联合检测NT-proBNP、H-FABP和cTnI对老年重症心力衰竭患者的临床价值
연합검측NT-proBNP、H-FABP화cTnI대노년중증심력쇠갈환자적림상개치
The clinical significance on the combined determination of NT-proBNP,H-FABP and cTnI in elder patients with severe heart failure
  • 万方数据
    检验医学 검험의학
    LABORATORY MEDICINE
    2014年 4期 312-318 ,共7页

    伍树芝%邓胜%秦伟国%陈健%易斌

    오수지%산성%진위국%진건%역빈

    氨基末端B型钠尿肽原%心型脂肪酸结合蛋白%肌钙蛋白I%心力衰竭 氨基末耑B型鈉尿肽原%心型脂肪痠結閤蛋白%肌鈣蛋白I%心力衰竭
    안기말단B형납뇨태원%심형지방산결합단백%기개단백I%심력쇠갈
    N-terminal pro-B-type natriuretic peptide%Heart-type fatty acid-binding protein%Troponin I%Heart failure
    目的：探讨氨基末端B型钠尿肽原（NT-proBNP）、心型脂肪酸结合蛋白（H-FABP）和心肌肌钙蛋白I （cTnI）联合检测对老年重症心力衰竭（HF）的临床价值。方法检测312例老年重症HF患者入院时、治疗后第7天、第15天、第30天、第60天及对照组（76例老年非重症HF患者和40名健康体检者）NT-proBNP、H-FABP 和cTnI水平。所有患者平均随访180 d，记录随访期间发生的主要不良心脏事件（MACE）。根据是否发生MACE分为MACE组（其中再入院组110例、死亡组84例）和无MACE组118例。采用受试者工作特征（ROC）曲线评估3项指标对重症HF诊断和预测死亡风险的价值。采用Kaplan-Meier曲线做生存分析。结果重症HF组入院时NT-proBNP、H-FABP和cTnI水平明显高于对照组（P＜0．01），其H-FABP阳性率为47．1％、cTnI阳性率为4．5％；且NT-proBNP水平与HF患者心功能分级[美国纽约心脏病协会（NYHA）Ⅰ～Ⅳ级]呈正相关（r＝0．77，P＜0．01）。根据ROC曲线选取血清 NT-proBNP、H-FABP 和 cTnI 值分别为4601．50 ng/L、5．16 ng/L 和0．025 ng/mL 及8178．50 ng/L、11．77 ng/L和0．038 ng/mL作为重症HF诊断及死亡预测的临界值，可获最佳诊断价值。3项指标联合检测对重症HF诊断及死亡预测的敏感性高于单项检测（P＜0．05）。治疗前，MACE组NT-porBNP水平明显高于无MACE组（P＜0．05），死亡组H-FABP水平明显高于非死亡组（P＜0．05），不同预后组cTnI水平差异无统计学意义（P＞0．05）。治疗后第7天，无MACE组3项指标水平明显下降（P＜0．05），且下降率均＞50％，H-FABP恢复正常；治疗后第15天，再入院组3项指标水平明显降低（P＜0．05），但下降率均＜30％，H-FABP仍高于参考区间；死亡组在治疗过程中3项指标水平未降反升，治疗后第7天、第30天cTnI均阳性。Kaplan-Meier曲线分析表明，不同NT-porBNP、H-FABP和cTnI水平的患者生存率有明显差异（P＜0．05）。结论定期联合检测NT-proBNP、H-FABP和cTnI水平对重症HF诊断、患者预后和死亡风险评估及疗效监测均有重要临床意义。
    목적：탐토안기말단B형납뇨태원（NT-proBNP）、심형지방산결합단백（H-FABP）화심기기개단백I （cTnI）연합검측대노년중증심력쇠갈（HF）적림상개치。방법검측312례노년중증HF환자입원시、치료후제7천、제15천、제30천、제60천급대조조（76례노년비중증HF환자화40명건강체검자）NT-proBNP、H-FABP 화cTnI수평。소유환자평균수방180 d，기록수방기간발생적주요불양심장사건（MACE）。근거시부발생MACE분위MACE조（기중재입원조110례、사망조84례）화무MACE조118례。채용수시자공작특정（ROC）곡선평고3항지표대중증HF진단화예측사망풍험적개치。채용Kaplan-Meier곡선주생존분석。결과중증HF조입원시NT-proBNP、H-FABP화cTnI수평명현고우대조조（P＜0．01），기H-FABP양성솔위47．1％、cTnI양성솔위4．5％；차NT-proBNP수평여HF환자심공능분급[미국뉴약심장병협회（NYHA）Ⅰ～Ⅳ급]정정상관（r＝0．77，P＜0．01）。근거ROC곡선선취혈청 NT-proBNP、H-FABP 화 cTnI 치분별위4601．50 ng/L、5．16 ng/L 화0．025 ng/mL 급8178．50 ng/L、11．77 ng/L화0．038 ng/mL작위중증HF진단급사망예측적림계치，가획최가진단개치。3항지표연합검측대중증HF진단급사망예측적민감성고우단항검측（P＜0．05）。치료전，MACE조NT-porBNP수평명현고우무MACE조（P＜0．05），사망조H-FABP수평명현고우비사망조（P＜0．05），불동예후조cTnI수평차이무통계학의의（P＞0．05）。치료후제7천，무MACE조3항지표수평명현하강（P＜0．05），차하강솔균＞50％，H-FABP회복정상；치료후제15천，재입원조3항지표수평명현강저（P＜0．05），단하강솔균＜30％，H-FABP잉고우삼고구간；사망조재치료과정중3항지표수평미강반승，치료후제7천、제30천cTnI균양성。Kaplan-Meier곡선분석표명，불동NT-porBNP、H-FABP화cTnI수평적환자생존솔유명현차이（P＜0．05）。결론정기연합검측NT-proBNP、H-FABP화cTnI수평대중증HF진단、환자예후화사망풍험평고급료효감측균유중요림상의의。
    Objective To study the clinical significance on the combined determination of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP),heart-type fatty acid-binding protein(H-FABP)and cardiac troponin I(cTnI)in elder patients with severe heart failure (HF ).Methods The serum NT-proBNP,H-FABP and cTnI levels were determined in 31 2 elder patients with severe HF {main adverse cardiovascular event (MACE )group (1 94 cases ) [cardiogenic readmission group(1 1 0 cases)and death group(84 cases)]and no-MACE group(1 1 8 cases)}on admission, day 7,1 5,30 and 60 after treatment,76 elder patients with no-severe HF and 40 elder healthy subjects.The MACE were followed and observed for 1 80 d.The significance of NT-proBNP,H-FABP and cTnI for the diagnosis of severe HF and the prediction of death risk was analyzed by receiver operating characteristic(ROC)curve.Survival analysis was performed by Kaplan-Meier curve.Results The serum NT-proBNP,H-FABP and cTnI levels in elder patients with severe HF were significantly higher than those in elder patients with no-severe HF and healthy subjects (P<0.01 ),the positive rate of H-FABP in elder patients with no-severe HF was 47.1%,and the positive rate of cTnI was 4.5%.The serum NT-proBNP levels were positively correlated with the grade of New York Heart Association (NYHA)Ⅰ-Ⅳ(r=0.77,P<0.01 ).The ROC curve indicated that the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for diagnosis in elder&nbsp;patients with severe HF were 4 601 .50 ng/L,5.1 6 ng/L and 0.025 ng/mL,and the optimal cut-off values of serum NT-proBNP,H-FABP and cTnI levels for the death risk evaluation in elder patients with severe HF were 8 1 78.50 ng/L, 1 1 .77ng/L and 0.038ng/mL,respectively.The sensitivity of the combined determination was obviously better than those of the individual determinations (P<0.05 ).Before the treatment,the serum NT-proBNP levels in MACE group were significantly higher than those in no-MACE group(P<0.05),the serum H-FABP levels in death group were significantly higher than those in no-death group(P<0.05 ),and the serum cTnI levels in various prognosis groups had no statistical significance (P>0.05 ).The serum NT-proBNP,H-FABP and cTnI levels in no-MACE group on day 7 after treatment were significantly lower than those before the treatment (P<0.05 ).The decreasing rates of the 3 parameters were >50%,and the serum H-FABP level was lower than the normal reference value.The serum NT-proBNP,H-FABP and cTnI levels in the cardiogenic readmission group on day 1 5 after treatment were significantly lower than those before treatment (P<0.05),but the decreasing rates of the 3 parameters were <30%,and the serum H-FABP level was higher than the normal reference value.The serum NT-proBNP,H-FABP and cTnI levels in death group on day 7 and day 30 after treatment were significantly higher than those before treatment(P<0.05),and the serum cTnI levels were higher than the normal reference value.Kaplan-Meier survival curve showed that the survival rates of serum NT-proBNP,H-FABP and cTnI levels had significant difference (P <0.05 ).Conclusions There is an important clinical significance of the combined determination of serum NT-proBNP,H-FABP and cTnI levels for the diagnosis,prognosis,death risk evaluation and curative effect survey in elder patients with severe HF.
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