抑郁症状与心力衰竭患者中 N 末端 B 型利钠肽原与功能状态的关系。
The Association Between Depressive Symptoms and N-Terminal Pro-B-Type Natriuretic Peptide With Functional Status in Patients With Heart Failure.
机构信息
Zyad T. Saleh, PhD, RN Assistant Professor, School of Nursing, The University of Jordan, Amman. Jia-Rong Wu, PhD, RN Assistant Professor, School of Nursing, University of North Carolina, Chapel Hill. Ibrahim Salami, PhD, RN Assistant Professor, School of Nursing, The University of Jordan, Amman. Khalil Yousef, PhD, RN Assistant Professor, School of Nursing, The University of Jordan, Amman. Terry A. Lennie, PhD, RN, FAAN Professor, Senior Associate Dean, and Co-Director of the RICH Heart Program, College of Nursing, University of Kentucky, Lexington.
出版信息
J Cardiovasc Nurs. 2018 Jul/Aug;33(4):378-383. doi: 10.1097/JCN.0000000000000470.
BACKGROUND
N-terminal pro-B-type natriuretic peptide (NT-proBNP) and depressive symptoms are each associated with functional status in patients with heart failure (HF), but their association together with functional status has not been examined.
OBJECTIVE
The aim of this study was to determine whether functional status scores differ as a function of depressive symptoms and NT-proBNP levels considered together.
METHODS
We studied 284 patients with HF who were divided into 4 groups based on the median split of NT-proBNP levels and cut point for depressive symptoms (Beck Depression Inventory ≥ 14): (1) low NT-proBNP of 562.5 pg/mL or less without depressive symptoms, (2) low NT-proBNP of 562.5 pg/mL or less with depressive symptoms, (3) high NT-proBNP of greater than 562.5 pg/mL without depressive symptoms, and (4) high NT-proBNP of greater than 562.5 pg/mL with depressive symptoms. The Duke Activity Status Index was used to assess functional status.
RESULTS
Nonlinear regression demonstrated that patients without depressive symptoms were more than twice as likely to have higher (better) functional status scores than patients with depressive symptoms regardless of NT-proBNP levels after controlling for age, gender, prescribed antidepressants, and body mass index. Functional status levels of patients with low NT-proBNP did not differ from those with high NT-proBNP in the presence of depressive symptoms.
CONCLUSION
When examined together, depressive symptoms rather than NT-proBNP levels predicted functional status.
CLINICAL IMPLICATIONS
Adequate treatment of depressive symptoms may lead to better functional status regardless of HF severity.
背景
N 端脑利钠肽前体（NT-proBNP）和抑郁症状均与心力衰竭（HF）患者的功能状态相关，但尚未研究它们与功能状态一起的关联。
目的
本研究旨在确定是否可以根据抑郁症状和 NT-proBNP 水平的综合考虑来确定功能状态评分是否有所不同。
方法
我们研究了 284 例 HF 患者，他们根据 NT-proBNP 水平的中位数和抑郁症状的切点（贝克抑郁量表≥14 分）分为 4 组：（1）NT-proBNP 低，即<562.5 pg/ml 且无抑郁症状，（2）NT-proBNP 低，即<562.5 pg/ml 且有抑郁症状，（3）NT-proBNP 高，即>562.5 pg/ml 且无抑郁症状，（4）NT-proBNP 高，即>562.5 pg/ml 且有抑郁症状。使用杜克活动状态指数评估功能状态。
结果
非线性回归显示，在控制年龄、性别、处方抗抑郁药和体重指数后，无论 NT-proBNP 水平如何，无抑郁症状的患者比有抑郁症状的患者更有可能具有更高（更好）的功能状态评分。在存在抑郁症状的情况下，低 NT-proBNP 患者的功能状态水平与高 NT-proBNP 患者无差异。
结论
当一起检查时，抑郁症状而不是 NT-proBNP 水平预测了功能状态。
临床意义
充分治疗抑郁症状可能会改善功能状态，而与 HF 的严重程度无关。
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