B型利钠肽与肾功能在心力衰竭诊断中的作用：来自“呼吸不畅”多国研究的分析

B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study.

作者信息

McCullough Peter A, Duc Philippe, Omland Torbjørn, McCord James, Nowak Richard M, Hollander Judd E, Herrmann Howard C, Steg Philippe G, Westheim Arne, Knudsen Cathrine Wold, Storrow Alan B, Abraham William T, Lamba Sumant, Wu Alan H B, Perez Alberto, Clopton Paul, Krishnaswamy Padma, Kazanegra Radmila, Maisel Alan S

机构信息

University of California, San Diego Veteran's Affairs Medical Center, San Diego, CA, USA.

出版信息

Am J Kidney Dis. 2003 Mar;41(3):571-9. doi: 10.1053/ajkd.2003.50118.

DOI:10.1053/ajkd.2003.50118

PMID:12612980

Abstract

BACKGROUND

Both B-type natriuretic peptide (BNP) and renal function are prognostic indicators of survival in patients with congestive heart failure (CHF). However, relationships between BNP, renal function, and heart failure as an emergency diagnosis are unknown.

METHODS

The Breathing Not Properly Multinational Study was a prospectively designed diagnostic test evaluation study conducted in seven centers. Of 1,586 participants who presented with acute dyspnea, 1,452 patients (91.6%) had both BNP level and baseline estimated glomerular filtration rate (eGFR) available. Patients with an eGFR less than 15 mL/min/1.73 m2 and those on dialysis therapy were excluded. The final diagnosis was adjudicated by two independent cardiologists who were blinded to BNP results.

RESULTS

The final diagnosis was CHF in 715 patients (49.2%). Raw and log-log transformed correlations between BNP and eGFR values were r = -0.19 and r = -0.17 for those with CHF and r = -0.20 and r = -0.31 for those without CHF (both P < 0.0001 for r not equal 0). Mean BNP levels were 561.6 pg/mL (162.3 fmol/mL), 647.5 pg/mL (187.1 fmol/mL), 745.6 pg/mL (215.5 fmol/mL), and 850.7 pg/mL (245.8 fmol/mL) for those with CHF and 85.4 pg/mL (24.7 fmol/mL), 131.7 pg/mL (38.1 fmol/mL), 297.2 pg/mL (85.9 fmol/mL), and 285.0 pg/mL (82.3 fmol/mL) for those without CHF in eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m2, respectively. The area under the receiver operating characteristic curve and optimum cut points for BNP were 0.91 and 70.7 pg/mL (20.4 fmol/mL), 0.90 and 104.3 pg/mL (30.1 fmol/mL), 0.81 and 201.2 pg/mL (58.1 fmol/mL), and 0.86 and 225.0 pg/mL (65.0 fmol/mL) for the eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m2, respectively.

CONCLUSION

Renal function correlates weakly with BNP and influences the optimal cut point for BNP, particularly in those with an eGFR less than 60 mL/min/1.73 m2.

摘要

背景

B型利钠肽（BNP）和肾功能都是充血性心力衰竭（CHF）患者生存的预后指标。然而，BNP、肾功能与作为急诊诊断的心力衰竭之间的关系尚不清楚。

方法

“呼吸不畅”多国研究是一项在7个中心进行的前瞻性设计的诊断试验评估研究。在1586例出现急性呼吸困难的参与者中，1452例患者（91.6%）有BNP水平和基线估计肾小球滤过率（eGFR）数据。排除eGFR低于15 mL/min/1.73 m²的患者和接受透析治疗的患者。最终诊断由两位对BNP结果不知情的独立心脏病专家裁定。

结果

715例患者（49.2%）最终诊断为CHF。CHF患者中BNP与eGFR值的原始及对数-对数转换后的相关性分别为r = -0.19和r = -0.17，非CHF患者中分别为r = -0.20和r = -0.31（r≠0时，P均<0.0001）。eGFR分别为90及以上、89至60、59至30和低于30 mL/min/1.73 m²时，CHF患者的平均BNP水平分别为561.6 pg/mL（162.3 fmol/mL）、647.5 pg/mL（187.1 fmol/mL）、745.6 pg/mL（215.5 fmol/mL）和850.7 pg/mL（245.8 fmol/mL），非CHF患者分别为85.4 pg/mL（24.7 fmol/mL）、131.7 pg/mL（38.1 fmol/mL）、297.2 pg/mL（85.9 fmol/mL）和285.0 pg/mL（82.3 fmol/mL）。eGFR分别为90及以上、89至60、59至30和低于30 mL/min/1.73 m²时，BNP的受试者工作特征曲线下面积及最佳切点分别为0.91和70.7 pg/mL（20.4 fmol/mL）、0.90和104.3 pg/mL（30.1 fmol/mL）、0.81和201.2 pg/mL（58.1 fmol/mL）以及0.86和225.0 pg/mL（65.0 fmol/mL）。