Pastural-Thaunat M, Ecochard R, Boumendjel N, Abdullah E, Cardozo C, Lenz A, M'pio I, Szelag J C, Fouque D, Walid A, Laville M
Association pour l'Utilisation du Rein Artificiel à Lyon, France.
Nephron Extra. 2012 Jan;2(1):311-8. doi: 10.1159/000343897. Epub 2012 Dec 12.
Cross-sectional studies have shown that B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are predictive of cardiovascular death in haemodialysis (HD) patients. In the present study, we tested the hypothesis that monitoring NT-proBNP measurements adds further prognostic information, i.e. predicts congestive heart failure (CHF) events.
In a prospective cohort of 236 HD patients, NT-proBNP levels were measured monthly during 18 months. Patients were divided according to the occurrence of CHF events. In a nested case-control study, we assessed the evolution of NT-proBNP levels.
On average, the 236 HD patients were followed up for 12.5 months, a period during which 44 patients developed a CHF event (half requiring hospitalisation). At baseline, patients who developed a CHF event had significantly more dilated cardiomyopathy and/or altered left ventricular ejection fraction and higher NT-proBNP levels compared with patients who did not develop a CHF event. During follow-up, we observed a significant increase in NT-proBNP levels preceding the CHF event. At a 20% relative increase of NT-proBNP, the sensitivity of NT-proBNP as a predictor of CHF events was 0.57 and the specificity 0.77.
The relative change in NT-proBNP levels is a significant risk predictor of a CHF event.
横断面研究表明，B型利钠肽（BNP）及其N端片段（NT-proBNP）可预测血液透析（HD）患者的心血管死亡。在本研究中，我们检验了以下假设：监测NT-proBNP测量值可提供更多预后信息，即预测充血性心力衰竭（CHF）事件。
在一个有236例HD患者的前瞻性队列中，在18个月内每月测量NT-proBNP水平。根据CHF事件的发生情况对患者进行分组。在一项巢式病例对照研究中，我们评估了NT-proBNP水平的变化。
236例HD患者平均随访12.5个月，在此期间44例患者发生CHF事件（其中一半需要住院治疗）。与未发生CHF事件的患者相比，发生CHF事件的患者在基线时患有扩张型心肌病和/或左心室射血分数改变的情况明显更多，且NT-proBNP水平更高。在随访期间，我们观察到CHF事件发生前NT-proBNP水平显著升高。当NT-proBNP相对升高20%时，NT-proBNP作为CHF事件预测指标的敏感性为0.57，特异性为0.77。
NT-proBNP水平的相对变化是CHF事件的一个重要风险预测指标。
