CAJ | 학술논문

目的探讨影响高龄老年人（年龄≥80岁）氮末端脑利钠肽前体（ NT-proBNP ）水平的相关因素。方法纳入2007年11月至2010年10月在解放军总医院老年病房住院，除外急性心功能不全，6个月内有急性心肌梗死、行冠状动脉旁路移植术或经皮冠状动脉成形术等病史的高龄（年龄≥80岁）老年患者共856例。测量身高、体重，采集病史；查血常规、血生化、NT-proBNP水平；完善超声心动图检查。结果（1） NT-proBNP水平与慢性肾功能不全（β＝0.290，P＝0.000）、慢性心功能不全（β＝0.321，P＝0.000）、高血压（β＝0.119，P＝0.004）、房颤（β＝0.358，P＝0.000）、起搏器植入（β＝0.231，P＝0.001）、脑梗死（β＝0.088， P＝0.014）、感染（β＝0.285，P＝0.000）及血红蛋白（β＝-0.007，P＝0.004）等临床因素显著相关；（2）NT-proBNP与年龄（β＝0.018，P＝0.000）、BMI（β＝-0.026，P＝0.000）等非疾病因素相关，校正慢性肾功能不全、慢性心功能不全、高血压、房颤、感染等因素后，其依然与年龄独立相关（β＝0.018， P＝0.000）；（3） NT-proBNP与左心房内径（β＝0.044，P＝0.000）、左心室质量指数（β＝0.016，P＝0.000）、左心室射血分数（β＝-0.017，P＝0.002）及E/A比值（β＝-0.218，P＝0.000）显著相关。结论在80岁以上的老年人中，NT-proBNP水平与多种疾病或非疾病因素相关，可以作为评价心脏结构和功能的指标。
목적탐토영향고령노년인（년령≥80세）담말단뇌리납태전체（ NT-proBNP ）수평적상관인소。방법납입2007년11월지2010년10월재해방군총의원노년병방주원，제외급성심공능불전，6개월내유급성심기경사、행관상동맥방로이식술혹경피관상동맥성형술등병사적고령（년령≥80세）노년환자공856례。측량신고、체중，채집병사；사혈상규、혈생화、NT-proBNP수평；완선초성심동도검사。결과（1） NT-proBNP수평여만성신공능불전（β＝0.290，P＝0.000）、만성심공능불전（β＝0.321，P＝0.000）、고혈압（β＝0.119，P＝0.004）、방전（β＝0.358，P＝0.000）、기박기식입（β＝0.231，P＝0.001）、뇌경사（β＝0.088， P＝0.014）、감염（β＝0.285，P＝0.000）급혈홍단백（β＝-0.007，P＝0.004）등림상인소현저상관；（2）NT-proBNP여년령（β＝0.018，P＝0.000）、BMI（β＝-0.026，P＝0.000）등비질병인소상관，교정만성신공능불전、만성심공능불전、고혈압、방전、감염등인소후，기의연여년령독립상관（β＝0.018， P＝0.000）；（3） NT-proBNP여좌심방내경（β＝0.044，P＝0.000）、좌심실질량지수（β＝0.016，P＝0.000）、좌심실사혈분수（β＝-0.017，P＝0.002）급E/A비치（β＝-0.218，P＝0.000）현저상관。결론재80세이상적노년인중，NT-proBNP수평여다충질병혹비질병인소상관，가이작위평개심장결구화공능적지표。
Objective To investigate how many factors will affect the serum N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) level in the very elderly people ( age≥80 years ) .Methods 856 in-patients who excluded acute heart failure ,acute myocardial infarction ,coronary artery bypass graft and percutaneous transcoronary angioplasty last six months from Nov 2007 to Oct 2010 in geriatric cardiology department in the PLA general hospital were enrolled in this study .Medical history,measured height and weight of body were collected ,both plasma marker (hemoglobin,blood glucose,serum total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,NT-proBNP)measurement and echocardiography were performed .Results A multiple linear regression analysis was done to determine the factors associated with the propeptide concentrations in very elderly population ,NT-proBNP was mainly associated with chronic kidney disease (β=0.290 , P =0.000 ) , chronic heart failure(β=0.321,P =0.000),hypertension(β=0.119,P =0.004),atrial fibrillation(β=0.358,P=0.000), pacemaker(β=0.231,P=0.001),brain infarction(β=0.088,P=0.014),infection(β=0.285,P=0.000)and anemia(β=-0.007,P=0.004).Multiple regression analysis showed that NT-proBNP was related significantly with non-disease factors such as age (β=0.018 , P =0.000 ) and BMI (β=-0.026 , P =0.000 ) , the correlation was remain significantly after adjust chronic renal disease ,chronic heart failure,hypertension,atrial fibrillation,post-pacemaker ,cerebral infarction , anemia and infection .Left atrial diameter (β=0.044 , P =0.000 ) , left ventricular mass index(β=0.016,P=0.000),left ventricular ejection fraction (β=-0.017,P=0.002)and E/A raito(β=-0.218,P=0.000)was significantly correlated with serum NT-proBNP.Conclusions Many factors,including non-diseases,such as age and BMI,and diseases,such as chronic heart failure,chronic renal disease,hypertension,atrial fibrillation,post-pacemaker,cerebral infarction,anaemia and infection were significantly affected serum NT-proBNP level in very elderly people (age≥80 years).Serum NT-proBNP concentration was related with change of structure and function of heart ,which imply that NT-proBNP remain as a marker to assessment structure and function of heart in very elderly people .