Pimenta Joana Martins, Almeida Rui, Araújo José Paulo, Azevedo Ana, Friões Fernando, Rocha-Gonçalves Francisco, Ferreira António, Bettencourt Paulo
Department of Internal Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
J Card Fail. 2007 May;13(4):275-80. doi: 10.1016/j.cardfail.2007.01.001.
Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable diagnostic and prognostic test in heart failure (HF). Limited information is available concerning its use in patients with renal failure, in whom dependence on renal clearance may negatively affect its performance.
We evaluated influence of renal function on NT-proBNP levels and on its prognostic value after hospital discharge in 283 acute HF patients. Admission and discharge NT-proBNP levels were higher in patients with decreased estimated glomerular filtration rate (eGFR). In these patients discharge NT-proBNP above median was associated to occurrence of death or readmission at 6 months (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.27-5.03); in patients with normal eGFR, a trend to this association was found (HR 1.64, CI 0.98-2.76). Decrease in NT-proBNP less than 30% of baseline was associated to outcome in patients with normal eGFR (HR 2.68, CI 1.54-4.68) and decreased eGFR (HR 2.54, CI 1.49-4.33).
Acute HF patients with renal failure have higher NT-proBNP levels than those with normal renal function. Discharge NT-proBNP has long-term prognostic value in HF patients with renal dysfunction. NT-proBNP variations during hospitalization provide additional prognostic information either in patients with normal or reduced eGFR.
氨基末端脑钠肽前体（NT-proBNP）是心力衰竭（HF）诊断和预后评估的一项重要指标。关于其在肾衰竭患者中的应用，目前信息有限，肾衰竭患者对肾脏清除的依赖可能会对其检测结果产生负面影响。
我们评估了肾功能对283例急性HF患者NT-proBNP水平及其出院后预后价值的影响。估算肾小球滤过率（eGFR）降低的患者入院和出院时的NT-proBNP水平较高。在这些患者中，出院时NT-proBNP高于中位数与6个月时死亡或再次入院的发生相关（风险比[HR]2.53，95%置信区间[CI]1.27 - 5.03）；在eGFR正常的患者中，也发现了这种关联趋势（HR 1.64，CI 0.98 - 2.76）。NT-proBNP下降幅度小于基线30%与eGFR正常患者（HR 2.68，CI 1.54 - 4.68）和eGFR降低患者（HR 2.54，CI 1.49 - 4.33）的预后相关。
肾衰竭的急性HF患者NT-proBNP水平高于肾功能正常的患者。出院时的NT-proBNP对肾功能不全的HF患者具有长期预后价值。住院期间NT-proBNP的变化在eGFR正常或降低的患者中均提供了额外的预后信息。
