Steno Diabetes Center Copenhagen, Gentofte, Denmark
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Diabetes Care. 2021 Feb;44(2):595-603. doi: 10.2337/dc20-2107. Epub 2020 Dec 15.
Few studies have compared midregional proatrial natriuretic peptide (MR-proANP) and N-terminal probrain natriuretic peptide (NT-proBNP). We compared their value as risk markers for all-cause mortality and cardiovascular (CV) and renal complications in individuals with type 1 diabetes.
MR-proANP and NT-proBNP were measured in 664 individuals. Hazard ratios (HRs) were assessed per doubling of NT-proBNP or MR-proANP for risk of a composite of ischemic events, heart failure (HF), a combined renal end point of end-stage kidney disease (ESKD), decline in estimated glomerular filtration rate (eGFR) ≥30%, and all-cause mortality or individual end points. Adjustments included CV risk factors and addition of MR-proANP or NT-proBNP.
Median follow-up was 5.1-6.2 years. MR-proANP was associated with higher risk of all-cause mortality ( = 57; HR 1.7, 95% CI 1.1-2.7), combined CV end point ( = 94; 1.6, 1.1-2.2), HF ( = 27; 2.8, 1.5-5.2), combined renal end point ( = 123; 1.6, 1.2-2.1), and ESKD ( = 21; 3.1, 1.2-7.8) independent of CV risk factors ( ≤ 0.02). After addition of NT-proBNP, significance for all end points was lost. A doubling of NT-proBNP was associated with higher risk of all-cause mortality (HR 1.5, 95% CI 1.2-1.8), the combined CV end point (1.3, 1.1-1.5), HF (1.7, 1.3-2.1), and the combined renal end point (1.3, 1.1-1.4) independent of CV risk factors (model 2 [ < 0.001]) and MR-proANP (model 3 [ ≤ 0.03]). There was no association with decline in eGFR ≥30% ( = 93).
Higher NT-proBNP was independently associated with all-cause mortality, CV disease, HF, and the combined renal end point. MR-proANP was associated with all end points but decline in eGFR, although not independent of NT-proBNP. MR-proANP may contribute to the predictive value of NT-proBNP for risk stratification in type 1 diabetes.
很少有研究比较中脑利钠肽前体（MR-proANP）和氨基末端脑利钠肽前体（NT-proBNP）。我们比较了这两种指标作为 1 型糖尿病患者全因死亡率和心血管（CV）及肾脏并发症风险标志物的价值。
在 664 名个体中测量了 MR-proANP 和 NT-proBNP。评估 NT-proBNP 或 MR-proANP 加倍与缺血事件、心力衰竭（HF）、终末期肾病（ESKD）、估算肾小球滤过率（eGFR）下降≥30%的复合终点、全因死亡率或各终点的风险比（HRs）。调整因素包括 CV 危险因素以及添加 MR-proANP 或 NT-proBNP。
中位随访时间为 5.1-6.2 年。MR-proANP 与全因死亡率（ = 57；HR 1.7，95%CI 1.1-2.7）、复合 CV 终点（ = 94；1.6，1.1-2.2）、HF（ = 27；2.8，1.5-5.2）、复合肾脏终点（ = 123；1.6，1.2-2.1）和 ESKD（ = 21；3.1，1.2-7.8）相关，独立于 CV 危险因素（均<0.02）。加入 NT-proBNP 后，所有终点的显著性均丧失。NT-proBNP 加倍与全因死亡率（HR 1.5，95%CI 1.2-1.8）、复合 CV 终点（1.3，1.1-1.5）、HF（1.7，1.3-2.1）和复合肾脏终点（1.3，1.1-1.4）相关，独立于 CV 危险因素（模型 2[<0.001]）和 MR-proANP（模型 3[≤0.03]）。与 eGFR 下降≥30%（ = 93）无关。
较高的 NT-proBNP 与全因死亡率、CV 疾病、HF 和复合肾脏终点独立相关。MR-proANP 与所有终点均相关，但与 eGFR 下降无关，尽管与 NT-proBNP 无关。MR-proANP 可能有助于 NT-proBNP 对 1 型糖尿病患者风险分层的预测价值。
