心脏磁共振延迟强化成像联合血清NT-proBNP及Hcy检测评估非缺血性心肌病预后的价值

The value of LGE combined with the detections of serum NT-proBNP and Hcy in assessing the prognosis of non-ischemic cardiomyopathy

目的:探讨心脏钆对比剂延迟增强磁共振成像(LGE-MRI)联合血清N-端B型尿钠肽原(NT-proBNP)、同型半胱氨酸(Hcy)检测对非缺血性心肌病预后的预测价值。方法:选取在医院治疗的152例扩张型心肌病(DCM)患者,根据发生主要心脏不良事件(MACE)情况,将其分为MACE组(47例)和非MACE组(105例)。测定并分析比较两组DCM患者入院24 h内、治疗1周后、出院时血清NT-proBNP以及Hcy水平。采用Logistic回归分析MACE的危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)分析LGE-MRI状态、出院时血清NT-pro BNP及Hcy水平对MACE的预测价值。结果:MACE组患者LGEMRI阳性率高于非MACE组,差异有统计学意义(χ^(2)=21.060,P<0.05)。两组治疗后1周及出院时血清NT-pro BNP、Hcy水平的差异有统计学意义(F=8.964,F=9.869;P<0.05);出院时MACE组血清NT-pro BNP、Hcy水平高于非MACE组,差异有统计学意义(t=13.398,t=10.519;P<0.05)。出院时血清NT-pro BNP、Hcy水平及LGE-MRI状态为发生MACE的独立预测影响因素(OR=1.003,OR=1.238,OR=3.097;P<0.05)。血清NT-pro BNP水平>2458.26 ng/L时预测MACE的AUC为0.846,血清Hcy水平>25.58 mol/L时预测MACE的AUC为0.755,LGE-MRI阳性预测MACE的AUC为0.680;三者联合预测MACE的AUC为0.913,与三者单独预测比较,差异有统计学意义(Z=2.584,Z=4.023,Z=6.011;P<0.05)。结论:LGE-MRI阳性率及出院时血清NT-pro BNP、Hcy水平为发生MACE的独立预测因素,三者联合对MACE发生有较好的预测价值。

Objective:To investigate the predictive value of cardiac late gadolinium enhancement magnetic resonance(LGE-MRI)combined with the detections of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)and homocysteine(Hcy)on the prognosis of non-ischemic cardiomyopathy.Methods:A total of 152 patients with dilated cardiomyopathy(DCM)who were treated in our hospital were included as the research objects.According to whether occurred major adverse cardiac events(MACE),they were divided into MACE group(47 cases)and nonMACE group(105 cases).And the serum NT-proBNP and Hcy levels of patients within 24 hours after admission,1week after treatment and hospital discharge were measured and compared.The risk factors of MACE were analyzed by Logistic analysis,and the predictive value of LGE status,serum NT-proBNP and Hcy levels at hospital discharge was analyzed by area under curve(AUC)of receiver operating characteristics(ROC)curve.Results:LGE-magnetic resonance imaging(LGE-MRI)positive rate of MACE group was significantly higher than that of non-MACE group(χ^(2)=21.060,P<0.05).There were significant differences in serum NT-proBNP and Hcy levels at 1 week after treatment and hospital discharge between two groups(F=8.964,F=9.869,P<0.05).The levels of serum NT-proBNP and Hcy in MACE group were significantly higher than those in non-MACE group at hospital discharge(t=13.398,t=10.519,P<0.05).The levels of serum NT-proBNP and Hcy,and LGE-MRI status at hospital discharge were independent predictors of occurring MACE(OR=1.003,OR=1.238,OR=3.097,P<0.05).The level of serum NT-proBNP was larger than 2458.26 ng/L,and AUC of that was 0.846 in predicting MACE,and the level of serum Hcy was larger than 25.58mol/L and AUC of that was 0.755 in predicting MACE.The AUC of positive LGE was 0.680 in predicting MACE.And the AUC of the combination of the three methods was 0.913 in predicting MACE,and there were significant differences in prediction among the combined method and each single prediction(Z=2.584,Z=4.023,Z=6.011,P<0.05),respectively.Conclusion:The positive rate of LGE and the serum levels of NT-proBNP and Hcy at hospital discharge are independent predictors of occurring MACE.The combination of three methods has a better predictive value for the occurrence of MACE.