高敏肌钙蛋白T和N末端B型钠尿肽前体与老年患者衰弱的相关性研究

Relationship of hs-cTnT and NT-proBNP with frailty in elderly patients

目的探讨非急性冠状动脉综合征(ACS)、无急慢性心力衰竭的老年住院患者高敏肌钙蛋白T(hs-cTnT)和N末端B型钠尿肽前体(NT-proBNP)与衰弱的关系。方法入选住院患者772例,根据Fried表型衰弱量表评估为无衰弱组309例、衰弱前期组199例,衰弱组264例。检测各组hs-cTnT及NT-proBNP水平。结果与无衰弱组比较,衰弱前期组和衰弱组血红蛋白、白蛋白水平明显降低,hs-cTnT及NT-proBNP水平明显升高,衰弱组左心室舒张末期内径(LVEDD)和LVEF明显降低(P<0.05,P<0.01)。衰弱组血红蛋白、白蛋白、LVEDD及LVEF明显低于衰弱前期组,hs-cTnT、NT-proBNP水平明显高于衰弱前期组(P<0.01)。校正合并慢性疾病后logistic回归分析显示,hs-cTnT、NT-proBNP对数转换(lgNT-proBNP)为衰弱前期和衰弱的独立危险因素(P<0.05,P<0.01),校正实验室及超声心动图检查指标等混杂因素后,hs-cTnT仍为衰弱前期和衰弱的独立危险因素(P<0.01),而lgNT-proBNP与衰弱及衰弱前期无相关性(P>0.05)。hs-cTnT预测衰弱的ROC曲线下面积(AUC)为0.676(95%CI:0.636~0.717),NT-proBNP预测衰弱的AUC为0.669(95%CI:0.629~0.708),hs-cTnT预测衰弱的AUC稍高于NT-proBNP(P>0.05)。结论无ACS及无急慢性心力衰竭的老年住院衰弱患者hs-cTnT和NT-proBNP水平高,hs-cTnT与衰弱、衰弱前期独立相关,hs-cTnT预测衰弱的AUC稍高于NT-proBNP。

Objective To study the relationship of hs-cTnT and NT-proBNP with frailty in elderly patients with no ACS and no acute HF or chronic HF.Methods Seven hundred and seventy-two elderly patients were divided into frailty-free group(n=309),prefrailty group(n=199),and frailty group(n=264) according to the Fried scale.The serum hs-cTnT and NT-proBNP levels in different groups were measured.Results The serum levels of hemoglobin and albumin were significantly lower while those of hs-cTnT and NT-proBNP were significantly higher in prefrailty group and frailty group than in frailty-free group(P<0.05,P<0.01).The LVEDD was significantly shorter and the LVEF was significantly lower in frailty group than in frailty-free group(P<0.05,P<0.01).The LVEDD was significantly shorter, the serum hemoglobin, albumin levels and LVEF were significantly lower while the serum hs-cTnT and NT-proBNP levels were significantly higher in frailty group than in prefrailty group(P<0.01).The hs-cTnT and lgNT-proBNP were independent risk factors for prefrailty and frailty after adjustment for chronic diseases(P<0.05,P<0.01),and hs-cTnT was still an independent risk factor for prefrailty and frailty even after adjustment for the confounding factors(P<0.01) while lgNT-proBNP was not related with frailty and prefrailty in elderly patients(P>0.05).ROC curve analysis displayed that the AUC of hs-cTnT and NT-proBNP for predicting frailty in elderly patients was 0.676(95%CI:0.636-0.717) and 0.669(95%CI:0.629-0.708) respectively.However, no significant difference was detected in AUC of hs-cTnT and NT-proBNP although the AUC of hs-cTnT was slightly larger than that of NT-proBNP(P>0.05).Conclusion The serum levels of hs-cTnT and NT-proBNP are elevated in elderly patients with no ACS and no acute HF or chronic HF.hs-cTnT is independently related with frailty and prefrailty.The AUC of hs-cTnT is slightly larger than that of NT-proBNP for predicting frailty in elderly patients.