N 末端 pro-B 型利钠肽与中国 B 型主动脉夹层患者的结局：一项回顾性多中心研究。
N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study.
机构信息
Cardiology, Afficiated Liutie Central Hospital &Clinical Medical College of Guangxi Medical University, Liuzhou, China.
Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
出版信息
BMJ Open. 2019 Sep 5;9(9):e029885. doi: 10.1136/bmjopen-2019-029885.
OBJECTIVES
N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is an unfavourable factor responsible for poor outcomes in the cardiovascular diseases. Nevertheless, the prognostic role of NT-pro-BNP in type B aortic dissection (TBAD) remains unclear. The aim of the current study was to investigate the relationship between NT-pro-BNP levels and in-hospital and long-term adverse prognosis in patients with TBAD.
DESIGN
A retrospective multicentre study.
SETTING
Liutie Central Hospital, Nanfang Hospital and Huiyang Hospital in China.
PARTICIPANTS
A total of 657 consecutive patients with TBAD were enrolled in the study. NT-pro-BNP was measured at admission and included patients were divided into three groups according to the tertiles of NT-pro-BNP (pg/mL): <95 (n=220), 95-312 (n=218) and >312 (n=219).
PRIMARY AND SECONDARY OUTCOME MEASURES
Long-term mortality and in-hospital major adverse clinical events.
RESULTS
Overall, in-hospital death occurred in 27 patients (4.1%), which was significantly higher in upper tertiles of NT-pro-BNP (0.5% vs 4.1% vs 7.8%, p<0.001). The incident of in-hospital major adverse clinical events increased along with higher NT-pro-BNP (1.4% vs 11.5% vs 15.5%, p<0.001). NT-pro-BNP >210 pg/mL had 81.5% sensitivity and 58.6% specificity for predicting in-hospital death (area under the curve= 0.774, 95% CI 0.692 to 0.855; p<0.001). After a median of 3.1 years of follow-up, 97 (14.8%) patients died. The Kaplan-Meier analysis indicated that the long-term cumulative mortality was higher in patients with NT-pro-BNP >210 pg/mL compared with patients with NT-pro-BNP ≤210 pg/mL (log-rank=26.92, p<0.001). In multivariable Cox survival modelling, NT-pro-BNP >210 pg/mL was independently associated with long-term death (adjusted HR 2.47, 95% CI 1.45 to 4.22, p=0.001).
CONCLUSIONS
NT-pro-BNP resulted as an independent predictor of adverse prognosis in patients with TBAD, thus could be used as a potential risk-stratification tool.
目的
N 端脑利钠肽前体（NT-pro-BNP）是心血管疾病不良预后的危险因素。然而，NT-pro-BNP 在 B 型主动脉夹层（TBAD）中的预后作用尚不清楚。本研究旨在探讨 NT-pro-BNP 水平与 TBAD 患者住院期间和长期不良预后的关系。
设计
回顾性多中心研究。
地点
中国的柳铁中心医院、南方医院和惠阳医院。
参与者
共纳入 657 例连续 TBAD 患者。入院时测量 NT-pro-BNP，并根据 NT-pro-BNP 的三分位值（pg/mL）将纳入患者分为三组：<95（n=220）、95-312（n=218）和>312（n=219）。
主要和次要结局测量
长期死亡率和住院期间主要不良临床事件。
结果
共有 27 例（4.1%）患者住院期间死亡，上三分位组的死亡率明显更高（0.5%比 4.1%比 7.8%，p<0.001）。随着 NT-pro-BNP 水平升高，住院期间主要不良临床事件的发生率也随之增加（1.4%比 11.5%比 15.5%，p<0.001）。NT-pro-BNP>210 pg/mL 对预测住院期间死亡的敏感性为 81.5%，特异性为 58.6%（曲线下面积=0.774，95%置信区间 0.692 至 0.855；p<0.001）。中位随访 3.1 年后，97 例（14.8%）患者死亡。Kaplan-Meier 分析表明，NT-pro-BNP>210 pg/mL 患者的长期累积死亡率高于 NT-pro-BNP≤210 pg/mL 患者（log-rank=26.92，p<0.001）。多变量 Cox 生存模型分析显示，NT-pro-BNP>210 pg/mL 与长期死亡独立相关（调整后的 HR 2.47，95%置信区间 1.45 至 4.22，p=0.001）。
结论
NT-pro-BNP 是 TBAD 患者不良预后的独立预测因子，因此可作为潜在的风险分层工具。
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