胱抑素 C 联合氨基末端 B 型利钠肽前体对合并与不合并慢性肾脏病的急性心力衰竭患者死亡率的预测价值。

Prognostic Value of Cysteine-Rich Protein 61 Combined with N-Terminal Pro-B-Type Natriuretic Peptide for Mortality in Acute Heart Failure Patients with and without Chronic Kidney Disease.

机构信息

Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China.

出版信息

Cardiorenal Med. 2020;10(1):11-21. doi: 10.1159/000501929. Epub 2019 Aug 30.

DOI:10.1159/000501929

PMID:31473733

Abstract

BACKGROUND

The ability of most biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), to predict prognosis in heart failure can be affected by the state of renal function; therefore, there is the need for a biomarker that can predict prognosis accurately without the influence of renal function. The prognostic value of cysteine-rich protein 61 (CYR61/CCN1) in acute heart failure (AHF) patients has been proven.

METHODS

A total of 248 patients hospitalized with AHF were recruited in this study, and serum CCN1 levels, NT-proBNP levels, and other necessary data of patients were collected upon admission. The correlation of serum CCN1 with estimated glomerular filtration rate (eGFR) was investigated, and the logistic regression model was used to investigate the prognostic value of serum CCN1 for 3-month mortality.

RESULTS

Fifty-four of 248 patients died (21.8%) during a 3-month follow-up. Serum CCN1 had no significant correlation with eGFR (rho = -0.088, p = 0.167). In the overall population and patients without chronic kidney disease, results showed that both serum CCN1 and NT-proBNP were significantly associated with 3-month mortality. In patients with chronic kidney disease, serum CCN1 was significantly associated with 3-month mortality in logistic regression analysis (odds ratio = 2.40, p = 0.002) while NT-proBNP was not. Further in tertile group comparison, in patients with chronic kidney disease, higher tertile levels of serum CCN1 had a significantly higher risk of 3-month mortality compared to the lower tertile ones (odds ratio = 4.17, p = 0.013), but that of NT-proBNP did not.

CONCLUSION

Serum CCN1 level is not associated with eGFR, and it maintains the prognostic value in AHF patients with chronic kidney disease. CCN1 could be a potential novel prognostic biomarker in AHF patients with chronic kidney disease.

摘要

背景

大多数生物标志物（如 N 末端脑利钠肽前体（NT-proBNP））预测心力衰竭预后的能力可能受到肾功能状态的影响；因此，需要一种能够准确预测预后且不受肾功能影响的生物标志物。胱抑素 61（CYR61/CCN1）在急性心力衰竭（AHF）患者中的预后价值已得到证实。

方法

本研究共纳入 248 例因 AHF 住院的患者，收集患者入院时的血清 CCN1 水平、NT-proBNP 水平及其他必要数据。研究了血清 CCN1 与估算肾小球滤过率（eGFR）的相关性，使用逻辑回归模型探讨了血清 CCN1 对 3 个月死亡率的预测价值。

结果

248 例患者中有 54 例（21.8%）在 3 个月随访期间死亡。血清 CCN1 与 eGFR 无显著相关性（rho = -0.088，p = 0.167）。在全人群和无慢性肾脏病的患者中，结果表明血清 CCN1 和 NT-proBNP 均与 3 个月死亡率显著相关。在慢性肾脏病患者中，血清 CCN1 在逻辑回归分析中与 3 个月死亡率显著相关（比值比=2.40，p=0.002），而 NT-proBNP 则不然。进一步进行三分位组比较，在慢性肾脏病患者中，血清 CCN1 三分位较高的患者与三分位较低的患者相比，3 个月死亡率的风险显著升高（比值比=4.17，p=0.013），而 NT-proBNP 则不然。