NT-pro BNP、MYO、CK-MB水平预测慢性肾衰合并心衰患者预后的价值

Prognostic value of NT-pro BNP,MYO and CK-MB levels in patients with chronic renal failure with heart failure

目的研究N-末端脑钠肽前体(NT-pro BNP)、肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)水平预测慢性肾衰合并心衰患者预后的价值。方法选择2018年1月-2019年12月濮阳市油田总医院的130例慢性肾衰合并心衰患者作为研究对象,按预后效果分为预后良好组(n=98)和预后不良组(n=32)。收集所有患者的临床资料,包括年龄、性别、体质量指数、病程、分期、合并症、NT-pro BNP、MYO、CK-MB水平。以ROC曲线分析NTpro BNP、MYO、CK-MB水平预测慢性肾衰合并心衰患者预后的价值,采取非条件Logistic逐步回归分析慢性肾衰合并心衰患者预后的影响因素。结果与预后不良组比较,预后良好组年龄<60岁、慢性肾脏病(CKD)分期1~3期、心衰分期A~B期、无合并症、病程<3年的患者明显更多,差异有统计学意义(P<0.05);预后良好组NT-pro BNP、MYO、CK-MB水平均低于预后不良组,差异有统计学意义(P<0.05);经ROC分析,NT-pro BNP、MYO、CK-MB预测慢性肾衰合并心衰预后的曲线下面积分别为0.877、0.730、0.774,差异均有统计学意义(P<0.05);经Logistic回归分析证实,年龄≥60岁、CKD分期为4或5期、心衰分期为C或D期、有合并症、病程≥3年、NT-pro BNP≥296.700 pg/mL、MYO≥266.500 ng/mL、CK-MB≥19.980 ng/mL是慢性肾衰合并心衰预后不良的危险因素,差异有统计学意义(P<0.05)。结论慢性肾衰合并心衰患者预后的影响因素很多,如年龄、CKD分期、心衰分期、合并症、病程以及NTpro BNP、MYO和CK-MB水平,其中NT-pro BNP≥296.700 pg/mL、MYO≥266.500 ng/mL、CK-MB≥19.980 ng/mL是慢性肾衰合并心衰预后不良的最佳截断值,对预测慢性肾衰合并心衰患者预后有一定意义。

Objective To study the prognostic value of N terminal protein B-type natriureti peptide(NT-pro BNP),myoglobin(MYO)and creatine kinase isoenzyme(CK-MB)in patients with chronic renal failure with heart failure.Methods 130 patients with chronic renal failure with heart failure in Puyang Oilfield General Hospital from January 2018 to December 2019 were selected as the research objects.According to the prognosis effect,all patients were divided into favorable prognosis group(n=98)and fair prognosis group(n=32).The clinical data of all patients were collected,such as age,gender,body mass index,course of disease,stage,complications,levels of NT-pro BNP,MYO and CK-MB.ROC curve was used to analyze the prognostic value of NT-pro BNP,MYO,CK-MB levels in patients with chronic renal failure with heart failure.Non conditional Logistic stepwise regression was used to analyze the influencing factors of prognosis in patients with chronic renal failure and heart failure.Results Compared with the fair prognosis group,patients with age<60 years old,chronic kidney disease(CKD)stage 1-3,heart failure stage A-B,no complications,course of disease<3 years were significantly more in the favorable prognosis group(P<0.05).The levels of NT-pro BNP,MYO and CK-MB in the favorable prognosis group were lower than those in the fair prognosis group(P<0.05).ROC analysis showed that the area under the curve of NT-pro BNP,MYO and CK-MB in predicting the prognosis of chronic renal failure with heart failure were0.877,0.730 and 0.774,respectively;the differences were statistically significant(P<0.05).Logistic regression analysis showed that age≥60 years old,CKD stage 4 or 5,heart failure stage C or D,complications,course of disease≥3 years,NT-Pro BNP≥296.700 pg/mL,MYO≥266.500 ng/mL,CK-MB≥19.980 ng/mL were the risk factors for fair prognosis of chronic renal failure complicated with heart failure;the differences were statistically significant(P<0.05).Conclusions There were many factors influencing the prognosis of patients with chronic renal failure with heart failure,such as age,CKD stage,heart failure stage,complications,course of disease,and NT-pro BNP,MYO and CK-MB levels.Among them,NT-pro BNP≥296.700 pg/mL,MYO≥266.500 ng/mL,CK-MB≥19.980 ng/mL were the best cut-off values of fair prognosis in patients with chronic renal failure and heart failure,which had a certain significance in predicting the prognosis of patients with chronic renal failure and heart failure.