N 端前脑钠肽是系统性硬化症患者死亡率的有力预测指标。

N-terminal pro-brain natriuretic peptide is a strong predictor of mortality in systemic sclerosis.

作者信息

Allanore Yannick, Komocsi Andras, Vettori Serena, Hachulla Eric, Hunzelmann Nicolas, Distler Jörg, Avouac Jérôme, Gobeaux Camille, Launay David, Czirjak Laszlo, Kahan André, Meune Christophe

机构信息

Department of Rheumatology A, Paris Descartes University, Cochin Hospital, INSERM U1016, Paris, France.

Heart Centre, Clinic Centre, University of Pécs, Pécs, Hungary.

出版信息

Int J Cardiol. 2016 Nov 15;223:385-389. doi: 10.1016/j.ijcard.2016.08.246. Epub 2016 Aug 13.

DOI:10.1016/j.ijcard.2016.08.246

PMID:27543715

Abstract

OBJECTIVES

Cardiovascular involvement is a major contributor to mortality in systemic sclerosis (SSc). We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor of mortality in SSc.

METHODS AND RESULTS

This multicentre prospective cohort study included 523 patients presenting with SSc, whose mean age was 54±13years, mean disease duration 8±9years, and diffuse cutaneous form in 168. Plasma NT-proBNP was measured at baseline and the patients were followed yearly. Overall mortality was measured at 3years. At baseline, cardiovascular involvement was present in 37 patients, including 17 with pulmonary artery hypertension (PAH) and 20 with a left ventricular ejection fraction (LVEF) <55%. At 3years, 32 (7%) patients had died. The median [25th-75th percentile] NT-proBNP concentration was 203ng/l [129-514] in patients who died within 3years, versus 88ng/l [47-167] in survivors (P<0.001). NT-proBNP was an independent predictor of 3-years mortality in multivariate analysis (P=0.046). The optimal cut-off derived from the ROC curve was 129ng/l; sensitivity and specificity to predict 3y mortality were 78.1 and 66.7%. Using the previously recommended 125-ng/l concentration as threshold value, NT-proBNP reliably and independently predicted 3year mortality, with a sensitivity of 78.1 and a negative predictive value of 97.6%, respectively (P=0.006). The consideration of SSc patients without PAH or LVEF<55% at baseline yielded similar results.

CONCLUSION

NT-proBNP appears as a reliable and independent predictor of mortality in patients with SSc.

摘要

目的

心血管受累是系统性硬化症（SSc）患者死亡的主要原因。我们研究了N端前脑钠肽（NT-proBNP）是否是SSc患者死亡的可靠预测指标。

方法与结果

这项多中心前瞻性队列研究纳入了523例SSc患者，其平均年龄为54±13岁，平均病程为8±9年，其中168例为弥漫性皮肤型。在基线时测量血浆NT-proBNP，并对患者进行每年一次的随访。在3年时测量总死亡率。基线时，37例患者存在心血管受累，其中17例患有肺动脉高压（PAH），20例左心室射血分数（LVEF）<55%。在3年时，32例（7%）患者死亡。在3年内死亡的患者中，NT-proBNP浓度的中位数[第25-75百分位数]为203ng/l[129-514]，而幸存者为88ng/l[47-167]（P<0.001）。在多变量分析中，NT-proBNP是3年死亡率的独立预测指标（P=0.046）。从ROC曲线得出的最佳临界值为129ng/l；预测3年死亡率的敏感性和特异性分别为78.1%和66.7%。以先前推荐的125ng/l浓度作为阈值，NT-proBNP可靠且独立地预测了3年死亡率，敏感性分别为78.1%，阴性预测值为97.6%（P=0.006）。对基线时无PAH或LVEF<55%的SSc患者进行分析，结果相似。