血浆N末端B型脑钠肽前体对非体外循环冠状动脉旁路移植术后早期心房颤动的预测价值

Predictive value of N-terminal B-type natriuretic peptide for early postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting

目的观察非体外循环冠状动脉旁路移植术(OPCABG)患者围术期血浆N末端B型脑钠肽前体(NT-proBNP)的释放规律并探讨术前NT-proBNP水平对OPCABG术后早期心房颤动的预测价值。方法选取2017年6月至2018年7月在河北大学附属医院心脏外科进行OPCABG的60例患者为研究对象。采集所有患者入院时、术前1 d、术后6 h、术后1 d、术后3 d、术后5 d的血样,观察NT-proBNP水平变化趋势;绘制受试者工作特征曲线,分析术前NT-proBNP水平对术后早期心房颤动的预测价值。结果 NT-proBNP水平于术后6 h即明显升高,术后3 d达到高峰,随后开始逐渐下降,术后5 d仍高于术前,术后各时点NT-proBNP水平与入院时和术前1 d比较[入院时、术前1 d、术后6 h和术后1、3、5 d的NT-proBNP水平分别为(328±225)、(296±117)、(535±188)、(1 254±235)、(1 958±425)、(1 152±414) ng/L],差异均有统计学意义(均P <0. 001)。Pearson线性相关分析显示,入院时NT-proBNP水平与左心室射血分数呈负相关(r=-0. 624,P <0. 001)。受试者工作特征曲线分析结果显示,入院时及术前1 d的NT-proBNP水平可预测术后心房颤动发生(入院时:曲线下面积=0. 922,95%置信区间:0. 857~0. 988,P <0. 001,截断值=325 ng/L,敏感度=0. 929,特异度=0. 826;术前1 d:曲线下面积=0. 798,95%置信区间:0. 653~0. 943,P=0. 001,截断值=362 ng/L,敏感度=0. 571,特异度=0. 957)。Logistic回归分析结果表明,入院时NT-proBNP> 325 ng/L(比值比=20. 227,95%置信区间:1. 968~207. 886,P=0. 011)和入院时左心室收缩末期内径(比值比=0. 069,95%置信区间:0. 007~0. 705,P=0. 024)是术后心房颤动的独立预测因子。结论 OPCABG患者术后NT-proBNP水平较术前明显升高,呈现术后6 h内即开始升高、术后3 d到达高峰并逐渐开始下降的趋势;入院时NT-proBNP> 325 ng/L是OPCABG患者术后心房颤动的独立预测因子,预测患者术后早期心房颤动的发生具有较高的敏感度和特异度。

Objective To observe the changes of blood N-terminal B-type natriuretic peptide(NT-proBNP during perioperative period in patients undergoing off-pump coronary artery bypass grafting( OPCABG),and to evaluate the value of NT-proBNP in predicting early postoperative atrial fibrillation. Methods Sixty patients undergoing OPCABG in Affiliated Hospital of Hebei University from June 2017 to July 2018 were recruited. Blood content of NT-proBNP in blood was tested at admission,1 d before,6 h,1 d,3 d and 5 d after surgery. Predictive value of NT-proBNP before surgery for early postoperative atrial fibrillation was analyzed by receiver operating characteristic curve. Results Blood level of NT-proBNP significantly increased since 6 h after surgery and reached the peak at 3 d;the level at 5 d was still significantly higher than that before surgery[levels of NT-proBNP at admission,1 d before,6 h,1 d,3 d and 5 d after surgery:(328 ± 225),(296 ± 117),(535 ± 188),(1 254 ±235),(1 958 ± 425),(1 152 ± 414) ng/L]( all P < 0. 001). Linear correlation analysis showed that NT-proBNP level at admission was negatively correlated with left ventricular ejection fraction( r =-0. 624,P < 0. 001).Receiver operating characteristic curve revealed good predictive value of NT-proBNP at admission and 1 d before surgery for early postoperative atrial fibrillation( area under curve = 0. 922,0. 798;95% confidence interval:0. 857-0. 988,0. 653-0. 943;P < 0. 001,P = 0. 001;sensitivity = 0. 929,0. 571;specificity = 0. 826,0. 957).Logistic regression analysis showed that NT-proBNP > 325 ng/L at admission( odds ratio = 20. 227,95% confidence interval: 1. 968-207. 886,P = 0. 011) and left ventricle end-systolic diameter(β=-2. 668,Wald = 5. 085,odds ratio = 0. 069,95% confidence interval: 0. 007-0. 705,P = 0. 024) were independent predictors of early postoperative atrial fibrillation. Conclusions NT-proBNP level in patients undergoing OPCABG significantly increases after operation;it rises within 6 h and peaks at 3 d. NT-proBNP > 325 ng/L at admission is an independent predictor of early postoperative atrial fibrillation following OPCABG with high sensitivity and specificity.