N末端B型利钠肽原（NT-proBNP）在接受心脏手术的先天性心脏病患者中的预后价值：队列研究的系统评价和荟萃分析
Prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease undergoing cardiac surgery: a systematic review and meta-analysis of cohort studies.
作者信息
Gong Ziqiang, Xing Dexiu, Wu Rong, Zhang Senmao, Ye Changxiang, Chen Yan, Liu Xiaoling, Chen Lizhang, Wang Tingting
机构信息
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Medical Records Statistics Room of Medical Affair Department, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China.
出版信息
Cardiovasc Diagn Ther. 2022 Dec;12(6):853-867. doi: 10.21037/cdt-22-155.
BACKGROUND
To perform an updated and comprehensive meta-analysis on the prognostic value of N-terminal pro-form B-type natriuretic peptide (NT-proBNP) in patients with congenital heart disease (CHD) undergoing cardiac surgery.
METHODS
A systematic search was conducted until September 2021 for relevant studies published in PubMed, Web of Science Database and Embase. Based on the average values, NT-proBNP concentrations were classified as high and low levels. The outcomes of interest were mortality, cardiovascular events, and other postoperative outcomes. A random-effects model was used to calculate composite risk estimates and corresponding 95% confidence intervals (CIs). Possible sources of heterogeneity and stability of results were analyzed using subgroup and sensitivity analyses.
RESULTS
A total of 32 studies published between 2008 and 2021 involving 7,571 participants were included. Results showed CHD patients at high NT-proBNP levels yielded an increased risk of mortality [risk ratio (RR) =1.14; 95% CI: 1.08-1.20] and cardiovascular events (RR =2.02; 95% CI: 1.26-3.24) compared with those at low NT-proBNP levels. No significant association was found between NT-proBNP and risks for other postoperative outcomes in CHD patients undergoing cardiac surgery (RR =1.73; 95% CI: 0.86-3.47). Significant heterogeneity was detected across studies regarding these risk estimates. Subgroup analysis found heterogeneity in the risk estimate of mortality was explained by geographic region, type of CHD, and assay method of NT-proBNP. Sensitivity analysis supported the robustness of results.
CONCLUSIONS
Compared with CHD patients at low NT-proBNP levels, CHD patients at high NT-proBNP levels had elevated risks of mortality and cardiovascular events. Further large-scale and well-controlled studies are needed to confirm our findings.
背景
对接受心脏手术的先天性心脏病（CHD）患者中N端前体B型利钠肽（NT-proBNP）的预后价值进行更新且全面的荟萃分析。
方法
截至2021年9月，在PubMed、科学网数据库和Embase中对相关研究进行系统检索。根据平均值，将NT-proBNP浓度分为高水平和低水平。感兴趣的结局包括死亡率、心血管事件和其他术后结局。采用随机效应模型计算综合风险估计值及相应的95%置信区间（CI）。使用亚组分析和敏感性分析来分析结果异质性的可能来源及结果的稳定性。
结果
纳入了2008年至2021年间发表的32项研究，涉及7571名参与者。结果显示，与NT-proBNP低水平的CHD患者相比，NT-proBNP高水平的CHD患者死亡率风险增加[风险比（RR）=1.14；95%CI：1.08-1.20]，心血管事件风险增加（RR =2.02；95%CI：1.26-3.24）。在接受心脏手术的CHD患者中，未发现NT-proBNP与其他术后结局风险之间存在显著关联（RR =1.73；95%CI：0.86-3.47）。在这些风险估计方面，各研究间检测到显著异质性。亚组分析发现，死亡率风险估计的异质性可由地理区域、CHD类型和NT-proBNP检测方法来解释。敏感性分析支持了结果的稳健性。
结论
与NT-proBNP低水平的CHD患者相比，NT-proBNP高水平的CHD患者死亡和心血管事件风险升高。需要进一步开展大规模且严格对照的研究来证实我们的发现。
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