N端前脑钠肽在评估结缔组织病合并肺动脉高压患者预后中的作用

Prognostic value of serum NT-pro-BNP level for connective tissue disease patients complicated with pulmonary arterial hypertension

目的探讨N末端B型脑钠肽前体(NT-pro-BNP)在评估结缔组织病(CTD)合并肺动脉高压(PAH)患者预后中的作用。方法选择2010年3月至2019年2月诊断为CTD,超声心动图检查诊断为PAH,同时经胸部CT排除肺血栓或肺动脉狭窄的297例患者,中心实验室检测NT-pro-BNP水平。根据NT-pro-BNP分为NT-pro-BNP升高组(41例,13.8%)及NT-pro-BNP正常组(256例,86.2%),采用生存分析及Cox回归分析对患者预后进行评估,主要终点事件为全因死亡,次要终点事件为心血管事件。结果 297例患者中类风湿关节炎89例(29.9%)、系统性红斑狼疮61例(20.6%)、硬皮病49例(16.5%)、混合性结缔组织病46例(15.5%)、其它CTD 52例(17.5%)。随访结束后,NT-pro-BNP升高组全因死亡率与心血管事件发生率均明显高于NT-pro-BNP正常组(均P<0.05)。生存分析提示NT-pro-BNP升高组与NT-pro-BNP正常组1、3与5年生存率分别为82.1%、51.1%、20.6%和90.2%、73.4%、43.7%。校正各种混杂因素后,发现NT-pro-BNP是CTD合并PAH患者全因死亡及心血管事件的独立危险因素。同时发现,NT-pro-BNP升高组中男性、高龄、高NT-pro-BNP水平、低混合静脉血氧饱和度是心血管事件的独立危险因素;而NT-pro-BNP正常组中男性、高龄是其心血管事件的独立危险因素。结论 NT-pro-BNP可作为预测CTD合并PAH患者全因死亡及心血管事件的较好指标,特别是对于高龄、男性及低混合静脉血氧饱和度患者。

Objective To assess the prognostic value of serum N terminal-pro-B type natriuretic peptide(NT-pro-BNP)level for connective tissue disease(CTD) patients complicated with pulmonary arterial hypertension(PAH). Methods Clinical data of 297 patients with CTD and PAH admitted in Wenzhou Central Hospital from March 2010 to February 2019 were retrospectively analyzed. Echocardiography was used to diagnose PAH and chest CT was used to exclude patients with pulmonary thrombosis or pulmonary stenosis. According to the level of NT-pro-BNP, patients were divided into NT-pro-BNP elevated group and NT-pro-BNP normal group. Survival analysis and COX regression analysis was adopted to evaluate the correlation of NT-pro-BNP with prognosis. The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular events. Results Among 297 CTD patients there were 89(29.9%) cases of rheumatoid arthritis, 61(20.6%) cases of systemic lupus erythematosus, 49(16.5%) cases of scleroderma, 46(15.5%) cases of mixed CTD, and 52(17.5%) cases of other CTDs. Serum NT-pro-BNP level was elevated in 41 patients(13.8%) and NT-pro-BNP level was normal in 256 patients(86.2%). During the follow-up the all-cause mortality and cardiovascular events in NT-pro-BNP elevated group were significantly higher than those in NT-pro-BNP normal group(OR=1.51, 95%CI:1.16~2.67, P=0.013;OR=1.72, 95%CI:1.12~2.53, P=0.002). Survival analysis showed that the 1-, 3-, and 5-year survival rates of NT-pro-BNP elevated and normal groups were82.1%, 51.1%, 20.6% and 90.2%, 73.4%, 43.7%, respectively. Cox regression analysis that elevated NT-pro-BNP was a predictor of death in CTD patients complicated with PAH(per 100 pg/ml, HR=1.09, 95%CI:1.03~1.52) and an independent risk factor for cardiovascular events(per 100 pg/ml, HR=1.12, 95%CI:1.05~1.61). In NT-pro-BNP elevated group the old age(every 10-year increase, HR=1.28, 95%CI:1.12~2.46), male sex(HR=1.41, 95%CI:1.17~2.80), NT-pro-BNP level(per 100 pg/ml increase, HR=1.16, 95%CI:1.10~1.53) and low mixed venous oxygen saturation(10% reduction, HR=2.21, 95%CI:1.59~4.33) were independent risk factors for cardiovascular events;in NT-pro-BNP normal group, the age(10-year increase, HR=1.26, 95%CI:1.12~2.38), male sex(HR=1.19, 95%CI:1.10~2.79) were independent risk factors for cardiovascular events. Conclusion NT-pro-BNP can be used as a indicator for assessing all-cause mortality and cardiovascular events in patients with CTD and PAH, especially in elderly, male, and those with low mixed venous oxygen saturation.