Otaki Yoichiro, Watanabe Tetsu, Sato Naohito, Shirata Toru, Kato Shigehiko, Tamura Harutoshi, Nishiyama Satoshi, Arimoto Takanori, Takahashi Hiroki, Shishido Tetsuro, Morikane Keita, Watanabe Masafumi
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine Yamagata Japan.
Division of Clinical Laboratory, Yamagata University Hospital Yamagata Japan.
Circ Rep. 2019 Jan 22;1(2):71-77. doi: 10.1253/circrep.CJ-18-0004.
Cardio-renal anemia syndrome (CRAS) is a growing health problem, with a high mortality rate. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are well-established diagnostic and prognostic biomarkers of heart failure (HF). The difference in the clinical significance of these biomarkers, however, has not yet been completely elucidated in HF. The aim of the present study was to compare the prognostic ability of BNP and NT-proBNP in HF patients with CRAS. We measured BNP and NT-proBNP in 492 consecutive HF patients and in 17 control subjects. All patients were prospectively followed up during a median follow-up period of 1,034 days. NT-proBNP/BNP ratio was elevated in HF patients with CRAS compared with those without CRAS and the control subjects. There was no significant difference in the prognostic abilities of BNP and NT-proBNP in all HF patients. The C-index for NT-proBNP for predicting cardiovascular events and mortality, however, was significantly higher than that for BNP in HF patients with CRAS. On multivariate Cox proportional hazards-regression analysis, NT-proBNP, but not BNP, was an independent predictor for clinical outcome in HF with CRAS. The difference in the prognostic abilities of BNP and NT-proBNP was high in HF patients with CRAS. NT-proBNP had a superior prognostic ability to BNP in HF patients with CRAS.
心肾贫血综合征（CRAS）是一个日益严重的健康问题，死亡率很高。脑钠肽（BNP）和N末端前脑钠肽原（NT-proBNP）是公认的心力衰竭（HF）诊断和预后生物标志物。然而，这些生物标志物在心力衰竭中的临床意义差异尚未完全阐明。本研究的目的是比较BNP和NT-proBNP对CRAS心力衰竭患者的预后能力。我们测量了492例连续心力衰竭患者和17例对照受试者的BNP和NT-proBNP。所有患者均进行前瞻性随访，中位随访期为1034天。与无CRAS的心力衰竭患者和对照受试者相比，CRAS心力衰竭患者的NT-proBNP/BNP比值升高。在所有心力衰竭患者中，BNP和NT-proBNP的预后能力没有显著差异。然而，在CRAS心力衰竭患者中，NT-proBNP预测心血管事件和死亡率的C指数显著高于BNP。在多变量Cox比例风险回归分析中，NT-proBNP而非BNP是CRAS心力衰竭临床结局的独立预测因子。在CRAS心力衰竭患者中，BNP和NT-proBNP的预后能力差异很大。在CRAS心力衰竭患者中，NT-proBNP的预后能力优于BNP。
