社区老年人N末端B型钠尿肽前体对不良心血管事件的独立预测作用

Role of NT-proBNP in predicting MACE occurred in elderly community residents

目的探讨社区老年人群N末端B型钠尿肽前体(NT-proBNP)对主要不良心血管事件(MACE)的预测作用。方法纳入北京石景山苹果园社区参加健康调查的老年人群833例,根据基线NT-proBNP水平四分位数分为A组(<27.5 ng/L)209例,B组(27.5~54.4 ng/L)208例,C组(54.5~105.8 ng/L)207例和D组(≥105.9 ng/L)209例,收集入选者临床基线资料,检测血清同型半胱氨酸(Hcy)和NT-proBNP,计算估算肾小球滤过率(eGFR)。记录MACE和全因死亡情况,采用Cox比例风险回归分析及ROC曲线评估NT-proBNP预测价值。结果C、D组女性比例明显高于A、B组,D组年龄、Hcy及hs-CRP明显高于A、B、C组,TG、LDL-C、舒张压及eGFR明显低于A、B、C组(P<0.05,P<0.01)。年龄、女性与NT-proBNP呈正相关,舒张压、eGFR与NT-proBNP呈负相关(P<0.05,P<0.01)。随访时间发生MACE 80例(9.6%),全因死亡41例(4.9%)。D组MACE发生率和全因死亡率明显高于A组(17.2%vs 3.3%,10.0%vs 1.0%,P<0.01)。校正传统危险因素后,Cox回归分析显示,D组MACE和全因死亡风险明显高于A、B、C组(P<0.05)。NT-proBNP对于MACE和全因死亡预测的ROC曲线下面积为0.654(95%CI:0.593~0.715)和0.661(95%CI:0.579~0.743)。结论在社区无症状老年人群中,血清NT-proBNP水平是MACE及全因死亡的强而独立的预测指标。

Objective To study the role of NT-proBNP in predicting MACE occurred in elderly community residents.Methods Eight hundred and thirty-three elderly residents from Shijinshan Apple Orchard Community were divided into group A(n=209),group B(n=208),group C(n=207)and group D(n=209)according to their serum NT-proBNP level.Their baseline clinical data were recorded,their serum Hcy and NT-proBNP levels were measured,and their eGFR was calculated.The incidence of MACE and all-cause mortality were recorded.The role of NT-proBNP in predicting MACE occurred in elderly community residents was assessed by Cox regression analysis and ROC curve analysis respectively.Results The age was significantly older,the number of female residents was significantly greater,the serum levels of Hcy and hs-CRP were significantly higher while those of TG,HDL-C,LDL-C,and the DBP and eGFR were significantly lower in group D than in groups A-C(P<0.05,P<0.01).The age and female were positively related with the serum NT-proBNP level while the DBP and eGFR were negatively related with the serum NT-proBNP level(P<0.05,P<0.01).MACE occurred in 80 residents(9.6%)and all-cause deaths occurred in 41 residents(4.9%)during the follow-up period.The incidence of MACE and all-cause mortality were significantly higher in group D than in group A(17.2%vs 3.3%,10.0%vs 1.0%,P<0.01).Cox regression analysis showed that the risk of MACE and all-cause death was significantly higher in group D than in groups A-C after adjustment for traditional risk factors(P<0.05).The area under the ROC curve for NT-proBNP in predicting MACE and all-cause death was 0.654(95%CI;2.136-14.739)and 0.661(95%CI:0.579-0.743)respectively.Conclusion Serum NT-proBNP level is an independent predictor of all-cause death and MACE in elderly community residents.