Satyan Sangeetha, Light Robert P, Agarwal Rajiv
Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA.
Am J Kidney Dis. 2007 Dec;50(6):1009-19. doi: 10.1053/j.ajkd.2007.08.017.
Although the cardiac biomarker troponin T (cTnT) is related strongly to mortality in patients with end-stage renal disease, the independent association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cTnT levels in predicting outcomes is unknown. The objective of this study is to determine factors associated with NT-pro-BNP and cTnT and determine whether these levels are associated with mortality.
Cohort study.
SETTING & PARTICIPANTS: Asymptomatic hemodialysis patients (n = 150) in 4 university-affiliated hemodialysis units. EXPOSURE & OUTCOMES: For cross-sectional analysis, echocardiographic variables as exposures and NT-pro-BNP and cTnT levels as outcomes; for longitudinal analysis, association of NT-pro-BNP and cTnT levels as exposures to all-cause and cardiovascular disease mortality as outcomes.
In a multivariate regression analysis, low midwall fractional shortening, a measure of poor systolic function, was an independent correlate of log NT-pro-BNP level (P < 0.01), whereas left ventricular mass index was an independent correlate of cTnT level (P < 0.01). During a median follow-up of 24 months, 46 patients died, 26 of cardiovascular causes. NT-pro-BNP levels had a strong graded relationship with all-cause (hazard ratios [HRs], 1.54, 4.78, and 4.03 for increasing quartiles; P < 0.001) and cardiovascular mortality (HRs, 2.99, 10.95, and 8.54; P < 0.01), whereas cTnT level had a weaker relationship with all-cause (HRs, 1.57, 2.32, and 3.39; P < 0.01) and cardiovascular mortality (HRs, 0.81, 2.12, and 2.14; P = 0.1). The combination of the 2 biomarker levels did not improve the association with all-cause or cardiovascular mortality compared with NT-pro-BNP level alone. NT-pro-BNP level was a marker of mortality even after adjusting for left ventricular mass index and midwall fractional shortening.
Our cohort was predominantly black and of limited sample size.
NT-pro-BNP level strongly correlates with left ventricular systolic dysfunction and is associated more strongly with mortality than cTnT level in asymptomatic hemodialysis patients.
尽管心脏生物标志物肌钙蛋白T（cTnT）与终末期肾病患者的死亡率密切相关，但N端前B型利钠肽（NT-pro-BNP）和cTnT水平在预测预后方面的独立关联尚不清楚。本研究的目的是确定与NT-pro-BNP和cTnT相关的因素，并确定这些水平是否与死亡率相关。
队列研究。
4家大学附属医院血液透析单位的无症状血液透析患者（n = 150）。暴露因素和结局指标：横断面分析中，超声心动图变量为暴露因素，NT-pro-BNP和cTnT水平为结局指标；纵向分析中，NT-pro-BNP和cTnT水平为暴露因素，全因死亡率和心血管疾病死亡率为结局指标。
在多变量回归分析中，反映收缩功能差的低室壁中层缩短率是log NT-pro-BNP水平的独立相关因素（P < 0.01），而左心室质量指数是cTnT水平的独立相关因素（P < 0.01）。在中位随访24个月期间，46例患者死亡，其中26例死于心血管疾病。NT-pro-BNP水平与全因死亡率（四分位数增加时的风险比[HR]分别为1.54、4.78和4.03；P < 0.001）和心血管疾病死亡率（HR分别为2.99、10.95和8.54；P < 0.01）呈强分级关系，而cTnT水平与全因死亡率（HR分别为1.57、2.32和3.39；P < 0.01）和心血管疾病死亡率（HR分别为0.81、2.12和2.14；P = 0.1）的关系较弱。与单独的NT-pro-BNP水平相比，这两种生物标志物水平的联合使用并未改善与全因或心血管疾病死亡率的关联。即使在调整左心室质量指数和室壁中层缩短率后，NT-pro-BNP水平仍是死亡率的标志物。
我们的队列主要为黑人，样本量有限。
在无症状血液透析患者中，NT-pro-BNP水平与左心室收缩功能障碍密切相关，且与死亡率的关联比cTnT水平更强。
