肾功能、充血性心力衰竭与氨基末端脑钠肽前体测定：急诊科呼吸困难的脑钠肽前体研究（PRIDE）结果

Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study.

作者信息

Anwaruddin Saif, Lloyd-Jones Donald M, Baggish Aaron, Chen Annabel, Krauser Daniel, Tung Roderick, Chae Claudia, Januzzi James L

机构信息

Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.

出版信息

J Am Coll Cardiol. 2006 Jan 3;47(1):91-7. doi: 10.1016/j.jacc.2005.08.051. Epub 2005 Dec 9.

DOI:10.1016/j.jacc.2005.08.051

PMID:16386670

Abstract

UNLABELLED

The relationship between renal insufficiency and amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels remains unclear. We examined this relationship in the context of patients who presented to the emergency department of an urban tertiary care medical center with dyspnea. Even in the presence of renal insufficiency, NT-proBNP remained a valuable tool for the diagnosis of acute congestive heart failure and it provides important prognostic information.

OBJECTIVES

We sought to examine the interaction between renal function and amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels.

BACKGROUND

The effects of renal insufficiency on NT-proBNP among patients with and without acute congestive heart failure (CHF) are controversial. We examined the effects of kidney disease on NT-proBNP-based CHF diagnosis and prognosis.

METHODS

A total of 599 dyspneic patients with glomerular filtration rates (GFRs) as low as 14.8 ml/min were analyzed. We used multivariate logistic regression to examine covariates associated with NT-proBNP results and linear regression analysis to analyze associations between NT-proBNP and GFR. Receiver-operating characteristic analysis determined the sensitivity and specificity of NT-proBNP for CHF diagnosis. We also assessed 60-day mortality rates as a function of NT-proBNP concentration.

RESULTS

Glomerular filtration rates ranged from 15 ml/min/1.73 m2 to 252 ml/min/1.73 m2. Renal insufficiency was associated with risk factors for CHF, and patients with renal insufficiency were more likely to have CHF (all p < 0.003). Worse renal function was accompanied by cardiac structural and functional abnormalities on echocardiography. We found that NT-proBNP and GFR were inversely and independently related (p < 0.001) and that NT-proBNP values of > 450 pg/ml for patients ages <50 years and >900 pg/ml for patients > or =50 years had a sensitivity of 85% and a specificity of 88% for diagnosing acute CHF among subjects with GFR > or =60 ml/min/1.73 m2. Using a cut point of 1,200 pg/ml for subjects with GFR <60 ml/min/1.73 m2, we found sensitivity and specificity to be 89% and 72%, respectively. We found that NT-proBNP was the strongest overall independent risk factor for 60-day mortality (hazard ratio 1.57; 95% confidence interval 1.2 to 2.0; p = 0.0004) and remained so even in those with GFR <60 ml/min/1.73 m2 (hazard ratio 1.61; 95% confidence interval 1.14 to 2.26; p = 0.006).

CONCLUSIONS

The use of NT-proBNP testing is valuable for the evaluation of the dyspneic patient with suspected CHF, irrespective of renal function.

摘要

未标注

肾功能不全与氨基末端脑钠肽前体（NT-proBNP）水平之间的关系仍不明确。我们在因呼吸困难到城市三级医疗中心急诊科就诊的患者中研究了这种关系。即使存在肾功能不全，NT-proBNP仍然是诊断急性充血性心力衰竭的重要工具，并且能提供重要的预后信息。

目的

我们试图研究肾功能与氨基末端脑钠肽前体（NT-proBNP）水平之间的相互作用。

背景

肾功能不全对合并或未合并急性充血性心力衰竭（CHF）患者的NT-proBNP的影响存在争议。我们研究了肾病对基于NT-proBNP的CHF诊断和预后的影响。

方法

共分析了599例肾小球滤过率（GFR）低至14.8 ml/min的呼吸困难患者。我们使用多因素逻辑回归分析与NT-proBNP结果相关的协变量，并使用线性回归分析来分析NT-proBNP与GFR之间的关联。通过受试者工作特征分析确定NT-proBNP对CHF诊断的敏感性和特异性。我们还评估了60天死亡率作为NT-proBNP浓度的函数。

结果

肾小球滤过率范围为15 ml/min/1.73 m2至252 ml/min/1.73 m2。肾功能不全与CHF的危险因素相关，肾功能不全患者更易患CHF（所有p<0.003）。肾功能越差，超声心动图显示的心脏结构和功能异常越明显。我们发现NT-proBNP与GFR呈负相关且独立相关（p<0.001），对于年龄<50岁的患者，NT-proBNP值>450 pg/ml，对于年龄≥50岁的患者，NT-proBNP值>900 pg/ml，在GFR≥60 ml/min/1.73 m2的受试者中诊断急性CHF的敏感性为85%，特异性为88%。对于GFR<60 ml/min/1.73 m2的受试者，使用1200 pg/ml的切点，我们发现敏感性和特异性分别为89%和72%。我们发现NT-proBNP是60天死亡率最强的总体独立危险因素（风险比1.57；95%置信区间1.2至2.0；p = 0.0004），即使在GFR<60 ml/min/1.73 m2的患者中也是如此（风险比1.61；95%置信区间1.14至2.26；p = 0.006）。