与高敏肌钙蛋白T相比，NTproBNP在透析患者中具有更高的预测价值：一项前瞻性观察性试点研究。

Superior predictive value for NTproBNP compared with high sensitivity cTnT in dialysis patients: a pilot prospective observational study.

作者信息

Voroneanu Luminita, Siriopol Dimitrie, Nistor Ionut, Apetrii Mugurel, Hogas Simona, Onofriescu Mihai, Covic Adrian

机构信息

Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.

出版信息

Kidney Blood Press Res. 2014;39(6):636-47. doi: 10.1159/000368452. Epub 2014 Dec 19.

DOI:10.1159/000368452

PMID:25571877

Abstract

BACKGROUND/AIMS: The clinical utility of the new biomarker, high sensitivity cardiac T troponin (hs-cTnT) is still unclear in dialysis patients. Furthermore, the prognostic value of combining N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and hs-cTnT has not been explored so far. The objective of this pilot study was to determine the utility of hs-cTnT alone versus hs-cTnT in combination with NT-proBNP for predicting death in a stable hemodialysis cohort.

METHODS

A prospective observational pilot study including 98 chronic asymptomatic hemodialysis patients with a follow up period of 24 months was designed. The cut-off values for NT-proBNP and hs-cTnT were calculated using receiver operating characteristic (ROC) analysis, using mortality as an end-point. Based on the cut-off values, the cohort was divided into four groups. Group 1--NT-proBNP < 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 2--NT-proBNP < 14275 pg/ml and hs-cTnT > 69.48 ng/l; group 3--NT-proBNP > 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 4--NT-proBNP > 14275 pg/ml and hs-cTnT > 69.48 ng/l. Survival for each group was determined using the Kaplan-Meier method and Cox regression analysis.

RESULTS

During the follow-up period 16 patients died. According to the ROC curves analysis, the cut-off point for hs-cTnT and for NT-proBNP were 69.43 ng/l (AUC = 0.618; p = 0.04) and 14275 pg/ml (AUC = 0.722; p = 0.003), respectively. In univariate Cox analysis, both hs-cTnT (HR = 3.34; p = 0.016) and NT-proBNP (HR = 5.94; p = 0.01) were predictors of death. In the multivariable Cox proportional hazards model, only NT-pro-BNP levels above the cut-off value remained an independent predictor of all-cause mortality. The combined elevation of both biomarkers did not improve significantly the prognostic value compared with NT-proBNP alone (HR = 6.15 versus HR =4 .78; p = 0.338).

CONCLUSION

NT-pro-BNP is a strong predictor of overall mortality in asymptomatic hemodialysis patients. The addition of hs-cTnT did not improve the prognostic accuracy compared with NT proBNP alone.

摘要

背景/目的：新型生物标志物高敏心肌肌钙蛋白T（hs-cTnT）在透析患者中的临床应用仍不明确。此外，迄今为止，尚未探讨N末端B型利钠肽原（NT-pro-BNP）与hs-cTnT联合应用的预后价值。本前瞻性研究的目的是确定单独使用hs-cTnT与hs-cTnT联合NT-proBNP预测稳定血液透析队列患者死亡的效用。

方法

设计了一项前瞻性观察性研究，纳入98例慢性无症状血液透析患者，随访期为24个月。以死亡率为终点，采用受试者工作特征（ROC）分析计算NT-proBNP和hs-cTnT的临界值。根据临界值，将队列分为四组。第1组——NT-proBNP<14275 pg/ml且hs-cTnT<69.48 ng/l；第2组——NT-proBNP<14275 pg/ml且hs-cTnT>69.48 ng/l；第3组——NT-proBNP>14275 pg/ml且hs-cTnT<69.48 ng/l；第4组——NT-proBNP>14275 pg/ml且hs-cTnT>69.48 ng/l。采用Kaplan-Meier法和Cox回归分析确定每组的生存率。

结果

随访期间16例患者死亡。根据ROC曲线分析，hs-cTnT和NT-proBNP的临界值分别为69.43 ng/l（AUC = 0.618；p = 0.04）和14275 pg/ml（AUC = 0.722；p = 0.003）。在单变量Cox分析中，hs-cTnT（HR = 3.34；p = 0.016）和NT-proBNP（HR = 5.94；p = 0.01）均为死亡的预测因素。在多变量Cox比例风险模型中，只有高于临界值的NT-pro-BNP水平仍然是全因死亡率的独立预测因素。与单独使用NT-proBNP相比，两种生物标志物的联合升高并没有显著提高预后价值（HR = 6.15对HR = 4.78；p = 0.338）。