肾功能对N末端B型利钠肽作为非心脏血管手术患者心脏预后风险标志物效用的影响。
Influence of renal function on the usefulness of N-terminal pro-B-type natriuretic peptide as a prognostic cardiac risk marker in patients undergoing noncardiac vascular surgery.
作者信息
Goei Dustin, Schouten Olaf, Boersma Eric, Welten Gijs M J M, Dunkelgrun Martin, Lindemans Jan, van Gestel Yvette R B M, Hoeks Sanne E, Bax Jeroen J, Poldermans Don
机构信息
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
出版信息
Am J Cardiol. 2008 Jan 1;101(1):122-6. doi: 10.1016/j.amjcard.2007.07.058.
N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is related to stress-induced myocardial ischemia and/or volume overload, both common in patients with renal dysfunction. This might compromise the prognostic usefulness of NT-pro-BNP in patients with renal impairment before vascular surgery. We assessed the prognostic value of NT-pro-BNP in the entire strata of renal function. In 356 patients (median age 69 years, 77% men), cardiac history, glomerular filtration rate (GFR, ml/min/1.73 m(2)), and NT-pro-BNP level (pg/ml) were assessed preoperatively. Troponin T and electrocardiography were assessed postoperatively on days 1, 3, 7, and 30. The end point was the composite of cardiovascular death, Q-wave myocardial infarction, and troponin T release. Multivariate analysis was used to evaluate the interaction between GFR, NT-pro-BNP and their association with postoperative outcome. Median GFR was 78 ml/min/1.73 m(2) and the median concentration of NT-pro-BNP was 197 pg/ml. The end point was reached in 64 patients (18%); cardiac death occurred in 7 (2.0%), Q-wave myocardial infarction in 34 (9.6%), and non-Q-wave myocardial infarction in 23 (6.5%). After adjustment for confounders, NT-pro-BNP levels and GFR remained significantly associated with the end point (p = 0.005). The prognostic value of NT-pro-BNP was most pronounced in patients with GFR > or =90 (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.80 to 1.76) compared with patients with GFR 60 to 89 (OR 1.04, 95% CI 1.002 to 1.07), and with GFR 30 to 59 (OR 1.12, 95% CI 1.03 to 1.21). In patients with GFR <30 ml/min/1.73 m(2), NT-pro-BNP levels have no prognostic value (OR 1.00, 95% CI 0.99 to 1.01). In conclusion, the discriminative value of NT-pro-BNP is most pronounced in patients with GFR > or =90 ml/min/1.73 m(2) and has no prognostic value in patients with GFR <30 ml/min/1.73 m(2).
N 端前 B 型利钠肽原（NT-pro-BNP）与应激诱导的心肌缺血和/或容量超负荷有关，这在肾功能不全患者中都很常见。这可能会削弱 NT-pro-BNP 在血管手术前肾功能损害患者中的预后预测价值。我们评估了 NT-pro-BNP 在整个肾功能分层中的预后价值。在 356 例患者（中位年龄 69 岁，77%为男性）中，术前评估了心脏病史、肾小球滤过率（GFR，ml/min/1.73 m²）和 NT-pro-BNP 水平（pg/ml）。术后第 1、3、7 和 30 天评估肌钙蛋白 T 和心电图。终点是心血管死亡、Q 波心肌梗死和肌钙蛋白 T 释放的综合结果。采用多变量分析评估 GFR、NT-pro-BNP 之间的相互作用及其与术后结局的关联。中位 GFR 为 78 ml/min/1.73 m²，NT-pro-BNP 的中位浓度为 197 pg/ml。64 例患者（18%）达到终点；7 例（2.0%）发生心源性死亡，34 例（9.6%）发生 Q 波心肌梗死，23 例（6.5%）发生非 Q 波心肌梗死。在对混杂因素进行校正后，NT-pro-BNP 水平和 GFR 仍与终点显著相关（p = 0.005）。与 GFR 为 60 至 89 的患者（比值比[OR]1.04，95%置信区间[CI]1.002 至 1.07）以及 GFR 为 30 至 59 的患者（OR 1.12，95%CI 1.03 至 1.21）相比，NT-pro-BNP 在 GFR≥90 的患者中的预后价值最为显著（OR 1.18，95%CI 0.80 至 1.76）。在 GFR<30 ml/min/1.73 m²的患者中，NT-pro-BNP 水平无预后价值（OR 1.00，95%CI 0.99 至 1.01）。总之，NT-pro-BNP 的鉴别价值在 GFR≥90 ml/min/1.73 m²的患者中最为显著，而在 GFR<30 ml/min/1.73 m²的患者中无预后价值。
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