老年患者心力衰竭生物标志物N末端B型钠尿肽前体水平检测及影响因素分析

Serum NT-proBNP level and its influencing factors as biomarkers of heart failure in elderly patients

目的探讨老年患者心力衰竭(心衰)生物标志物N末端B型钠尿肽前体(NT-proBNP)水平及影响因素。方法选择2008年4月~2010年7月北京地区军队干休所离退休干部及家属526例,根据NT-proBNP水平由低到高按四分位法分为Q1组(0.8,38.0μg/L)131例,Q2组(38.1,72.3μg/L)132例,Q3组(72.4,133.7μg/L)131例,Q4组(135.5,2901.6μg/L)132例。收集临床资料,采用对数NT-proBNP(logNT-proBNP)进行相关分析。结果Q1组、Q2组、Q3组、Q4组年龄、女性、冠心病、慢性肾功能不全、硝酸酯类药占比例呈明显增加趋势(P<0.05),抗凝血酶Ⅲ活性呈明显下降趋势(P<0.05)。单因素相关分析显示,logNT-proBNP与年龄、肌酐、白细胞计数呈正相关,与抗凝血酶Ⅲ活性、红细胞计数、血红蛋白水平呈负相关(P<0.05,P<0.01)。多元线性回归分析显示,logNT-proBNP与年龄(β=0.015,95%CI:0.009~0.021,P=0.000)、女性(β=0.297,95%CI:0.199~0.396,P=0.000)、抗血小板药物(β=0.268,95%CI:0.160~0.376,P=0.000)、心房颤动(β=0.357,95%CI:0.201~0.513,P=0.000),冠心病(β=0.094,95%CI:0.013~0.175,P=0.024)及肌酐水平(β=0.004,95%CI:0.002~0.005,P=0.000)呈正相关,与抗凝血酶Ⅲ活性呈负相关(P=0.014)。结论老年人群NT-proBNP水平主要受到4类因素影响,生物学性状:年龄与性别;慢病与共病:冠心病、心房颤动和肾功能不全;血液学成分:白细胞计数、红细胞计数、血红蛋白水平和抗凝血酶Ⅲ活性;心血管用药:抗血小板药物等。

Objective To study the serum NT-proBNP level and its influencing factors as biomarkers of HF in elderly patients.Methods Five hundred and twenty-six old patients(retired military veterans and their family members)enrolled from Beijing area in April 2008-July 2010were divided into Q1group or serum NT-proBNP level=0.8-38.0μg/L group(n=131),Q2group or serum NT-proBNP level=38.1-72.3μg/L group(n=132),Q3group or serum NT-proBNP level=72.4-133.7μg/L group(n=131)and Q4group or serum NT-proBNP level=135.5-2901.6μg/L group(n=132)according to the quatering classification.Their clinical data were recorded and the influencing factors of serum NT-proBNP level were analyzed.Results The age,number of female patients,incidence of CHD,chronic renal insufficiency and ratio of used nitrate ester analogues increased significantly while the antithrombinⅢactivity decreased significantly with the elevated serum NT-proBNP level in 4groups(P<0.05).Univariate correlation analysis showed that logNT-proBNP was positively related with age,serum creatinine level,white blood cell count and negatively related with antithrombinⅢactivity,red blood cell count and serum hemoglobin level(P<0.05,P<0.01).Multivariate linear regression analysis showed that logNT-proBNP was positively related with age,female gender,antiplatelet drugs,AF,CHD and serum antithrombin level(β=0.015,95%CI:0.009-0.021,P=0.000;β=0.297,95%CI:0.199-0.396,P=0.000;β=0.268,95%CI:0.160-0.376,P=0.000;β=0.357,95%CI:0.201-0.513,P=0.000;β=0.094,95%CI:0.013-0.175,P=0.024;β=0.004,95%CI:0.002-0.005,P=0.000)and negatively related with antithrombinⅢactivity(P=0.014)).ConclusionSerum NT-proBNP level in elderly patients is affected by 4types of factors,namely biological characteristics:age and gender;chronic diseases and comorbidity:CHD,AF and renal insufficiency;hematological components:white blood cell count,red blood cell count,serum hemoglobin level and antithrombinⅢactivity;drugs for treatment of cardiovascular diseases:antiplatelet drugs.