氨基末端脑钠肽前体在重度风湿性主动脉瓣置换术后患者中的预后价值

Prognostic value of N-terminal pro-brain natriuretic peptide for adverse outcomes in patients with severe rheumatic aortic valve disease underwent replacement surgery

目的探讨氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)对重症风湿性主动脉瓣病患者置换手术不良结局的预后价值。方法分析2009年3月至2015年12月696例在广东省人民医院接受置换手术的重度风湿性主动脉瓣病患者NT-proBNP与不良结局的关系。进行多因素Logistic回归分析,以确定NT-proBNP是否是不良结局的独立危险因素。结果根据NT-proBNP基线的四分位数,患者分为4组:Q1(<526 pg/mL)组、Q2(526~1238 pg/mL)组、Q3(1238~2713 pg/mL)组和Q4(>2713 pg/mL)组。19例(2.7%)患者在住院期间死亡,其中Q1组1例(0.6%),Q2组3例(1.7%),Q3组4例(2.3%),Q4组11例(6.3%)。多变量Logistic回归分析表明,lgNT-proBNP是院内病死率的独立预测因子(OR=3.48,95%CI:1.32~9.13,P=0.011)。NT-proBNP>1800 pg/mL预测院内死亡的敏感度和特异度分别为78.9%和64.0%(曲线下面积=0.739,P<0.001)。Kaplan-Meier分析显示,NT-proBNP>1800 pg/mL的患者一年累计病死率高于NT-proBNP≤1800 pg/mL的患者(7.7%vs.2.1%,Log-rank=11.89,P=0.001)。结论NT-proBNP可以作为主动脉瓣置换术后的风湿性主动脉瓣疾病患者住院和一年病死率的风险预测指标。

Objectives To explore the prognostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP)for adverse outcomes in patients with severe rheumatic aortic valve disease who underwent replacement surgery.Methods The association between NT-proBNP and adverse outcomes was analyzed in 696 patients with severe rheumatic aortic valve disease who underwent replacement surgery from March 2009 to December 2015 in Guangdong Provincial People′s Hospital.Multivariate Logistic regression analysis was conducted to determine whether NT-proBNP was an independent risk factor of adverse outcomes.Results Patients were categorized into 4 groups based on the quartiles of baseline NTproBNP:Q1(<526 pg/mL)group,Q2(526-1238 pg/mL)group,Q3(1238-2713 pg/mL)group and Q4(>2713 pg/mL)group.19(2.7%)patients died during the hospitalization,among which were 1(0.6%)in Q1 group,3(1.7%)in Q2 group,4(2.3%)in Q3 group and 11(6.3%)in Q4 group.Mutivariate Logistic regression analysis showed that lgNT-proBNP was an independent predictor for in-hospital mortality(OR=3.48,95%CI:1.32-9.13,P=0.011).When NT-proBNP was>1800 pg/mL,the sensitivity and specificity in predicting in-hospital death were 78.9%and 64.0%,respectively(area under the curve=0.739,P<0.001).Kaplan-Meier analysis revealed that higher cumulative rate of one-year mor⁃tality was found in patients with NT-proBNP>1800 pg/mL than those with NT-proBNP≤1800 pg/mL(7.7%vs.2.1%,Log-rank=11.89,P=0.001).Conclusions NT-proBNP could be considered as a risk predictor for in-hospital and one-year mortality in patients with rheumatic aortic valve disease underwent replacement surgery.