Campbell Duncan J, Woodward Mark, Chalmers John P, Colman Samuel A, Jenkins Alicia J, Kemp Bruce E, Neal Bruce C, Patel Anushka, MacMahon Stephen W
St. Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
Hypertension. 2005 Jan;45(1):69-74. doi: 10.1161/01.HYP.0000151103.02424.c3. Epub 2004 Nov 29.
B-type natriuretic peptide (BNP) and C-reactive protein (CRP) are elevated in persons at risk for congestive heart failure (CHF). However, limited data are available directly comparing BNP-related peptides and CRP in persons at risk of CHF. To evaluate amino terminal-pro-BNP (NT-proBNP) and CRP, separately and together, for assessment of risk of CHF, we performed a nested case-control study of the 6105 participants of the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack (TIA). Each of 258 subjects who developed CHF resulting in death, hospitalization, or withdrawal of randomized therapy during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. NT-proBNP and CRP predicted CHF; the odds ratio for subjects in the highest compared with the lowest quarter was 4.5 (95% confidence interval, 2.7 to 7.5) for NT-proBNP and 2.9 (confidence interval, 1.9 to 4.7) for CRP, and each remained a predictor of CHF after adjustment for all other predictors. Screening for both markers provided better prognostic information than screening for either alone. Elevation of NT-proBNP above 50 pmol/L and CRP above 0.84 mg/L predicted CHF with sensitivity of 64% and specificity of 66%. NT-proBNP and CRP predicted CHF in subjects receiving perindopril-based therapy. We conclude that NT-proBNP and CRP are independent predictors of CHF risk after stroke or TIA. Moreover, NT-proBNP and CRP may be markers of mechanisms of CHF pathogenesis distinct from those responsive to angiotensin-converting enzyme inhibitor-based therapy.
B型利钠肽（BNP）和C反应蛋白（CRP）在有充血性心力衰竭（CHF）风险的人群中会升高。然而，直接比较有CHF风险人群中BNP相关肽和CRP的数据有限。为了分别及联合评估氨基末端前BNP（NT-proBNP）和CRP以评估CHF风险，我们对培哚普利预防复发性卒中研究（PROGRESS）的6105名参与者进行了一项巢式病例对照研究，该研究是一项针对既往有卒中或短暂性脑缺血发作（TIA）的个体的基于培哚普利的降压方案的安慰剂对照研究。在平均3.9年的随访期间发生CHF导致死亡、住院或随机治疗退出的258名受试者中的每一位都与1至3名对照受试者进行匹配。NT-proBNP和CRP可预测CHF；与最低四分位数的受试者相比，最高四分位数的受试者的NT-proBNP的比值比为4.5（95%置信区间，2.7至7.5），CRP为2.9（置信区间，1.9至4.7），并且在对所有其他预测因素进行调整后，每一个仍然是CHF的预测因素。同时筛查这两种标志物比单独筛查任何一种提供了更好的预后信息。NT-proBNP高于50 pmol/L和CRP高于0.84 mg/L可预测CHF，敏感性为64%，特异性为66%。NT-proBNP和CRP在接受基于培哚普利治疗的受试者中可预测CHF。我们得出结论，NT-proBNP和CRP是卒中或TIA后CHF风险的独立预测因素。此外，NT-proBNP和CRP可能是CHF发病机制的标志物，与那些对基于血管紧张素转换酶抑制剂的治疗有反应的机制不同。
