C 端前血管加压素原（ copeptin ）作为急性心肌梗死的一种新型预后标志物：莱斯特急性心肌梗死肽（ LAMP ）研究

C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) study.

作者信息

Khan Sohail Q, Dhillon Onkar S, O'Brien Russell J, Struck Joachim, Quinn Paulene A, Morgenthaler Nils G, Squire Iain B, Davies Joan E, Bergmann Andreas, Ng Leong L

机构信息

University of Leicester, Department of Cardiovascular Sciences, Leicester Royal Infirmary, Leicester LE2 7LX, UK.

出版信息

Circulation. 2007 Apr 24;115(16):2103-10. doi: 10.1161/CIRCULATIONAHA.106.685503. Epub 2007 Apr 9.

DOI:10.1161/CIRCULATIONAHA.106.685503

PMID:17420344

Abstract

BACKGROUND

The role of the vasopressin system after acute myocardial infarction is unclear. Copeptin, the C-terminal part of the vasopressin prohormone, is secreted stoichiometrically with vasopressin. We compared the prognostic value of copeptin and an established marker, N-terminal pro-B-type natriuretic peptide (NTproBNP), after acute myocardial infarction.

METHODS AND RESULTS

In this prospective single-hospital study, we recruited 980 consecutive post-acute myocardial infarction patients (718 men, median [range] age 66 [24 to 95] years), with follow-up over 342 (range 0 to 764) days. Plasma copeptin was highest on admission (n=132, P<0.001, day 1 versus days 2 to 5) and reached a plateau at days 3 to 5. In the 980 patients, copeptin (measured at days 3 to 5) was elevated in patients who died (n=101) or were readmitted with heart failure (n=49) compared with survivors (median [range] 18.5 [0.6 to 441.0] versus 6.5 [0.3 to 267.0] pmol/L, P<0.0005). With logistic regression analysis, copeptin (odds ratio, 4.14, P<0.0005) and NTproBNP (odds ratio, 2.26, P<0.003) were significant independent predictors of death or heart failure at 60 days. The area under the receiver operating characteristic curves for copeptin (0.75) and NTproBNP (0.76) were similar. The logistic model with both markers yielded a larger area under the curve (0.84) than for NTproBNP (P<0.013) or copeptin (P<0.003) alone, respectively. Cox modeling predicted death or heart failure with both biomarkers (log copeptin [hazard ratio, 2.33], log NTproBNP [hazard ratio, 2.70]). In patients stratified by NTproBNP (above the median of approximately 900 pmol/L), copeptin above the median (approximately 7 pmol/L) was associated with poorer outcome (P<0.0005). Findings were similar for death and heart failure as individual end points.

CONCLUSIONS

The vasopressin system is activated after acute myocardial infarction. Copeptin may predict adverse outcome, especially in those with an elevated NTproBNP (more than approximately 900 pmol/L).

摘要

背景

急性心肌梗死后血管加压素系统的作用尚不清楚。 copeptin是血管加压素原激素的C末端部分，与血管加压素按化学计量比分泌。我们比较了急性心肌梗死后copeptin与已确立的标志物N末端B型利钠肽原（NTproBNP）的预后价值。

方法与结果

在这项前瞻性单中心研究中，我们连续招募了980例急性心肌梗死后患者（718例男性，年龄中位数[范围]为66 [24至95]岁），随访时间超过342天（范围0至764天）。血浆copeptin在入院时最高（n = 132，P <0.001，第1天与第2至5天相比），并在第3至5天达到平台期。在这980例患者中，死亡患者（n = 101）或因心力衰竭再次入院患者（n = 49）的copeptin（在第3至5天测量）高于幸存者（中位数[范围] 18.5 [0.6至441.0]对6.5 [0.3至267.0] pmol/L，P <0.0005）。通过逻辑回归分析，copeptin（优势比，4.14，P <0.0005）和NTproBNP（优势比，2.26，P <0.003）是60天时死亡或心力衰竭的重要独立预测因素。copeptin（0.75）和NTproBNP（0.76）的受试者工作特征曲线下面积相似。包含两种标志物的逻辑模型产生的曲线下面积（0.84）分别大于单独的NTproBNP（P <0.013）或copeptin（P <0.003）。Cox模型预测两种生物标志物均提示死亡或心力衰竭（log copeptin [风险比，2.33]，log NTproBNP [风险比，2.70]）。在按NTproBNP分层（高于约900 pmol/L的中位数）的患者中，copeptin高于中位数（约7 pmol/L）与较差的预后相关（P <0.0005）。将死亡和心力衰竭作为单独终点的结果相似。