cox proportional hazard model showed that the ANT-proBNP （P = 0.019）, Aplasma levels of cystatin C （P = 0.037）, Atroponin I （P = 0.028）and LVEF （P = 0.045） have signifi- cant influence on the prognosis of the patients and the ANT-proBNP has the highest degree （RR = 1.598） ; The AUC of the NT-proBNP combined with LVEF in diagnosis of patients with cardiac surgery was 0.842, and the sen- sitivity and specificity were 75.3% and 76.2%, respectively. Conclusions The level of ANT-proBNP and LVEF have a good predictive ability for cardiac outcome in patients undergoing surgery, which is expected as a conventional evaluation index of cardiac surgery with cardiopulmonary bypass.