Jha Mayank, Wang Mianbo, Steele Russell, Baron Murray, Fritzler Marvin J, Hudson Marie
McGill University, Montreal, QC, Canada.
Lady Davis Institute, Montreal, QC, Canada.
J Scleroderma Relat Disord. 2022 Feb;7(1):62-70. doi: 10.1177/23971983211040608. Epub 2021 Sep 3.
The aim of this study was to determine the independent value of N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein to predict onset of cardiopulmonary disease in a large, multi-center systemic sclerosis cohort followed prospectively.
Subjects from the Canadian Scleroderma Research Group registry with data on N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein were identified. Outcomes of interest were death, systolic dysfunction (left ventricular ejection fraction < 50% or medications for heart failure), pulmonary arterial hypertension by right heart catheterization, pulmonary hypertension by cardiac echocardiography (systolic pulmonary artery pressures ⩾ 45 mmHg), arrhythmias (pacemaker/implantable cardiac defibrillator or anti-arrhythmic medications), and interstitial lung disease. Multivariate Cox proportional hazard models were generated for each outcome.
A total of 675 subjects were included with a mean follow-up of 3.0 ± 1.8 years. Subjects were predominantly women (88.4%) with mean age of 58.2 ± 11.3 years and mean disease duration of 13.7 ± 9.1 years. One hundred and one (101, 15%) subjects died during follow-up, 37 (6.4 %) developed systolic dysfunction, 18 (2.9%) arrhythmias, 34 (5.1%) pulmonary arterial hypertension, 43 (7.3%) pulmonary hypertension, and 48 (12.3%) interstitial lung disease. In multivariate analyses, elevated levels of N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein were associated with increased risk of death, while elevated levels of N-terminal pro b-type natriuretic peptide and C-reactive protein were associated with increased risk of developing pulmonary hypertension.
In systemic sclerosis, N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein have independent predictive value for death and pulmonary hypertension. A larger study would be required to determine the predictive value of these biomarkers for less common systemic sclerosis outcomes.
本研究旨在确定N末端B型脑钠肽前体、高敏心肌肌钙蛋白T和C反应蛋白在一个前瞻性随访的大型多中心系统性硬化症队列中预测心肺疾病发病的独立价值。
从加拿大硬皮病研究组登记处中识别出有N末端B型脑钠肽前体、高敏心肌肌钙蛋白T和C反应蛋白数据的受试者。感兴趣的结局包括死亡、收缩功能障碍（左心室射血分数<50%或使用治疗心力衰竭的药物）、通过右心导管检查诊断的肺动脉高压、通过心脏超声心动图诊断的肺动脉高压（收缩期肺动脉压⩾45 mmHg）、心律失常（起搏器/植入式心脏除颤器或抗心律失常药物）以及间质性肺疾病。针对每个结局生成多变量Cox比例风险模型。
共纳入675名受试者，平均随访3.0±1.8年。受试者以女性为主（88.4%），平均年龄58.2±11.3岁，平均病程13.7±9.1年。101名（15%）受试者在随访期间死亡，37名（6.4%）发生收缩功能障碍，18名（2.9%）发生心律失常，34名（5.1%）发生肺动脉高压，43名（7.3%）发生肺动脉高压，48名（12.3%）发生间质性肺疾病。在多变量分析中，N末端B型脑钠肽前体、高敏心肌肌钙蛋白T和C反应蛋白水平升高与死亡风险增加相关，而N末端B型脑钠肽前体和C反应蛋白水平升高与发生肺动脉高压的风险增加相关。
在系统性硬化症中，N末端B型脑钠肽前体、高敏心肌肌钙蛋白T和C反应蛋白对死亡和肺动脉高压具有独立的预测价值。需要进行更大规模的研究来确定这些生物标志物对较罕见的系统性硬化症结局的预测价值。
