Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Environ Health Prev Med. 2021 Apr 12;26(1):47. doi: 10.1186/s12199-021-00970-0.
Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population.
A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007-2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model.
The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32-104) pg/mL and 20 (18-25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R] = 0.72): urinary concentrations of 20, 27, and 43 pg/mL were equivalent to serum concentrations of 55, 125, and 300 pg/mL, respectively. During the follow-up period, 170 subjects developed CVD. The age- and sex-adjusted risk of CVD increased significantly with higher urinary NT-proBNP levels (P for trend < 0.001). This association remained significant after adjustment for traditional cardiovascular risk factors (P for trend = 0.009). The multivariable-adjusted risk of developing CVD almost doubled in subjects with urinary NT-proBNP of ≥ 43 pg/mL as compared to those with urinary NT-proBNP of ≤ 19 pg/mL (HR 2.07, 95% CI 1.20-3.56).
The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.
流行病学证据表明，血清 N 末端脑利钠肽前体（NT-proBNP）浓度是心力衰竭的诊断生物标志物，与心血管风险呈正相关。由于血清中的 NT-proBNP 会从尿液中排出，因此假设尿 NT-proBNP 浓度与血清浓度相关，并与普通人群中的心血管风险相关。
共纳入 3060 名年龄≥40 岁且无心血管疾病（CVD）病史的社区居民，中位随访时间为 8.3 年（2007-2015 年）。比较基线时血清和尿 NT-proBNP 浓度。使用 Cox 比例风险模型计算 NT-proBNP 浓度与 CVD 风险之间的关联的风险比（HR）及其 95%置信区间（CI）。
基线时血清和尿 NT-proBNP 浓度的中位数（四分位距）分别为 56（32-104）pg/mL 和 20（18-25）pg/mL。血清和尿 NT-proBNP 浓度之间存在很强的二次相关性（决定系数[R] = 0.72）：尿浓度为 20、27 和 43 pg/mL 分别相当于血清浓度为 55、125 和 300 pg/mL。在随访期间，170 例患者发生 CVD。经年龄和性别校正后，CVD 的风险随着尿 NT-proBNP 水平的升高而显著增加（趋势 P<0.001）。在调整传统心血管危险因素后，这种相关性仍然显著（趋势 P=0.009）。与尿 NT-proBNP 浓度≤19 pg/mL 的患者相比，尿 NT-proBNP 浓度≥43 pg/mL 的患者发生 CVD 的风险几乎增加了一倍（HR 2.07，95%CI 1.20-3.56）。
本研究表明，尿 NT-proBNP 浓度与血清浓度密切相关，并与心血管风险呈正相关。鉴于尿样采集无创且不需要专门培训的人员，尿 NT-proBNP 浓度有可能成为一种简单而有用的生物标志物，用于检测心血管风险较高的人群。
