NT-proBNP、ETX及HBP水平对重症心力衰竭合并急性肾损伤患者预后的预测价值

Predictive value of NT-proBNP, ETX and HBP levels in prognosis of patients with severe heart failure complicating acute kidney injury

目的 探讨N末端B型脑钠肽前体(NT-proBNP)、内毒素(ETX)及肝素结合蛋白(HBP)水平对重症心力衰竭(以下简称心衰)合并急性肾损伤患者预后的预测价值。方法 选取2019年1月—2022年2月连云港市第一人民医院收治的重症心衰合并急性肾损伤患者89例。收集患者NT-proBNP、ETX、HBP等临床资料,入院治疗后随访3个月预后情况。分析不同心功能分级、急性肾损伤分期患者NT-proBNP、ETX、HBP水平,分析影响重症心衰合并急性肾损伤患者预后的因素,分析NT-proBNP、ETX、HBP对重症心衰合并急性肾损伤患者预后的预测价值。结果 NYHA心功能分级Ⅳ级患者NT-proBNP、ETX、HBP高于Ⅲ级患者(P <0.05)。急性肾损伤分期1、2期患者NT-proBNP、ETX、HBP均低于3期患者(P <0.05),1期患者NT-proBNP、ETX、HBP低于2期患者(P <0.05)。死亡组急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、Ⅳ级心功能占比、急性肾损伤3期占比、心肌肌钙蛋白I (cTnI)、NT-proBNP、ETX、HBP高于生存组(P <0.05),LVEF低于生存组(P <0.05)。逐步多因素Logistic回归分析结果显示:APACHEⅡ评分[O^R=5.165(95%CI:2.125,12.554)]、SOFA评分[O^R=5.048(95%CI:2.077,12.268)]、心功能分级[O^R=4.889(95%CI:2.012,11.882)]、NT-proBNP[O^R=4.464(95%CI:1.837,10.849)]、ETX[O^R=3.983(95%CI:1.639,9.680)]、HBP [O^R=3.861(95%CI:1.589,9.384)]是影响重症心衰合并急性肾损伤患者预后的危险因素(P <0.05)。ROC曲线分析结果显示,NT-proBNP、ETX、HBP及3者联合预测重症心衰合并急性肾损伤患者预后的敏感性分别为76.67%、70.00%、73.33%和80.00%,特异性分别为71.19%、66.10%、72.88%和89.83%,AUC分别为0.741、0.719、0.721和0.908。结论 NT-proBNP、ETX、HBP与重症心衰合并急性肾损伤患者预后有关,3者联合预测患者预后效能良好。

Objective To investigate the predictive values of N-terminal pro B-type natriuretic peptide(NTproBNP), endotoxin(ETX) and heparin-binding protein(HBP) levels in prognosis of patients with severe heart failure complicating acute kidney injury. Methods A total of 89 patients with severe heart failure complicating acute kidney injury who were admitted to our hospital from January 2019 to March 2022 were selected. The clinical data including levels of NT-proBNP, ETX and HBP were collected, and the patients were followed up for 3 months after admission to evaluate their prognosis. The levels of NT-proBNP, ETX and HBP in patients with different New York Heart Association(NYHA) functional classes and acute kidney injury stages were detected. Factors affecting the prognosis of patients with severe heart failure complicating acute kidney injury were analyzed. The values of NTproBNP, ETX and HBP levels in predicting the prognosis of patients with severe heart failure complicating acute kidney injury were determined. Results The levels of NT-proBNP, ETX and HBP in NYHA class IV patients were higher than those in class III patients(P < 0.05). The levels of NT-proBNP, ETX and HBP in patients with acute kidney injury stage 1 to 2 were lower than those in stage 3 patients(P < 0.05), while they were even lower in stage 1patients than in stage 2 patients(P < 0.05). The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score, Sequential Organ Failure Assessment(SOFA) score, the proportions of NYHA class IV and acute kidney injury stage 3 patients, and the levels of cardiac troponin I(cTnI), NT-proBNP, ETX and HBP were higher, but left ventricular ejection fraction(LVEF) was lower in the death group compared with the survival group(P < 0.05).Multivariable Logistic regression analysis showed that the APACHE Ⅱ score [O^R = 5.165(95% CI: 2.125, 12.554) ],the SOFA score [O^R = 5.048(95% CI: 2.077, 12.268) ], the NYHA functional class [O^R = 4.889(95% CI: 2.012,11.882) ], the NT-proBNP level [O^R = 4.464(95% CI: 1.837, 10.849) ], the ETX level [O^R = 3.983(95% CI: 1.639,9.680) ], and the HBP level [ O^R = 3.861(95% CI: 1.589, 9.384) ] were risk factors affecting the prognosis of patients with severe heart failure complicating acute kidney injury(P < 0.05). The receiver operating characteristic(ROC) curve analysis showed that the sensitivities of NT-proBNP, ETX, HBP and their combination in predicting the prognosis of patients with severe heart failure complicating acute kidney injury were 76.67%, 70.00%, 73.33% and 80.00%, with the specificities being 71.19%, 66.10%, 72.88% and 89.83%, and the area under the ROC curves(AUCs) were 0.741, 0.719, 0.721 and 0.908, respectively. Conclusions NT-proBNP, ETX, and HBP are related to the prognosis of patients with severe heart failure complicating acute kidney injury, and combination of the three indicators yields great predictive efficacy for the prognosis of these patients.