Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Clin Chim Acta. 2019 Apr;491:8-14. doi: 10.1016/j.cca.2018.12.025. Epub 2018 Dec 28.
OBJECTIVE: To investigate whether the combination of measuring amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) could provide additional prognostic value in hospitalized heart failure patients. METHODS: We measured both BNP and NT-proBNP simultaneously at baseline in 1464 hospitalized heart failure patients who were admitted to our heart failure center. All patients were followed-up with the median follow-up period of 533 days. The primary endpoint is a composite of all-cause death (non-transplantation patients) or heart transplantation. RESULTS: The median molar ratio of NT-proBNP/BNP was 2.37, but the range of the molar ratio varied from 1.57 to 3.75 (lower quartile to higher quartile). Using the cut-off value of 1790 pg/mL for NT-proBNP and 495 pg/mL for BNP from the ROC curve analysis, univariate Cox proportional regression analysis showed that the low/high group (NT-proBNP < 1790 pg/mL and BNP ≥ 495 pg/mL), high/low group (NT-proBNP ≥ 1790 pg/mL and BNP < 495 pg/mL) and high/high group (NT-proBNP ≥ 1790 pg/mL and BNP ≥ 495 pg/mL) had significant higher risk of all-cause death or heart transplantation [HR (hazard ratio): 2.87, 95% CI (confidence interval): 1.69-4.89, p < .001; HR: 2.68, 95% CI: 1.91-3.76, p < .001; HR:5.07, 95% CI: 3.85-6.67, p < .001] than low/low group (NT-proBNP < 1790 pg/mL and BNP < 495 pg/mL). In turn, the high/high group had higher risk of all-cause death or heart transplantation than low/high (HR: 1.70, 95% CI: 1.04-2.80, p = .035) and high/low groups (HR: 1.88, 95% CI: 1.42-2.49, p < .001). The low/high and high/low groups had a similar risk of all-cause death or heart transplantation. Further multivariable Cox regression analysis also showed that both BNP and NT-proBNP above the cut-off values independently predicted the worst prognosis, while either one of the two biomarkers above the cut-off value indicated the moderate poor prognosis and both below the cut-off values indicated the best prognosis (p for trend< 0.001). CONCLUSION: The plasma levels of NT-proBNP and BNP do not always increase proportionally in heart failure patients. The combination of testing NT-proBNP and BNP may add prognostic value to predict adverse events in hospitalized heart failure patients.
目的：探讨同时检测氨基末端 pro-B 型利钠肽（NT-proBNP）和 B 型利钠肽（BNP）能否为住院心力衰竭患者提供额外的预后价值。
方法：我们在 1464 名入住我院心力衰竭中心的住院心力衰竭患者中同时检测了基线时的 BNP 和 NT-proBNP。所有患者均进行了中位随访 533 天的随访。主要终点是全因死亡（非移植患者）或心脏移植的复合终点。
结果：NT-proBNP/BNP 的摩尔比中位数为 2.37，但摩尔比的范围从 1.57 到 3.75（下四分位数到上四分位数）。使用 ROC 曲线分析得出的 NT-proBNP 截断值 1790pg/mL 和 BNP 截断值 495pg/mL，单因素 Cox 比例风险回归分析显示，低/高组（NT-proBNP<1790pg/mL 且 BNP≥495pg/mL）、高/低组（NT-proBNP≥1790pg/mL 且 BNP<495pg/mL）和高/高组（NT-proBNP≥1790pg/mL 且 BNP≥495pg/mL）的全因死亡或心脏移植风险显著升高[风险比（HR）：2.87，95%置信区间（CI）：1.69-4.89，p<0.001；HR：2.68，95%CI：1.91-3.76，p<0.001；HR：5.07，95%CI：3.85-6.67，p<0.001]，低于低/低组（NT-proBNP<1790pg/mL 且 BNP<495pg/mL）。反过来，高/高组的全因死亡或心脏移植风险高于低/高组（HR：1.70，95%CI：1.04-2.80，p=0.035）和高/低组（HR：1.88，95%CI：1.42-2.49，p<0.001）。低/高组和高/低组的全因死亡或心脏移植风险相似。进一步的多变量 Cox 回归分析还表明，两个截断值以上的 BNP 和 NT-proBNP 均独立预测预后最差，而两个标志物中任何一个截断值以上均提示预后中等不良，两个截断值以下均提示预后最佳（p 值趋势<0.001）。
结论：心力衰竭患者的 NT-proBNP 和 BNP 水平并不总是成比例升高。同时检测 NT-proBNP 和 BNP 可能会增加预测住院心力衰竭患者不良事件的预后价值。
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