正常范围的N末端B型利钠肽原对心功能不全患者预后的影响

Clinical Features and Outcome of Patients With Cardiac Dysfunction With N-terminal Pro-B-type Natriuretic Peptide in Normal Range

目的:探讨心功能不全患者中N末端B型利钠肽原(NT-proBNP)正常的人群的临床特征,并观察其临床预后。方法:连续纳入2019年1月至2021年10月郑州大学第一附属医院收治的心功能不全患者,根据其住院期间多次测得NT-proBNP结果均低于年龄及肾功能分层切点,筛选出NT-proBNP正常组,并随机挑选同期1个月内收治的NT-proBNP升高的心力衰竭患者作为对照,分析NT-proBNP正常组与NT-proBNP升高组的临床特征,并比较两组患者出院6个月内再住院率。结果:本研究共纳入198例心功能不全患者,其中NT-proBNP正常组患者86例(43.4%),NT-proBNP升高组患者112例(56.6%)。与NT-proBNP升高组相比,NT-proBNP正常组患者体重指数(BMI)较高,血红蛋白、血钠、估算肾小球滤过率(eGFR)值高,左心室射血分数(LVEF)高,合并高脂血症的比例高,服用钙拮抗剂的比例高;而左心室舒张末期内径、左心房内径值小,合并心房颤动、肾功能不全、心脏瓣膜病的比例低,服用利尿剂、盐皮质激素受体拮抗剂(MRA)的比例低(P均<0.05)。在校正了BMI、高血压、利尿剂及MRA服用情况后,eGFR、LVEF、心房颤动、心脏瓣膜病仍是影响NT-proBNP升高的独立相关因素(P均<0.05)。NT-proBNP正常组的心功能不全患者,住院天数比NT-proBNP升高组短,出院6个月内心力衰竭再住院率比NT-proBNP升高组低(P均<0.001)。结论:eGFR、LVEF、心房颤动、心脏瓣膜病是影响NT-proBNP升高的独立相关因素。与NT-proBNP升高的心力衰竭患者相比,NT-proBNP正常的心功能不全患者再住院的风险低,预后较好。

Objectives:To investigate the clinical characteristics and prognosis of patients with cardiac dysfunction with normal N-terminal pro-B-type natriuretic peptide(NT-proBNP).Methods:Patients with cardiac dysfunction admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to October 2021 were consecutively enrolled.The normal NT-proBNP group was screened according to the NTproBNP results measured during hospitalization,which were lower than the age and renal function stratified cut-off point.Heart failure patients with elevated NT-proBNP admitted in the same period were randomly selected as the elevated NTproBNP group.The clinical characteristics of the two groups were analyzed,and the rehospitalization rate within 6 months after discharge was compared between the two groups.Results:A total of 198 patients were enrolled in this study,including 86 cases(43.4%)in the normal NT-proBNP group and 112 cases(56.6%)in the elevated NT-proBNP group.Compared with the elevated NT-proBNP group,the normal NTproBNP group had higher body mass index(BMI),higher hemoglobin,serum sodium,estimated glomerular filtration rate(eGFR),higher left ventricular ejection fraction(LVEF),and higher proportion of patients who had hyperlipidemia and took calcium channel blockers(CCB);however,the left ventricular end-diastolic diameter and left atrial diameter were smaller,the proportion of patients with atrial fibrillation,renal insufficiency and heart valve disease was lower,and the proportion of patients taking diuretics and salt corticosteroid receptor antagonist(MRA)was lower in the normal NT-proBNP group(all P<0.05).After adjusting for BMI,hypertension,diuretics and MRA use,eGFR,LVEF,atrial fibrillation and valvular heart disease remained independent determinants of elevated NT-proBNP(all P<0.05).Compared with those in the elevated NTproBNP group,patients with cardiac dysfunction in the normal NT-proBNP group had shorter hospitalization duration,and lower rate of rehospitalization within 6 months after discharge(all P<0.001).Conclusions:eGFR,LVEF,atrial fibrillation and valvular heart disease are independent factors affecting the elevation of NT-proBNP.Compared with heart failure patients with elevated NT-proBNP,patients with cardiac dysfunction with normal NT-proBNP have a lower risk of rehospitalization and a better prognosis.