在同时患有人类免疫缺陷病毒和心力衰竭的患者中，氨基末端 B 型利钠肽前体。
Amino-terminal Pro-B-Type Natriuretic Peptide Among Patients Living With Both Human Immunodeficiency Virus and Heart Failure.
机构信息
Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Metabolism Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
出版信息
Clin Infect Dis. 2020 Aug 22;71(5):1306-1315. doi: 10.1093/cid/ciz958.
BACKGROUND
Among persons living with human immunodeficiency virus (PHIV), incident heart failure (HF) rates are increased and outcomes are worse; however, the role of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations among PHIV with HF has not been characterized.
METHODS
Patients were derived from a registry of those hospitalized with HF at an academic center in a calender year. We compared the NT-proBNP concentrations and the changes in NT-proBNP levels between PHIV with HF and uninfected controls with HF.
RESULTS
Among 2578 patients with HF, there were 434 PHIV; 90% were prescribed antiretroviral therapy and 62% were virally suppressed. As compared to controls, PHIV had higher admission (3822 [IQR, 2413-7784] pg/ml vs 5546 [IQR, 3257-8792] pg/ml, respectively; P < .001), higher discharge (1922 [IQR, 1045-4652] pg/ml vs 3372 [IQR, 1553-5452] pg/ml, respectively; P < .001), and lower admission-to-discharge changes in NT-proBNP levels (32 vs 48%, respectively; P = .007). Similar findings were noted after stratifying based on left ventricular ejection fraction (LVEF). In a multivariate analysis, cocaine use, a lower LVEF, a higher NYHA class, a higher viral load (VL), and a lower CD4 count were associated with higher NT-proBNP concentrations. In follow-up, among PHIV, a higher admission NT-proBNP concentration was associated with increased cardiovascular mortality (first tertile, 11.5; second tertile, 20; third tertile, 44%; P < .001). Among PHIV, each doubling of NT-proBNP was associated with a 19% increased risk of death. However, among patients living without HIV, each doubling was associated with a 27% increased risk; this difference was attenuated among PHIV with lower VLs and higher CD4 counts.
CONCLUSIONS
PHIV with HF had higher admission and discharge NT-proBNP levels, and less change in NT-proBNP concentrations. Among PHIV, VLs and CD4 counts were associated with NT-proBNP concentrations; in follow-up, higher NT-proBNP levels among PHIV were associated with cardiovascular mortality.
背景
在人类免疫缺陷病毒（HIV）感染者（PHIV）中，心力衰竭（HF）的发生率增加，结局更差；然而，HF 合并 PHIV 患者的氨基末端 B 型利钠肽前体（NT-proBNP）浓度的作用尚未明确。
方法
本研究患者来源于某学术中心住院 HF 患者的登记系统，在该系统中，我们比较了 HF 合并 PHIV 患者与未感染 HF 的对照组之间的 NT-proBNP 浓度和 NT-proBNP 水平变化。
结果
在 2578 例 HF 患者中，有 434 例为 PHIV；90%接受了抗逆转录病毒治疗，62%病毒得到了抑制。与对照组相比，PHIV 的入院时（3822[IQR，2413-7784]pg/ml 比 5546[IQR，3257-8792]pg/ml；P<0.001）、出院时（1922[IQR，1045-4652]pg/ml 比 3372[IQR，1553-5452]pg/ml；P<0.001）和 NT-proBNP 水平入院-出院变化（32%比 48%；P=0.007）均较高。基于左心室射血分数（LVEF）分层后也有类似发现。在多变量分析中，可卡因使用、较低的 LVEF、较高的纽约心脏协会（NYHA）分级、较高的病毒载量（VL）和较低的 CD4 计数与较高的 NT-proBNP 浓度相关。随访期间，PHIV 中，较高的入院 NT-proBNP 浓度与心血管死亡率增加相关（第 1 三分位，11.5；第 2 三分位，20；第 3 三分位，44%；P<0.001）。PHIV 中，NT-proBNP 每增加一倍，死亡风险增加 19%。然而，在未感染 HIV 的患者中，NT-proBNP 每增加一倍，死亡风险增加 27%；这种差异在 VL 较低和 CD4 计数较高的 PHIV 中减弱。
结论
HF 合并 PHIV 的入院和出院 NT-proBNP 水平较高，NT-proBNP 浓度变化较小。VL 和 CD4 计数与 PHIV 的 NT-proBNP 浓度相关；随访期间，PHIV 中较高的 NT-proBNP 水平与心血管死亡率相关。
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