NT-proBNP eGFR-CysC诊断CRF患者心功能不全的临床价值分析

Clinical Value Analysis of NT-proBNP and eGFR-CysC in Diagnosis of Cardiac Insufficiency in CRF Patients

目的:探索N末端脑钠肽前体(NT-proBNP)、基于血清胱抑素C估算的肾小球滤过率(eGFR-CysC)对慢性肾功能衰竭并发心功能不全患者的早期诊断效能。方法:选取2015年12月至2017年8月诊断为慢性肾功能衰竭的患者147例,其中检查出心功能不全的患者83例为研究组,剩余64例未发生心功能障碍的慢性肾功能衰竭患者做对照组;记录两组临床资料、左室舒张末期内径(LVDd)、左房内径(LADd)、左室射血分数(LVEF)、肌钙蛋白(cTnI)、NT-proBNP、肾小球滤过率(CysC)水平、估算e GFR-CysC。单因素分析及多因素非条件Logistic回归评价可能影响慢性肾功能衰竭患者并发心功能不全的因素;Pearson分析患者eGFR-CysC与心功能传统指标NT-proBNP之间的关系;ROC曲线分析上述指标对慢性肾功能衰竭合并心功能不全诊断的敏感性和特异性。结果:单因素分析显示:研究组研究对象的LVDd、c TnI、NT-proBNP、CysC水平高于对照组;但其LVEF、eGFR-CysC水平均低于对照组,差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果显示过低的LVEF、过高的NT-proBNP及低水平eGFR-CysC是肾功能衰竭患者发生心功能不全的危险因素。Pearson相关性分析表明,eGFR-CysC增加与NT-proBNP的升高呈负相关(r=-0.665,P=0.002);ROC曲线下eGFR-CysC的AUC最高,其特异性为79.67%,敏感度为82.89%。结论:eGFR-CysC对慢性肾功能衰竭患者并发心功能不全有较好的诊断效能,有望应用于临床作为慢性肾功能衰竭患者发生心功能不全的早期检出指标之一。

Objective:To explore the early diagnostic efficacy of NT-proBNP and eGFR-CysC in patients with chronic renal failure complicated with cardiac insufficiency.Methods:A total of 147 patients with chronic renal failure diagnosed in our department from December 2015 to August 2017 were selected as the study subjects.83 patients with cardiac insufficiency included in the study group,and the remaining 64 patients without cardiac insufficiency were treated as control group.Their baseline data,left ventricular end-diastolic diameter(LVDd),left atrial diameter(LADd),left ventricular ejection fraction(LVEF),troponin(cTnI),NT-proBNP,glomerular filtration rate(CysC)and eGFR-CysC were recorded.Univariate analysis and multivariate unconditional logistic regression were applied to select the factor that may affect chronic heart failure complicated with cardiac insufficiency.The relationship between eGFR-CysC and NT-proBNP was analyzed by Pearson analysis and ROC curve was used to show the sensitivity and specificity of above indicators in the diagnosis of patients with chronic renal failure complicated with cardiac insufficiency.Results:Univariate analysis showed that the levels of LVDd,cTnI,NT-proBNP,and CysC in patients with cardiac insufficiency were higher than those in control group;while the levels of LVEF and eGFR-CysC were lower than those in control group,and the differences were statistically significant(P<0.05);Multivariate Logistic regression analysis showed low LVEF,high NT-proBNP and Low levels of eGFR-CysC were risk factors for cardiac insufficiency in patients with renal failure.Pearson correlation analysis showed that the increase of eGFR-CysC was negatively correlated with the increase of NT-proBNP(r=-0.665,P=0.002).The AUC of eGFR-CysC under the ROC curve was the highest,with a specificity of 79.67%and a sensitivity of 82.89%.Conclusion:eGFR-CysC has a good diagnostic effect on patients with chronic renal failure complicated with cardiac insufficiency.It is expected to be used as one of the early detection indicators of cardiac insufficiency in patients with chronic renal failure.