NT-proBNP联合RDW或NLR对射血分数保留的心力衰竭的诊断价值

Diagnostic value of NT-proBNP combined with RDW or NRL for patients with heart failure with preserved ejection fraction

目的探讨红细胞分布宽度(Red cell distribution width,RDW)、中性粒淋巴细胞比值(Neutrophil lymphocyte ratio,NLR)、联合氨基末端B型利钠肽前体(N-terminal fragment of brain natriuretic peptide prohormone,NT-proBNP)对射血分数保留的心力衰竭(Heart failure with preserved ejection fraction,HFpEF)的诊断价值。方法回顾性分析2020年1月至2022年6月在邵阳市中心医院心内科住院且参照《中国心力衰竭诊断和治疗指南2018》诊断为HFpEF的患者120例(HFpEF组)及同期就诊的非心力衰竭患者90例(对照组)的临床资料。入组的HFpEF患者进行纽约心功能分级。比较HFpEF组与对照组基线资料、RDW、NLR及NT-proBNP水平的差异;比较不同心功能分级的HFpEF组间RDW、NLR水平的差异;分析HFpEF组RDW、NLR与NT-proBNP的相关性;绘制ROC曲线分析RDW、NLR在HFpEF中的联合诊断价值。结果HFpEF组患者的RDW、NLR、NT-proBNP水平较对照组高,差异有统计学意义(P<0.05);HFpEF组RDW、NLR均与NT-proBNP呈正相关;NT-proBNP诊断HFpEF的曲线下面积为0.844,RDW+NT-proBNP诊断HFpEF的曲线下面积为0.891,NLR+NT-proBNP诊断HFpEF的曲线下面积为0.894。结论RDW+NT-proBNP、NLR+NT-proBNP联合检测能有效提高HFpEF诊断的准确率。

Objective To investigate the diagnostic value of red blood cell distribution width(RDW),neutrophil-lymphocyte ratio(NLR)in combination with amino-terminal precursor B-type natriuretic peptide(NT-proBNP)in heart failure with preserved ejection fraction(to HFpEF).Methods In this study,we retrospectively collected and analyzed clinical data from 120 inpatients(a HFpEF group)who was diagnosed with HFpEF according to the Chinese Heart Failure Diagnosis and Treatment Guidelines 2018 from June 2020 to December 2021,as well as 90 patients(a control group)without heart failure during the same time period.Patients Heart function was evaluated according to the New York Heart Association(NYHA)Cardiac Function Classification Standard when they were admitted to the hospital.Baseline data including RDW,NLR,and NT-proBNP in the HFpEF group were compared to the control group.Meanwhile,we compared the RDW and NLR levels across HFpEF patients with different grades of cardiac function,and assessed their association with NT-proBNP level,respectively.Finally,we plotted the ROC curve to determine the diagnostic value of NT-proBNP combined with RDW or NLR in patients with HFpEF.Results The RDW,NLR,and NT-proBNP levels in the HFpEF group were significantly higher than those in the control group(P<0.05).RDW and NLR in the HFpEF group were positively correlated with NT-proBNP;the area under the curve of NT-proBNP for diagnosing HFpEF was 0.844(95%CI:0.788-0.890),and the optimal cut-off value was 630 pg/mL;the area under the curve of RDW+NT-proBNP in the diagnosis of HFpEF was 0.891(95%CI:0.841-0.930);the area under the curve of NLR+NT-proBNP in the diagnosis of HFpEF was 0.894(95%CI:0.845-0.933).A positive correlation between RDW or NLR and NT-proBNP was found in the HFpEF group.The area under the curve(AUC)of NT-proBNP for the diagnosis of HFpEF was 0.844(95%CI:0.788-0.890),and the optimal cutoff value was 630 pg/mL.Exhilaratingly,the AUC for NT-proBNP in combination with the RDW and NLR in the setting of a diagnosis of HFpEF was raised to 0.891(95%CI:0.841-0.930)and 0.894(95%CI:0.845-0.933),respectively.Conclusion NT-proBNP combined with the RDW or NLR on the basis of ROC curves may effectively improve the accuracy of HFpEF diagnosis.