Ohkuma Toshiaki, Jun Min, Woodward Mark, Zoungas Sophia, Cooper Mark E, Grobbee Diederick E, Hamet Pavel, Mancia Giuseppe, Williams Bryan, Welsh Paul, Sattar Naveed, Shaw Jonathan E, Rahimi Kazem, Chalmers John
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
The George Institute for Global Health, University of Oxford, Oxford, U.K.
Diabetes Care. 2017 Sep;40(9):1203-1209. doi: 10.2337/dc17-0509. Epub 2017 Jul 6.
This study examined the individual and combined effect of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), interleukin-6 (IL-6), and hs-CRP on the prediction of heart failure incidence or progression in patients with type 2 diabetes.
A nested case-cohort study was conducted in 3,098 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.
A higher value of each biomarker was significantly associated with a higher risk of heart failure incidence or progression, after adjustment for major risk factors. The hazard ratios per 1-SD increase were 3.06 (95% CI 2.37, 3.96) for NT-proBNP, 1.50 (1.27, 1.77) for hs-cTnT, 1.48 (1.27, 1.72) for IL-6, and 1.32 (1.12, 1.55) for hs-CRP. The addition of NT-proBNP to the model including conventional risk factors meaningfully improved 5-year risk-predictive performance (C statistic 0.8162 to 0.8800; continuous net reclassification improvement [NRI] 73.1%; categorical NRI [<5%, 5-10%, >10% 5-year risk] 24.2%). In contrast, the addition of hs-cTnT, IL-6, or hs-CRP did not improve the prediction metrics consistently in combination or when added to NT-proBNP.
Only NT-proBNP strongly and consistently improved the prediction of heart failure in patients with type 2 diabetes beyond a wide range of clinical risk factors and biomarkers.
本研究探讨了N末端B型利钠肽原（NT-proBNP）、高敏心肌肌钙蛋白T（hs-cTnT）、白细胞介素-6（IL-6）和高敏C反应蛋白（hs-CRP）对2型糖尿病患者心力衰竭发生率或病情进展预测的个体及联合作用。
在糖尿病和血管疾病行动：培哚普利吲达帕胺缓释片对照评估（ADVANCE）试验中，对3098例2型糖尿病参与者进行了巢式病例队列研究。
在调整主要危险因素后，每种生物标志物的较高值均与心力衰竭发生率或病情进展的较高风险显著相关。NT-proBNP每增加1个标准差的风险比为3.06（95%可信区间2.37，3.96），hs-cTnT为1.50（1.27，1.77），IL-6为1.48（1.27，1.72），hs-CRP为1.32（1.12，1.55）。在包含传统危险因素的模型中加入NT-proBNP，显著改善了5年风险预测性能（C统计量从0.8162提高到0.8800；连续净重新分类改善[NRI]为73.1%；分类NRI[<5%，5-10%，>10% 5年风险]为24.2%）。相比之下，加入hs-cTnT、IL-6或hs-CRP，无论是联合加入还是加入到NT-proBNP中，均未持续改善预测指标。
在众多临床危险因素和生物标志物之外，只有NT-proBNP能强有力且持续地改善2型糖尿病患者心力衰竭的预测。
