恶性肿瘤与血清氨基末端脑钠肽前体的相关性:一项横断面研究

Correlation between malignant tumors and serum N-terminal pro-brain natriuretic peptide: a cross-sectional study

目的 探讨恶性肿瘤与血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)的相关性。方法 选择2009年1月1日至2020年12月31日在中国人民解放军总医院第一医学中心心内科住院并行冠脉造影的患者,新近诊断且尚未接受任何抗肿瘤治疗的恶性肿瘤患者共336例(肿瘤组),采用倾向性评分,以性别、年龄为匹配因素,按1∶3的比例匹配1 008例患者(非肿瘤组)。收集患者临床资料,包括年龄、性别、血清NT-proBNP、左心室射血分数(left ventricular ejection fraction, LVEF)、SYNTAX评分、血清肌酐以及肿瘤诊断信息等。根据纳入患者的NT-proBNP四分位数分为4组:低水平组(NT-proBNP≤61.80 pg/mL)、中水平组(61.80pg/mL<NT-proBNP≤152.95pg/mL)、高水平组(152.95pg/mBNP470.10pg/mL)以及很高水平组(NT-proBNP>470.10Pg/mL)。采用有序logistic回归分析患恶性肿瘤与血清NT-proBNP的相关性。结果 共纳入1 344例患者,平均年龄(65.78±9.18)岁,男性1 003例(74.63%),LVEF 60.00%(55.00%, 64.00%),SYNTAX评分(13.84±11.63)分,肌酐76.60(66.50, 88.88)μmol/L。336例肿瘤患者中,患病人数前3位的肿瘤分别为肺癌(84例, 25.00%)、肠道肿瘤(58例, 17.26%)和胃癌(52例, 15.48%)。肿瘤组患者的NT-proBNP水平显著高于非肿瘤组[208.45(85.75, 601.83)pg/mL vs 134.35(57.18, 430.23)pg/mL, P<0.001]。有序logistic回归分析显示,在未经调整的模型中,患恶性肿瘤与NTproBNP水平较高相关(OR=1.561, 95%CI 1.538~1.584, P<0.001);在校正相关影响因素后,患恶性肿瘤仍与血清NTproBNP水平较高显著相关(OR=1.384,95%CI 1.070~1.791, P=0.013)。结论 恶性肿瘤患者的NT-proBNP水平高于非恶性肿瘤患者,患恶性肿瘤与血清NT-proBNP水平显著相关。

Objective To explore the correlation between malignant tumors and serum N-terminal pro-brain natriuretic peptide(NT-proBNP) levels. Methods A total of 336 patients with malignant tumors(cancer group) who were admitted to the Department of Cardiology, Chinese PLA General Hospital and underwent coronary angiography from January 1, 2009 to December31, 2020, and were newly diagnosed and had not received any anti-tumor treatment were selected. They were matched with 1 008patients(non-cancer group) in a 1∶3 ratio using propensity score matching based on gender and age. Clinical data of the patients were collected, including age, gender, serum NT-proBNP, left ventricular ejection fraction(LVEF), SYNTAX score, serum creatinine, and tumor diagnosis information. The patients were divided into 4 groups based on the quartiles of NT-proBNP levels:low-level group(NT-proBNP≤61.80 pg/mL), medium-level group(61.80 pg/mL470.10 pg/mL). Ordered logistic regression analysis was used to analyze the correlation between malignant tumors and serum NT-proBNP. Results A total of 1 344patients were included, with an average age of(65.78±9.18) years old, 1 003 males(74.63%), LVEF of 60.00%(55.00%, 64.00%),SYNTAX score of(13.84±11.63) points, and creatinine level of 76.60(66.50, 88.88) μmol/L. Among the 336 cancer patients, the top 3 types of cancer were lung cancer(84 cases, 25.00%), colorectal cancer(58 cases, 17.26%), and gastric cancer(52 cases,15.48%). The NT-proBNP levels in the cancer group were significantly higher than those in the non-cancer group(208.45[85.75,601.83] pg/mL vs 134.35[57.18, 430.23] pg/mL, P<0.001). Ordered logistic regression analysis showed that in the unadjusted model, malignant tumors were significantly associated with higher NT-proBNP levels(OR=1.561, 95% CI 1.538-1.584, P<0.001);after adjusting for relevant factors, malignant tumors remained significantly associated with higher serum NT-proBNP levels(OR=1.384, 95% CI 1.070-1.791, P=0.013). Conclusions NT-proBNP in malignant tumor patients is higher than that in nonmalignant tumor patients, and there is a significant correlation between malignant tumors and serum NT-proBNP levels.