NT-proBNP联合红细胞分布宽度预测老年慢性心力衰竭合并Ⅱ型心肾综合征的临床价值

Clinical value of N-terminal of the prohormone brain natriuretic peptide combined with red blood cell distribution width in predicting elderly chronic heart failure combined with type Ⅱ cardiorenal syndrome

目的探讨NT-proBNP联合红细胞分布宽度(RDW)预测老年慢性心力衰竭(CHF)合并Ⅱ型心肾综合征(Ⅱ型CRS)的临床价值。方法选取丽水市第二人民医院收治的老年CHF患者168例,患者入院后均随访1年,按照随访结果是否发生Ⅱ型CRS分为Ⅱ型CRS组(n=48)和非Ⅱ型CRS组(n=120)。收集两组的一般临床资料和实验室检查指标,采用Pearson相关性分析NT-proBNP、RDW与相关指标的关系,采用Logistic回归方程分析NT-proBNP和RDW与老年CHF患者发生Ⅱ型CRS的关系,采用受试者工作特征(ROC)曲线分析两者预测Ⅱ型CRS的价值。结果与非Ⅱ型CRS组比较,Ⅱ型CRS组年龄、收缩压(SBP)、NYHAⅢ-Ⅳ级比例、左心室舒张末期内径(LVEDD)、血肌酐(Cr)、血尿素氮(BUN)、尿酸(UA)、C反应蛋白(CRP)偏高,而左心室射血分数(LVEF)、血红蛋白(Hb)偏低,差异有统计学意义(P<0.05);Ⅱ型CRS组RDW和NT-proBNP水平高于非Ⅱ型CRS组(t=4.840、11.515,P<0.01)。Pearson相关性分析显示,RDW和NT-proBNP分别与NYHA分级、LVEDD、Cr、BUN、UA、CRP呈正相关(r=0.241、0.204、0.223、0.190、0.294、0.289、0.494、0.323、0.282、0.190、0.311、0.210,P<0.05),而与LVEF、Hb呈负相关(r=-0.257、-0.493、-0.521、-0.123,P<0.05),两者之间亦呈正相关(r=0.282,P<0.05)。多元Logistic回归方程显示RDW、NT-proBNP是老年CHF患者发生Ⅱ型CRS的独立危险因素(OR=1.994、3.187,P<0.05)。ROC曲线显示RDW、NT-proBNP预测Ⅱ型CRS的曲线下面积(AUC)分别为0.72和0.75,敏感度分别为74.39%和81.92%,特异度分别为76.10%和73.12%。最佳诊断值分别为15.13%和4875.54 ng/L。两者联合预测的AUC为0.80,明显高于各单项预测价值(Z=3.121、2.862,P<0.05)。结论RDW、NT-proBNP是老年CHF患者发生Ⅱ型CRS的独立危险因素,两者联合检测可提高对Ⅱ型CRS的预测能力。

Objective To explore the clinical value of N-terminal of the prohormone brain natriuretic peptide(NT-proBNP) combined with red blood cell distribution width(RDW) in predicting chronic heart failure(CHF) combined with type Ⅱ cardiorenal syndrome(CRS). Methods 168 elderly CHF patients admitted to Lishui second people’s hospital were followed up for 1 year. According to the follow-up results, they were divided into two groups: type Ⅱ CRS group(n=48) and non-type Ⅱ CRS group(n=120). The relationship between NT-proBNP, RDW and related indicators was analyzed by Pearson correlation analysis. Logistic regression equation was used to analyze the relationship between NT-proBNP and RDW and type Ⅱ CRS in elderly CHF patients. The value of predicting type Ⅱ CRS was analyzed by ROC curve. Results Compared with non-type Ⅱ CRS group, age, systolic blood pressure(SBP), NYHA grade Ⅲ-Ⅳ ratio, left ventricular end-diastolic diameter(LVEDD), serum creatinine(Cr), blood urea nitrogen(BUN), uric acid(UA) and C-reactive protein(CRP) were higher in type Ⅱ CRS group, while left ventricular ejection fraction(LVEF) and hemoglobin(Hb) were lower, the differences were statistically significant(P < 0.05). The levels of RDW and NT-proBNP in type Ⅱ CRS group were higher than those in non-type Ⅱ CRS group(t=4.840, 11.515, P < 0.01). Pearson correlation analysis showed that RDW and NT-proBNP were positively correlated with NYHA classification, LVEDD, Cr, BUN, UA and CRP(r=0.241, 0.204, 0.223, 0.190, 0.294, 0.289, 0.494, 0.323, 0.282, 0.190, 0.311, 0.210, P < 0.05), and negatively correlated with LVEF and Hb(r=-0.257,-0.493,-0.521,-0.123, P < 0.05), RDW was positively correlated with NT-proBNP(r=0.282, P < 0.05). Multivariate logistic regression equation showed that RDW and NT-proBNP were independent risk factors of type Ⅱ CRS in elderly CHF patients(OR=1.994, 3.187, P < 0.05). ROC curves showed that the area under curve(AUC) of RDW and NT-proB NP predicting type Ⅱ CRS were 0.72 and 0.75, with sensitivity of 74.39% and 81.92%, specificity of 76.10% and 73.12%, respectively. The best diagnostic values were 15.13% and 4 875.54 ng/L, respectively. The AUC of the combined prediction was 0.80, which was significantly higher than that of the single prediction value(Z=3.121, 2.862, P < 0.05). Conclusion RDW and NT-proBNP may be the independent risk factors of type Ⅱ CRS for elderly patients with CHF. The combined detection of RDW and NT-proBNP can improve the predictive ability of type Ⅱ CRS.