不同肾小球滤过率下血清CA-125和NT-proBNP对急性心力衰竭患者预后的预测价值

The predictive value of serum CA-125 and NT-proBNP at different glomerular filtration rates in the prognosis of the patients with acute heart failure

目的评估入院时基线估算肾小球滤过率(estimated glomerular filtration rate,eGFR)水平是否会影响血清糖类抗原125(carbohydrate antigen 125,CA-125)和N末端B型钠尿肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)对急性心力衰竭(acute heart failure,AHF)患者预后的预测价值。方法应用前瞻性队列研究方法,根据患者入院时基线估算肾小球滤过率(eGFR)水平将其分为四组:eGFR≥60 mL/(min·1.73 m^(2))为组1,eGFR 45~59 mL/(min·1.73 m^(2))为组2,eGFR 30~44 mL/(min·1.73 m^(2))为组3,eGFR<30 mL/(min·1.73 m^(2))为组4。对比分析四组患者的基线资料、出院后1年预后及基线CA-125、NT-proBNP对AHF患者出院后1年预后的预测价值。结果(1)232例AHF患者中,44例在出院后1年内全因死亡,全因病死率18.97%;28例在出院后1年内心血管死亡,心血管病死率12.07%;(2)血清CA-125(OR=1.336,P=0.000)、NT-proBNP(OR=1.231,P=0.017)是AHF患者出院后1年全因死亡(CA-125:OR=1.336,P=0.000;NT-proBNP:OR=1.193,P=0.000)和心血管死亡(CA-125:OR=1.225,P=0.000;NT-proBNP:OR=1.193,P=0.000)的影响因素;(3)组1、2、3、4中,血清CA-125对AHF患者出院后1年全因死亡预测价值的曲线下面积(AUC)分别为0.752、0.759、0.757、0.764,对出院后1年心血管死亡预测价值的AUC分别为0.779、0.748、0.774、0.783;(4)组1、2、3、4中,血清NT-proBNP对AHF患者出院后1年全因死亡预测价值的AUC分别为0.785、0.754、0.727、0.673,对出院后1年心血管死亡预测价值的AUC分别为0.742、0.749、0.726、0.668。结论CA-125和NT-proBNP对AHF患者均具有一定的预后预测价值,但在eGFR严重降低的AHF患者中,CA-125比NT-proBNP具有更高的预后预测价值。

Objective To evaluate whether the baseline estimated glomerular filtration rates(eGFR)at admission affect the predictive value of carbohydrate antigen 125(CA-125)and serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the prognosis of acute heart failure(AHF)patients.Methods Prospective Cohort study was used.Patients were divided into four groups based on their baseline eGFR levels at admission:eGFR was≥60 mL/(min·1.73 m^(2))in Group 1,eGFR was 45-59 mL/(min·1.73 m^(2))in Group 2,eGFR was 30-44 mL/(min·1.73 m^(2))in Group 3,eGFR was<30 mL/(min·1.73 m^(2))in Group 4.The baseline data,the prognosis one year after discharge,the predictive value of baseline CA-125 and baseline NT-proBNP for the prognosis of AHF patients one year after discharge were compared and analyzed in four groups.Results(1)Among 232 AHF patients,44 died from all causes within one year after discharge,with the all-cause mortality rate of 18.97%;28 cases died of cardiovascular disease within one year after discharge,with a cardiovascular mortality rate of 12.07%.(2)Serum CA-125(OR=1.336,P=0.000)and NT-proBNP(OR=1.231,P=0.017)were influencing factors for all-cause mortality(CA-125:OR=1.336,P=0.000;NT-proBNP:OR=1.193,P=0.000)and cardiovascular death in AHF patients one year after discharge(CA-125:OR=1.225,P=0.000;NT-proBNP:OR=1.193,P=0.000).(3)The AUC values of serum CA-125 for predicting all-cause mortality in AHF patients one year after discharge were 0.752,0.759,0.757 and 0.764 in groups 1,2,3 and 4,respectively;The AUC values of serum CA-125 for predicting cardiovascular death in AHF patients one year after discharge were 0.779,0.748,0.774 and 0.783 in groups 1,2,3 and 4,respectively.(4)The AUC of the predictive value of serum NT-proBNP for all-cause mortality in AHF patients one year after discharge was 0.785,0.754,0.727 and 0.673 in groups 1,2,3 and 4,respectively;The AUC of the predictive value of serum NT-proBNP for cardiovascular death in AHF patients one year after discharge was 0.742,0.749,0.726 and 0.668 in groups 1,2,3 and 4,respectively.Conclusions In AHF patients,both CA-125 and NT-proBNP have certain prognostic predictive value,but CA-125 has higher prognostic predictive value than NT-proBNP in AHF patients with significant eGFR reduction.